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PCOS vs. Endometriosis: What are the Differences?

Polycystic ovarian syndrome (PCOS) and endometriosis are both conditions that affect the reproductive system in women of childbearing age. While both can disrupt the menstrual cycle and cause infertility, they each have their unique causes and symptoms. PCOS affects the ovaries, while endometriosis can cause problems in your ovaries, uterus, and other organs. 

Because each diagnosis affects your body differently, treatment options will also vary. Below you’ll find the differences between PCOS and endometriosis and ways to manage them. 

How common is PCOS vs. endometriosis?

According to the CDC, PCOS is the most common cause of infertility in women of childbearing age. It affects 6-12% of women – or about 5 million people. 

Endometriosis affects about 11% of women, or about 6.5 million people. Researchers are unsure of the exact number of people with either condition. This is because some women don’t have symptoms or never seek treatment.

What is PCOS?

PCOS is a hormonal disorder that affects a woman’s ovaries. The ovaries are responsible for releasing certain hormones and an egg during ovulation. In PCOS, the ovaries produce too much of a hormone called androgen. The androgen hormone, also known as the male hormone, leads to many problems throughout the body, like excess hair growth, weight gain, and insulin resistance. It interferes with ovulation and causes irregular periods. Some people will also develop fluid-filled cysts on their ovaries. 

Read More: Things No One Tells You About PCOS

What is endometriosis?

The endometrium is the uterus lining, which grows and then sheds from the body during your period. In women with endometriosis, the endometrium grows outside the uterus. It often grows on the ovaries and fallopian tubes and can affect ovulation and cause painful periods. 

Read More: Endometriosis Explained: Causes, Symptoms, and Treatment

What are the causes of PCOS vs. endometriosis?

Experts don’t know the exact cause of either condition. However, each has its own possible explanations and risk factors.


PCOS is a disorder of the endocrine system. Essentially the ovaries produce too much androgen, but no one is sure why. Some believe diet and lifestyle play a role in androgen overproduction. Others link it to insulin resistance or inflammation, which can cause the ovaries to make too much androgen. 

 Some risk factors for PCOS include:

  • Female relatives who have PCOS
  • Diabetes
  • Being overweight
  • Going through puberty at an early age (8-9 years old)


Endometrial tissue that finds its way out of the uterus still acts like normal uterine tissue. This means that it will grow and bleed in tune with your menstrual cycle. Unlike the endometrium inside the uterus, the tissue outside has no way of leaving the body. This can lead to very painful periods and pelvic pain. 

Some possible causes are retrograde menstruation (menstrual flow in the wrong direction), genetics, or overproduction of estrogen (female hormone). Another theory is that lymph nodes and blood vessels can carry endometrial tissue to other body parts. Having abdominal surgery is another possible factor, as endometrial cells may implant themselves at the incision site. 

Some risk factors for endometriosis include:

  • Family history of endometriosis
  • Starting your menstrual cycle before age 11
  • Menstrual cycles that are less than 27 days
  • Heavy periods
  • Having high levels of estrogen
  • Never having been pregnant

Can you have both PCOS and endometriosis?

Yes, you can have both PCOS and endometriosis. One study showed women were more likely to be diagnosed with endometriosis if they already had PCOS. 

Diagnosing PCOS is easier than endometriosis. For PCOS, blood tests can show if you have high androgen hormone levels. An ultrasound will also look for cysts on the ovaries. 

Unfortunately, the only way to get a true endometriosis diagnosis is to undergo laparoscopic surgery to look for tissue outside the uterus. Many people don’t like the idea of having surgery, so your healthcare provider will usually base your diagnosis on your symptoms. 

Read More: When to See a Fertility Specialist

What are the similarities between PCOS and endometriosis?

The most significant similarity that PCOS and endometriosis share is infertility. Many women don’t find out they have either condition until they have trouble getting pregnant. Knowing the signs and paying close attention to your menstrual cycle before you try to conceive can lead to an earlier diagnosis and treatment. 

Another similarity between PCOS and endometriosis is an irregular menstrual cycle. Short cycles, long periods, and heavy bleeding are signs of something not quite right in the ovulation department. Always talk to your healthcare provider about irregularities in your menstrual cycle. They’ll be able to run tests and determine what’s causing it.

What are the differences between PCOS and endometriosis?

While there are a few overlaps between PCOS and endometriosis symptoms, several differences set them apart. 

Since PCOS is a hormonal disorder involving the male hormone, some symptoms will affect other areas of the body. Women may notice abnormal hair growth on their face and chest, severe acne, and male-pattern baldness. They may also become insulin resistant and have fluid-filled sacs develop on their ovaries. 

On the other hand, endometriosis symptoms usually involve pain of some kind. Women can have painful periods, abdominal pain, pelvic pain, and pain with bowel movements and urination. Sex can even be painful with endometriosis. 

What are the treatment options for PCOS vs. endometriosis?

Unfortunately, there’s no cure for either condition. Treatment options for PCOS and endometriosis will focus on your symptoms and whether or not you’re trying to get pregnant. 

PCOS treatment regulates hormones and prevents long-term health complications like insulin resistance. Hormonal birth control is one option to lower androgen levels, but it isn’t used if you’re trying to conceive. 

Diet and exercise can also lower androgen levels and greatly impact your PCOS symptoms. Losing even a little bit of weight can reduce insulin resistance. 

Treatment for endometriosis is mainly based on pain management. Over-the-counter pain medications work well for many women to lower pain around their period. Hormonal birth control can also help regulate or even stop your period from happening each month. And in serious cases, pelvic or abdominal surgery can remove some of the endometrial tissue. 


PCOS and endometriosis are very different gynecological conditions, and both can be hard to manage. Unfortunately, neither is curable. It’s important to talk to your healthcare provider if you have an irregular menstrual cycle or painful periods. Diet and lifestyle changes are effective treatments for both conditions. Other treatment options are based on symptoms and whether you’re trying to get pregnant. 

Read More: Diminished Ovarian Reserve: What You Need to Know

If you’re having trouble getting pregnant, be sure to have a conversation with your provider. Infertility is a shared complication between PCOS and endometriosis. Having an accurate diagnosis will help you decide the best path forward toward your goal of having a baby.

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