Endometriosis vs PCOS: What’s The Difference?

Endometriosis vs PCOS: What’s the difference?

Navigating the hurdles of reproductive health can be overwhelming, especially when faced with conditions like endometriosis and polycystic ovary syndrome (PCOS).

Both conditions can affect fertility and menstrual health, but they are different with unique characteristics, causes, and treatment approaches.

While some symptoms may overlap, it's crucial to differentiate between them for an accurate diagnosis and effective management plan.

This article delves into the nuances of endometriosis and PCOS, shedding light on their causes, symptoms, diagnosis, and treatment options.

Ultimately, we hope it helps you understand the differences and empower you to be in the driver’s seat of your own reproductive journey, and seek appropriate care!

So, let’s delve in!

What is endometriosis?

Endometriosis is a chronic condition where tissue similar to the lining of the uterus (endometrium) grows outside the uterine cavity.

This misplaced tissue, most commonly found in the pelvic cavity (ovaries, fallopian tubes, ligaments), responds to hormonal changes during the menstrual cycle, just like the uterine lining.

During menstruation, this misplaced tissue breaks down, bleeds, and has nowhere to go, leading to inflammation, scarring, and adhesions. These changes can cause a variety of symptoms, including:

• Pelvic pain: The hallmark symptom of endometriosis is pelvic pain, often worsening during menstruation (dysmenorrhea) or ovulation. Pain can also occur during intercourse (dyspareunia) or bowel movements.

• Heavy menstrual bleeding: Women with endometriosis may experience heavy or prolonged menstrual bleeding (menorrhagia).

• Infertility: Endometriosis is a leading cause of infertility in women, affecting ovulation, egg quality, and implantation.

• Gastrointestinal symptoms: Some individuals with endometriosis may experience gastrointestinal symptoms such as bloating, diarrhea, constipation, or abdominal discomfort.

• Urinary symptoms: Endometriosis can also affect the urinary tract, leading to symptoms like urinary urgency, frequency, or pain.

What is PCOS?

Polycystic ovary syndrome (PCOS) is a complex hormonal disorder characterised by irregular menstrual cycles, elevated levels of androgens (male hormones), and multiple small cysts in the ovaries. The exact cause of PCOS remains unknown, but it's believed to be a combination of genetic and environmental factors. PCOS affects up to 10% of women of reproductive age and presents with a range of symptoms:

• Irregular menstrual cycles: Women with PCOS may have infrequent, irregular, or absent menstrual periods due to hormonal imbalances.

• Ovulatory dysfunction: PCOS often disrupts ovulation, leading to difficulty conceiving and infertility.

• Hyperandrogenism: Elevated levels of androgens can cause symptoms like acne, hirsutism (excess facial or body hair).

• Polycystic ovaries: On ultrasound, the ovaries of women with PCOS may appear enlarged and contain multiple small follicles, giving them a characteristic "polycystic" appearance.

• Metabolic disturbances: PCOS is associated with insulin resistance, obesity, and an increased risk of type 2 diabetes and cardiovascular disease.

Differentiating Between Endometriosis and PCOS

While endometriosis and PCOS share some overlapping symptoms, several key differences can help distinguish between the two conditions:

1. Menstrual irregularity: PCOS is primarily characterised by irregular menstrual cycles, whereas endometriosis may cause cyclic pelvic pain and heavy menstrual bleeding.

2. Hormonal profiles: Endometriosis typically does not affect hormone levels, while PCOS is associated with elevated levels of androgens and luteinizing hormone (LH), and often insulin resistance.

3. Imaging findings: Endometriosis may be visualised on imaging studies such as ultrasound or magnetic resonance imaging (MRI), showing characteristic endometrial-like lesions. PCOS is diagnosed based on clinical and biochemical criteria, including ovarian morphology on ultrasound.

4. Symptomatology: While both conditions can cause infertility, endometriosis is more strongly associated with pelvic pain and dyspareunia, whereas PCOS is primarily characterised by menstrual irregularities and hyperandrogegism.

Diagnosing Endometriosis and PCOS

Diagnosing endometriosis and PCOS typically involves a combination of medical history, physical examination, imaging studies, and laboratory tests:

1. Endometriosis

Diagnosis of endometriosis may involve a pelvic exam, ultrasound, or MRI (to detect deeper structures or smaller sites of endometriosis) to visualize endometrial lesions, followed by laparoscopic surgery for definitive diagnosis and treatment.

2. PCOS

Diagnosis of PCOS is based on the Rotterdam criteria, which include at least two of the following three criteria:

• Irregular menstrual cycles (oligoovulation or anovulation)

• Clinical or biochemical signs of hyperandrogegism

• Polycystic ovaries on ultrasound

Blood tests may also be performed to evaluate hormone levels, including testosterone, LH, follicle-stimulating hormone (FSH), and fasting blood sugar to assess insulin resistance.

Treatment approaches for endometriosis and PCOS

Treatment for endometriosis and PCOS varies depending on the severity of symptoms, reproductive goals, and individual preferences:

• Endometriosis: Treatment options for endometriosis may include pain management, hormonal therapy (such as oral contraceptives or gonadotropin-releasing hormone agonists), and surgical intervention (such as laparoscopic excision of endometrial implants).

• PCOS: Management of PCOS focuses on symptom relief, hormonal regulation, and fertility optimization. Lifestyle modifications, such as diet, exercise, and weight management, are often recommended, along with medications to regulate menstrual cycles and improve insulin sensitivity.

Is egg freezing possible with endometriosis?

The good news is that egg freezing remains a viable option for many women with endometriosis. While endometriosis can affect fertility, it doesn't necessarily mean you can't conceive naturally or through assisted reproductive technologies (ART) like IVF with frozen eggs. Here's why egg freezing can still be a good option:

• Preserves fertility potential: Endometriosis may decrease egg quality over time. Freezing your eggs when they are young and healthy can increase your chances of a successful pregnancy later in life, regardless of how endometriosis progresses.

• Improves IVF success rates: Studies suggest that egg quality can be a significant factor in IVF success rates. Freezing eggs before endometriosis potentially worsens egg quality can offer a better chance of successful implantation during IVF cycles.

• Provides time for treatment: If you're diagnosed with endometriosis, your doctor may recommend treatment options like medication or surgery to manage symptoms and improve your chances of natural conception. Egg freezing allows you to preserve your fertility before or while undergoing treatment.

Take control of your fertility journey with Arva

Endometriosis can pose challenges, but it doesn't have to deter your future family planning.

At Arva, we understand the complexities of endometriosis and its impact on fertility. That’s why we’ve put together a comprehensive approach to support women throughout their fertility journey:

• At-Home fertility test: Our convenient at-home test fertility test provides valuable insights into your ovarian reserve by measuring Anti-Müllerian Hormone (AMH) levels. AMH is a good indicator of your remaining egg pool. This information can be helpful in making informed decisions about egg freezing, especially if endometriosis is a concern.

• Expert guidance and diagnosis: Our network of experienced gynecologists can review your test results, discuss your medical history, including endometriosis diagnosis, and recommend the most suitable course of action. This may involve further testing, exploring treatment options for endometriosis management, or proceeding with egg freezing.

Going through the egg freezing journey alone, can feel intimidating.

That’s why at Arva we provide ongoing support throughout your egg freezing journey, from initial consultations to post-retrieval care.

Our dedicated team is here to answer your questions, address your concerns, make your egg freezing journey less of a maze, and empower you to make informed decisions about your reproductive health.

We’re here, cheering for you, every step of the way!