It is possible for individuals to experience both endometriosis and polycystic ovary syndrome (PCOS) simultaneously. These are two distinct and common gynecological conditions that affect many people of reproductive age. While they originate from different underlying biological mechanisms, their co-occurrence is recognized and can present a complex clinical picture. Understanding each condition separately helps clarify how they might exist together, impacting diagnosis and management.
What is Endometriosis?
Endometriosis is a condition where tissue similar to the lining of the uterus, known as the endometrium, grows outside the uterus. This misplaced tissue can be found on organs such as the ovaries, fallopian tubes, and the outer surface of the uterus, or even less commonly in other parts of the body like the bowel or bladder. This tissue responds to hormonal changes during the menstrual cycle, thickening and then attempting to shed. However, unlike the uterine lining, this tissue has no way to exit the body, leading to inflammation, pain, and the formation of scar tissue or cysts.
Common symptoms of endometriosis include chronic pelvic pain, which can last for more than six months, and severe pain during menstrual periods, known as dysmenorrhea. Pain during sexual intercourse (dyspareunia) is also frequently reported. Some individuals may experience heavy or prolonged menstrual bleeding, pain during bowel movements or urination, and significant fatigue. Endometriosis can also contribute to fertility challenges. Globally, endometriosis affects approximately 10% of reproductive-aged women, which is about 190 million individuals worldwide.
What is Polycystic Ovary Syndrome (PCOS)?
Polycystic ovary syndrome (PCOS) is a hormonal disorder characterized by symptoms resulting from hormonal imbalances. This condition typically involves the ovaries producing unusually high levels of hormones called androgens, which are sometimes referred to as “male hormones.” This hormonal imbalance disrupts normal ovulation.
Key features of PCOS include irregular or absent menstrual periods, indicating a lack of regular ovulation. Elevated androgen levels can lead to symptoms such as excessive hair growth on the face or body (hirsutism), acne, and thinning hair on the scalp. While the name suggests “polycystic ovaries,” this refers to the presence of many small, fluid-filled sacs (follicles) on the ovaries observed via ultrasound. However, the presence of these ovarian cysts is not always required for a PCOS diagnosis. PCOS can also be associated with metabolic issues, including insulin resistance. PCOS is considered the most common endocrine disorder among women of reproductive age, affecting an estimated 6% to 13% globally.
The Co-occurrence: Understanding the Overlap
While distinct in their primary causes—endometriosis involves tissue growth outside the uterus and PCOS is a hormonal disorder—they can share some overlapping symptoms. Both conditions can manifest with irregular periods, pelvic pain, and difficulties with fertility, which can complicate the diagnostic process. These shared symptoms often make it challenging for healthcare providers to initially distinguish between the two.
Research indicates that the co-occurrence of endometriosis and PCOS is more common than previously thought. For instance, some studies suggest that among women undergoing gynecologic procedures, nearly 1 in 20 may have both conditions. This coexistence can be influenced by shared contributing factors, such as genetic predispositions. Hormonal interactions might also play a role, as high androgen levels, characteristic of PCOS, could potentially influence estrogen levels, which are relevant in endometriosis.
This overlap means individuals might experience a combination of symptoms from both conditions, creating a more complex clinical picture. For example, a person might have the chronic pelvic pain associated with endometriosis along with the irregular periods and androgen-related symptoms of PCOS. The presence of subfertility is also a significant shared risk factor, with a higher prevalence in individuals with both conditions.
Diagnosis and Management When Both Are Present
Diagnosing both endometriosis and PCOS simultaneously requires a comprehensive approach due to their overlapping symptoms. For endometriosis, definitive diagnosis typically involves a minimally invasive surgical procedure called laparoscopy. During this procedure, a surgeon can directly visualize and, if necessary, take biopsies of endometrial-like tissue outside the uterus to confirm the diagnosis. Imaging techniques like ultrasound or MRI can sometimes identify larger areas of endometriosis, but they are not conclusive for all cases.
PCOS is diagnosed based on clinical criteria, usually involving at least two of three key features: irregular or absent periods, clinical or biochemical signs of elevated androgens, and polycystic ovaries seen on an ultrasound. Blood tests are often used to assess hormone levels, including androgens. A thorough medical history and physical examination are also important to differentiate PCOS from other conditions with similar symptoms.
Managing both conditions simultaneously involves a personalized strategy aimed at addressing the most bothersome symptoms and potential health risks. Pain management is a central aspect, often involving various medications and therapies to alleviate the chronic pelvic pain associated with endometriosis. Hormonal therapies, such as oral contraceptives, can help regulate menstrual cycles and manage symptoms in both conditions. Lifestyle interventions, including dietary adjustments and regular exercise, are particularly beneficial for managing PCOS symptoms, especially those related to insulin resistance and weight. For individuals facing fertility challenges, specialized treatments may be considered, tailored to address the specific contributions of both endometriosis and PCOS to infertility.