What If You Have Both PCOS and Endometriosis?

These are two distressing hormonal conditions that affect many women, but do you know the difference between them?


Lara Briden is a health blogger with a particular interest in hormonal health and so I thought it would be useful to see what she has to say about these two common conditions.

PCOS and endometriosis are two very different conditions but they’re also very common. It’s possible to have both PCOS and endometriosis at the same time and that can make for some pretty tricky diagnosis and treatment.

Here’s what you need to know.

PCOS is a whole-body hormonal condition that has nothing to do with cysts on the ovaries.

PCOS is a condition of excess male hormones and irregular ovulation. It may or may not present with “polycystic ovaries” on ultrasound but that finding means almost nothing.

Why? Because polycystic ovaries are not abnormal structures like other types of pathological ovarian cysts. Instead, they are the developing ovarian follicles or eggs, which are normal for the ovary. You have more eggs when you’re younger (up to 25 on each ovary) but that does not mean you have PCOS.

Neither polycystic ovaries nor the hormonal condition PCOS is a cause of pain. So, if pain is your main symptom, there’s something else going on.

Endometriosis is an inflammatory disease that has very little to do with “hormone imbalance.”

Endometriosis is an inflammatory disease of the pelvis that causes pain and lesions and a type of ovarian cyst called an endometrioma or chocolate cyst. Endometriosis is affected by hormones but is not caused by hormones or hormone imbalance.

If you suffer severe pain, you should be assessed for endometriosis. That’s true even if you’ve already been told you have PCOS. Endometriosis cannot always be picked up by ultrasound.

Symptoms of PCOS and endometriosis

Possible symptoms of each condition include the following. (It’s possible to have either or both of the conditions without having all of the symptoms listed.)

Symptoms of PCOS

– facial hair

– acne

– hair loss

– weight gain

– irregular periods

– heavy periods

– long bleeds (more than 7days)

– bleeding between periods

– infertility

Symptoms of endometriosis

– pain

– fatigue

– headaches

– bladder and bowel symptoms

– heavy periods

– bleeding between periods

– infertility

As you can see, the only symptoms the two conditions have in common are heavy periods, bleeding between periods, and infertility; and they occur for different reasons!

In PCOS, abnormal bleeding is usually the result of anovulation or lack of ovulation, which means there is no progesterone to mature the uterine lining.

Infertility is caused by lack of ovulation or low progesterone.

In endometriosis, abnormal bleeding relates directly to the inflammatory disease process in the pelvis. Ovulation and progesterone are usually normal with endometriosis.

Infertility is caused by inflammation and the presence of endometriosis lesions on the ovaries or Fallopian tubes.

Reversing PCOS can sometimes result in the emergence of endometriosis

If you’re recovering from PCOS, and your periods suddenly start to become painful, it’s a sign that you may be flaring up an underlying problem with endometriosis.

It happens because endometriosis is sensitive to estrogen. As long as you had active PCOS or were on the pill, your estrogen was relatively low and so endometriosis stayed dormant. As soon as you move into healthy regular cycling, your estrogen is higher and so endometriosis can potentially activate.

If you have both endometriosis and PCOS, start with endometriosis

Endometriosis should be treated first because it is the more serious disease. Possible treatments include surgery, dairy-free diet, zinc, turmeric, and N-acetyl cysteine.

Once endometriosis treatment is in place, you can turn your attention to finding treatment for your type of PCOS. (Read 4 Types of PCOS. Treat the Cause). If you have the inflammatory type of PCOS, you may have found that your PCOS symptoms improved with the natural treatment for endometriosis. If you have another type of PCOS, you may need to look at normalizing insulin or taking steps to reduce male hormones.

Helpful information: 

Both these conditions are made worse by low progesterone and high oestrogen so rebalancing with progesterone can be helpful and progesterone is also effective for helping inflammatory conditions such as endometriosis.