Polycystic ovarian syndrome (PCOS) and Endometriosis often go undiagnosed because many afflicted women assume their symptoms are variations of a normal menstrual cycle. Although any woman within childbearing years can develop either disorder, research shows endometriosis is more commonly diagnosed in women in their 30s and 40s, while PCOS often presents while a woman is in her 20s.

So how do you know whether you have PCOS, Endometriosis, or both? 

TC46 connected with Dr Suhasini Inamdar, Consultant Obstetrics & Gynaecology at Motherhood Hospitals in Bangalore to understand the symptoms, causes, treatments and differences between these two conditions.

1. Who is more susceptible to PCOS?

PCOS is a genetic hormone disease. It is related to diabetes. It is a genetically acquired disease meaning you are born with it. Women between the age of 15 and 44 are said to be more susceptible to having PCOS. Most women discover that they have PCOS when they find it difficult to get pregnant and then visit the doctor. And women between the ages 15-44, almost 5 – 10% of them have reported having PCOS. PCOS does not have a particular age or time to occur, it can be found in women of any age group after they attain their puberty. 

2. Who is more susceptible to Endometriosis?

Endometriosis is a painful disorder where the tissue similar to the tissue inside one’s uterus lining grows outside. Any menstruating girl or woman is capable of having endometriosis. However, it is most commonly found in women between the age group 30-40. Women who have never had children and women who menstruate for more than 7 days are said to be more likely to experience endometriosis. 

3. Can a woman have both PCOS & Endometriosis?

Yes. It is definitely possible for a woman to have both PCOS and Endometriosis. In these cases, it would be better if you treated Endometriosis before you begin treating yourself for PCOS. This is because endometriosis is a more harmful and painful disease and treating PCOS first can increase the estrogen level in your body, worsening your endometriosis. A number of treatments are available for endometriosis like surgery, dairy-free and nickel-free diets, zinc, turmeric and N-acetyl cysteine.

4. What are the similarities in terms of signs & symptoms in both conditions?

Both PCOS and Endometriosis come with similar symptoms like complications during menstruation, period cramps, painful periods, fertility issues and psychological concerns. It is quite easy to be misdiagnosed. Especially in cases where people are diagnosed with PCOS and Endometriosis, they tend to experience more symptoms like bad skin, odd hair growth and chronic pelvic pain.

5. What are the differences in terms of signs & symptoms?

A few significantly different symptoms between PCOS and Endometriosis are that PCOS comes with excessive hair growth (hirsutism), acne and sudden weight gain. However, endometriosis is accompanied by extreme cramps, pain during sex (dyspareunia), and while using the bathroom. Things tend to get a little complicated when one tends to have both PCOS and endometriosis. The person tends to show symptoms for both the diseases, making it slightly more complicated to diagnose.

6. What are the 4 types of PCOS?

The 4 types of PCOS are;

  • Insulin-resistant PCOS 
  • Inflammatory PCOS
  • Hidden-cause PCOS 
  • Pill-induced PCOS

Insulin-resistant PCOS is caused by sugar, smoking and trans-fat. The high levels of insulin prevent ovulation, triggering the ovaries to create more testosterone. The best way to control this is by quitting sugar. 

Inflammatory PCOS is when ovulation is prevented, the hormones are imbalanced, and androgens are produced. This is caused by stress, toxins of the environment and gluten. Avoiding stress and trying to calm down is the best way to control this type of PCOS. 

The hidden PCOS is a simpler form of PCOS which can be resolved in 3-4 months. The causes for this are Thyroid disease, iodine deficiency, vegetarian diet and artificial sweeteners. 

Pill-induced PCOS is developed due to birth control pills that suppress ovulation. This is not long-term and the results wear off after the effects of the pill get over.

7. What are the 3 types of Endometriosis?

The 3 types of endometriosis are peritoneal superficial endometriosis, ovarian endometriomas, and deep infiltrating endometriosis (DIE). The peritoneum is a thin membrane lining the abdomen and pelvis.

In the peritoneal superficial endometriosis, the endometrial tissue attaches itself to the peritoneum. This is the least severe form. 

Endometrioma or ovarian lesion is the presence of dark, fluid-filled cysts. It is also called chocolate cysts.

Deeply infiltrating endometriosis grows under the peritoneum involving the organs near your uterus, like the bowels and bladder.

8. How does one get diagnosed for either condition?

There is no test to definitely diagnose and identify PCOS. A transvaginal ultrasound can be done to check for clues of indication of endometriosis. A pelvic exam can also be done where the doctor will manually feel the pelvis area for abnormalities. In PCOS the doctor will begin by asking for your medical history, menstrual cycles and weight changes. A physical examination can also be done to check for signs for excessive hair, growth, insulin resistance and acne.

9. What are the lifestyle & treatment options for PCOS?

PCOS is a treatment that focuses on managing individual concerns like infertility, hirsutism, acne or obesity.  A few lifestyle changes like following a low-calorie diet with the combination of physical activity is every doctor’s top recommendation. This is because losing weight will help improve your condition if you are diagnosed with PCOS.  It also helps tackle infertility and increases the effectiveness of the medication prescribed. 

A couple of medications like a combination of birth control pills or a progestin therapy will be recommended as well. Medications like Clomiphene, Letrozole or Metformin are given to encourage ovulation and birth control pills, Spironolactone, Eflornithine or electrolysis are given to reduce excessive hair growth.

10. What are the lifestyle & treatment options for Endometriosis?

A healthy lifestyle has not been proven to improve endometriosis, but a decline of a healthy lifestyle is not going to help it either. So, here are a few things that can be done and how they help. Physical activity is very helpful in maintaining a healthy lifestyle. 20 – 30 minutes of exercise and movement of the body every day will help reduce pain. 

Sleep is very important. It will help your immune system to function at its best. This can be done best by avoiding caffeine at night, avoiding heavy meals before bed and maintaining a regular sleep schedule. 

Stress management and relaxation are important to ease your body during this period. Yoga, relaxation techniques, organised day and seeking professional help are a few ways to keep yourself calm and relaxed.