PCOS vs. Endometriosis

Sep 01, 2022 | By Heather Frame, BSN, RN

Polycystic ovarian syndrome (PCOS) and endometriosis are two complex, yet common, diagnoses that affect up to 21% of women collectively – that’s over 11.5 million women in the United States!  It is unclear exactly what causes either condition, but they are both often associated with a hormonal imbalance.

Differences and Similarities between PCOS and Endometriosis

While PCOS and endometriosis do share some similarities, such as unknown causes and difficulty conceiving, most other characteristics and symptoms are quite different.  Even though they can greatly differ, it is possible to carry both diagnoses.

A comparison between PCOS and Endometriosis

Because all endometrial tissue is shed during menstruation, this results in inflammation often causing:

  • Severe cramping
  • Mild to severe pain in affected areas
  • Pain during intercourse
  • Painful urination
  • Irregular bowel movements
  • Digestive issues

Endometriosis has a completely different cause of symptoms. During each menstrual cycle, the endometrium that lines the uterus becomes thick and rich with blood vessels in preparation for a pregnancy, but then sheds if a woman does not become pregnant resulting in a period.  This endometrial lining should only grow within the uterus, but with endometriosis, the endometrial tissue grows outside the uterus. 

PCOS is a condition that causes longer, irregular menstrual cycles due to disrupted ovulation, increased levels of male hormones called androgens, and insulin sensitivity. 

As its name suggests, the ovaries accumulate multiple small cysts that don’t grow large enough for ovulation to occur.  Luteinizing hormone (LH) and follicle-stimulating hormone (FSH), the hormones responsible for triggering ovulation, become imbalanced.  A woman with PCOS usually has higher baseline levels of LH equating to 3 times higher than her FSH level. 

In addition, androgens may become increased in women with PCOS because of the high levels of LH and increased levels of insulin that are usually seen with PCOS.  These imbalances are enough to disrupt healthy hormonal cycling and regular ovulation.

Excess androgens are likely to cause:

  • Irregular menstrual cycles
  • Weight gain
  • Excess body hair
  • Acne or oily skin
  • Male-pattern baldness or thinning hair
  • Blood sugar instability

How do I know if I have PCOS or Endometriosis?

PCOS is a diagnosis of exclusion, meaning any other causes for the symptoms, such as another underlying health condition must be ruled out first.  This is often diagnosed through means of physical exam, ultrasound, and laboratory tests ordered by your doctor.

PCOS vs. Endometriosis

Endometriosis can only be officially diagnosed through a surgical procedure called a laparoscopy.  The laparoscopy allows your doctor to perform an internal visual examination in order to see if you have signs of endometrial tissue outside of the uterus.  Afterward, endometriosis is often staged, based on severity, ranging from 1 to 4 – stage 1 is mild, stage 4 is severe.

Treatments for PCOS and Endometriosis

While there is no one-size-fits-all cure for either diagnosis, there are options that make living with either of these conditions and getting pregnant easier!

PCOS treatment is focused on managing symptoms by balancing hormones.  Being overweight or obese can intensify some symptoms of PCOS making it even more difficult to conceive. Weight loss, following a healthy diet, and physical exercise can not only make you feel better, but can improve insulin sensitivity, hormone regulation, and fertility!  If this approach is unsuccessful, a fertility specialist can offer alternative treatment including medications to induce ovulation and increase the body’s sensitivity to insulin.


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Endometriosis can be treated by surgically removing the abnormal endometrial tissue during a laparoscopy – 95% of women achieved pregnancy following this procedure!  If this is unsuccessful, assisted reproductive technology, such as IUI or IVF, can be utilized. There are also root cause approaches to improving endometriosis through the balancing of estrogen and progesterone, utilization of some targeted supplements, and decreasing inflammation by avoiding inflammatory foods. 

When to seek help to get pregnant faster

If you are experiencing symptoms of PCOS, endometriosis, or both, be sure to reach out to your doctor to discuss your concerns.  Your provider can not only help you manage these symptoms but also aid with optimizing your fertility to achieve a healthy pregnancy.

The goal to optimize fertility with PCOS is aimed at restoring regular ovulation; while the goal for endometriosis is reducing inflammation and balancing estrogen.  Women who focus on treating the root cause of these conditions can achieve these goals to get pregnant.

When you are able to understand your body better, pregnancy can feel more achievable.  Using ovulation strips with the Premom ovulation tracker app can help you find your ovulation day and peak fertility more easily.  

Due to longer cycles, women with PCOS may have to test for a longer period of time before finding their peak; but women with endometriosis should be able to find their peak easily. Finding your peak allows you to time intercourse more accurately, giving you your best chance of conceiving more quickly!

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About Author:


Heather Frame is a compassionate Women's Health nurse. She specializes in obstetrics, postpartum, newborn care, and lactation counseling. She is committed to providing women the support they need to achieve pregnancy and thereafter. As a personal user of Premom, she can attest to how important charting your cycles is in conjunction with achieving pregnancy. She would love to help you navigate your fertility journey. Schedule a consultation with Nurse Heather right through your Premom app!






fertility, fertility clinic, fertility consultation, infertiity, PCOS, PCOS symptoms
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