Did you know that 5-10% of women experience either endometriosis or PCOS throughout their reproductive years? Conditions unique to women, both endometriosis and PCOS affect the reproductive system and are difficult to diagnose. Each can have long-lasting effects and can play a significant role in fertility and reproductive health.

While many of the symptoms are the same in endometriosis and PCOS, there are several key differences to be aware of. Keep reading to learn more about each condition and how to tell the difference.

What is Endometriosis?

Endometriosis is a common inflammatory condition resulting in tissues that are much like the lining of the uterus growing in other areas of the body, most often in the pelvis. This condition can be painful, with moderate to severe pelvic pain, severe menstrual pain, and excessive menstrual bleeding.

What is PCOS?

PCOS, also known as polycystic ovarian syndrome, is thought to be a genetic condition that affects women’s hormone levels in the body. This condition is most closely associated with having higher levels of male hormones known as ‘androgens,’ which can lead to excessive hair growth, weight gain, and acne. Some, but not all, cases will present with small cysts that appear on the uterus, hence this condition’s name.

Can You Have Both Endometriosis and PCOS?

While it is a rare occurrence, there are occasions where women can be diagnosed with both endometriosis and PCOS at the same time. In fact, recent studies have shown that women with PCOS experience endometriosis 7-8% of the time, typically with mild symptoms. Many of the symptoms of these reproductive conditions do tend to overlap, which can lead to confusion in diagnosis.



While many symptoms of endometriosis and PCOS tend to overlap, there are a few key symptom areas to pay attention to when considering the differences between the two conditions.

What are the Symptoms of Endometriosis?

While some women with endometriosis will experience little to no symptoms of their condition, there are several key signs to look out for when considering if you may have it:

1. Menstrual Disorders: Severe menstrual pain, lower back pain during periods, and excessive menstrual bleeding.

2. Localized Pelvic Pain: Mild to severe chronic pelvic pain.

3. Increased Pain During Activities: Painful urination, painful bowel movements, and pain during sexual intercourse.

4. Fertility Challenges: Difficulty getting pregnant.

What are the Symptoms of PCOS?

Many women who suffer from PCOS experience small cysts on or in their ovaries as well as a few (or all!) of the following symptoms:

1. Menstrual Disorders: Irregular or missed periods and heavy bleeding.

2. Physically Presenting Symptoms: Excessive hair growth, thinning hair, oily skin, and acne.

3. Fertility Challenges: Difficulty getting pregnant.


Both endometriosis and PCOS affect women of childbearing age, typically between ages 12 – 50 years old. However, there are different causes and risk factors that come into play for each reproductive condition.

What are the Causes of Endometriosis and Risk Factors?

Unfortunately, there is no known cause of endometriosis. However, it is hypothesized to result from a hormonal imbalance in the body, particularly that of estrogen. This imbalance is thought to be caused by something called ‘retrograde menstruation,’ in which blood passes backwards through the fallopian tubes. In a woman without endometriosis, these glands and blood are then absorbed back into the body. On the other hand, for a woman with endometriosis, they can instead stick to the uterine tubes, ovaries, ligaments, or pelvis.

There are several risk factors to consider for endometriosis:

1. Infertility

2. High estrogen levels

3. Heavy menstrual bleeding

4. Short menstrual cycles (less than 27 days)

5. Early menarche (younger than age 11)

6. Family history of endometriosis

What are the Causes of PCOS and Risk Factors?

Similarly to endometriosis, there is no one known cause of PCOS. However, it is thought to be a genetic condition that can be linked to certain genes but is also affected by activity and diet. It is most associated with an excess production of androgen, a ‘male’ hormone. PCOS has also been linked to insulin resistance in the body, which contributes to an increased level of androgens. Additionally, PCOS can be linked to polycystic cysts on the ovaries which increase inflammation in the body, leading to a higher rate of production of androgens.

There are a few key risk factors that come into play with PCOS:

1. Diabetes or insulin resistance

2. Obesity

3. Premature puberty (younger than age 8)

4. Family history of PCOS


Both endometriosis and PCOS are conditions that are difficult to diagnose, even for the most experienced doctors. These reproductive challenges each require unique methods to effectively diagnose.

How is Endometriosis Diagnosed?

Endometriosis cannot be diagnosed based on symptoms alone. To determine if you have endometriosis and its level of severity, you will likely need to have a full pelvic exam and a laparoscopy. This procedure involves inserting a small camera into the abdomen that allows your physician to see the surface of your pelvis and reproductive organs, giving them the ability to visually determine what stage of endometriosis you may be in.

How is PCOS Diagnosed?

Much like endometriosis, PCOS is not something that can be diagnosed based solely on symptoms. To determine if you have PCOS, your physician will likely recommend a full pelvic exam to check for enlarged ovaries as well as a pelvic ultrasound to determine if polycystic cysts are present on the ovaries. Additionally, many physicians will also recommend comprehensive bloodwork to check for increased presence of androgens, blood sugar and cholesterol levels, and the condition of the thyroid.


The final key difference between endometriosis and PCOS is in how each condition is treated. While both can involve multiple methods of treatment, each has a unique approach.

How is Endometriosis Treated?

In determining treatment options for endometriosis, the first step is most often that of pain management through the introduction of anti-inflammatory medications. These are often accompanied by oral contraceptives, which help to relieve pelvic pain, cramping, and excessive bleeding that can come with menstrual cycles.

Surgical procedures are one of the more involved treatment options for particularly difficult cases of endometriosis. This is often suggested when the goal is preservation of fertility. These procedures, such as laparoscopy, involve removal of implants, cysts, and adhesions to provide pain relief.

How is PCOS Treated?

The first step in PCOS treatment is often the introduction of an oral contraceptive and / or antiandrogen. These medications work to balance hormone levels, thereby reducing androgen levels and lessening the symptoms associated with this hormone.

In addition, PCOS treatment often involves making a variety of lifestyle changes, including adjusting one’s diet and increasing exercise. In fact, studies have shown that losing up to 5 – 7% of body weight can help you achieve a regular menstrual cycle. Additionally, an improved lifestyle can also affect mood, helping to have a positive effect on anxiety and depression, both of which are prevalent in women with PCOS.


Remember, while endometriosis and PCOS can present similar symptoms within women of childbearing age, they are completely different conditions. Each has a range of unique symptoms, a method of diagnosis, risk factors, and treatment options available.

Interested in learning more about endometriosis? Visit our Endometriosis 101 blog for an in-depth look at this reproductive condition.


If you have been diagnosed with endometriosis or PCOS and are unsure of how to proceed, Holness Nutrition can be a great resource for support and information. Led by Nicole Holness, a Registered Dietician Nutritionist with a wealth of experience and knowledge in fertility disorders and nutrition, Holness Nutrition can help you take the first steps towards recovery through custom lifestyle and diet plans with a holistic, body and mind-nurturing approach.


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Patient Information Series: Endometriosis, American Society for Reproductive Medicine.

Polycystic Ovary Syndrome. Office on Women’s Health, www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome

What are the risk factors for endometriosis? (2022).