Endometriosis and PCOS: What's the Difference?

When considering fertility, it’s important to understand the various health conditions that can have an impact on fertility. Endometriosis and polycystic ovary syndrome (PCOS) are two common conditions that can pose problems when trying to become pregnant. While both conditions can affect fertility and share some overlapping symptoms, they are different in their causes, symptoms, and treatments.

What is Endometriosis?

Endometriosis is a condition where tissue similar to the lining inside the uterus, known as the endometrium, starts to grow outside of the uterus. This can lead to inflammation, pain, and the formation of scar tissue within the pelvic region. The condition affects about 10% of reproductive-aged women globally. A person with endometriosis may experience:

• Very painful periods.
• Pain with sexual intercourse.
• Pain with bowel movements or urination, especially during your period.
• Periods that are extremely heavy or abnormally long, or spotting between periods.
• Pelvic pain that ranges from mild discomfort to severe cramps.
• Bloating, diarrhea, constipation, or nausea.
• Chronic fatigue.

Although the exact cause of endometriosis is unknown, we do know why the disorder causes these symptoms. During your menstrual cycle, the lining inside the uterus thickens to prepare for pregnancy. If a pregnancy does not occur, the endometrium breaks down and sheds, exiting the body through the vagina. Whenendometrial tissue grows outside of the uterus, there is no way for it to shedand exit the body. This causes the inflammation, scarring, and other symptoms seenin patients with endometriosis.

What is PCOS?

PCOS is a hormonal disorder common among women of reproductive age. It is characterized by long or irregular menstrual cycles and elevated levels of male hormones (androgens). The disorder affects approximately 8-13% of reproductive-aged women globally, with up to 70%remaining undiagnosed.

PCOS characterized by a combination of symptoms that can impact the menstrual cycle, fertility, hormones, appearance, and long-term health. These symptoms include:

• Irregular menstrual cycles or the absence of menstruation.
• Excess hair on the face, chest, abdomen, or upper thighs, known as hirsutism.
• Severe acne or acne that doesn't respond to usual treatments.
• Thinning hair or male-pattern baldness.
• Weight gain or difficulty losing weight.
• Darkening of the skin, particularly along neck creases, in the groin, and underneath breasts.
• Skin tags, which are small excess flaps of skin in the armpits or neck area.

The exact cause of PCOS is unknown, but several factors are thought to play a role in its development.

Insulin Resistance: Insulin resistance is common in people with PCOS. This can lead to higher insulin levels, which can increase androgen production and affect ovulation.

Hormonal Imbalance: Sex hormone imbalances are common with PCOS, including elevated levels of androgens. This can disrupt menstrual cycles and cause symptoms like acne and excess hair growth.

Low-grade Inflammation: People with PCOS may have a type of low-grade inflammation that prompts the ovaries to produce androgens.This can contribute to cardiovascular and metabolic issues.

Heredity: Having family members with PCOS increases a woman's risk of having the disorder.

Excess Gonadotropin Production: An imbalance in luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels can contribute to the development of PCOS, affecting ovarian function and hormone production.

The primary difference between endometriosis and PCOS lies in the causes of the disorders. Endometriosis involves the growth of uterine-like tissue outside of the uterus, causing physical symptoms mainly related to menstruation and fertility. In contrast, PCOS is characterized by hormonal imbalances affecting the ovaries, leading to symptoms related to menstrual irregularity, changes in physical appearance, and insulin resistance.

How Does Endometriosis Impact Fertility?

Women with endometriosis do experience infertility more often than women without endometriosis though it is important to know that women with endometriosis can and do get pregnant, even without assistance. The growth of endometrial type tissue outside of the uterus can significantly impact a woman's fertility in several ways:

Obstruction and Scarring: Endometriosis can cause scarring and adhesions on the ovaries and fallopian tubes. This can interfere with the release of eggs from the ovaries and their subsequent fertilization and journey to the uterus.

Inflammation: The presence of endometrial tissue outside the uterus creates an inflammatory response that can affect the quality of eggs, sperm, and even a fertilized embryo. This can cause complications with the fertilization process and embryo implantation.

Hormonal and Ovarian Function Disruption:Endometriosis can  affect ovarian reserve and the pool of eggs available for fertilization, either through damage to the ovaries or through surgery to remove endometriosis lesions. Many women with endometriosis have cysts inside of the ovaries we call endometriomas that can be seen on ultrasound.

Immune System Response: Some theories suggest that an abnormal immune response may be involved in endometriosis, which might affect fertility by targeting the embryo or disrupting the environment necessary for a successful pregnancy.

How Does PCOS Impact Fertility?

PCOS primarily affects fertility through hormonal imbalances and ovulatory dysfunction:

Irregular Ovulation: The hallmark of PCOS is irregular or absent ovulation, which directly impacts fertility since ovulation is necessary for conception. Women with PCOS may have fewer opportunities to conceive due to infrequent ovulation, making it difficult to become pregnant.

Hormonal Imbalances: Elevated levels of androgens(male hormones) and insulin resistance can disrupt not only the environment necessary for regular ovulation, but also the development of the uterine lining. This makes it difficult for an embryo to successfully implant in the uterus.

Ovarian Environment: The ovaries of people with PCOS often contain multiple immature follicles that do not grow to full maturity. This contributes to difficulties with poor egg quality and normal ovulation.

Metabolic Factors: Obesity and insulin resistance are common in PCOS, which can further exacerbate hormonal imbalances and inflammation. This affects an individual’s overall reproductive health and the ability to conceive.

What should I do if I think I have endometriosis or PCOS?

If you suspect you have PCOS or endometriosis, you should make an appointment with your primary care provider, gynecologist, or one of our reproductive specialists to discuss your concerns. Explain your symptoms openly and honestly, providing detailed information about your menstrual cycle, pain levels, and any other relevant symptoms.

Maintaining a journal to track your symptoms can also be helpful. Include the frequency and severity of any pain you are experiencing and record your menstrual cycles and any other relevant changes in your body. This information can help your healthcare provider make an accurate diagnosis and develop an effective treatment plan.

Once you have a diagnosis, your provider will review your treatment options with you. Treatment approaches may vary depending on the severity of your symptoms, your overall health, and your reproductive goals.

How Is Endometriosis Treated?

Living with endometriosis or PCOS can be challenging, but a range of treatments is available to manage symptoms and improve quality of life. The right treatment depends on several factors, including the severity of symptoms, the individual's health profile, and their family planning goals.

Endometriosis treatments aim to alleviate pain, reduce endometrial growth, and address fertility issues. Options include:

• ‍Pain Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage menstrual pain and discomfort associated with endometriosis.
• ‍Hormonal Therapies: Hormone-based treatments, such as birth control pills, gonadotropin-releasing hormone (GnRH)agonists, and progestins, can help control hormonal fluctuations and reduce the growth of endometrial type tissue.‍
• Surgical Options: For more severe cases or when fertility is a concern, surgical interventions like laparoscopy can remove endometrial growths. Surgery is often not recommended for the sole purpose of treating infertility, however, as there is not a lot of data to suggest that it necessarily improves your chances of getting pregnant. Sometimes it is necessary to obtain a diagnosis or to simply treat the pain often associated with endometriosis. Whether you need to have surgery would definitely be a conversation to have with your physician.  In extreme cases, a hysterectomy might be considered, though this is generally a last resort, especially for women who wish to have children.
• ‍Assisted Reproductive Technologies (ART): For women with endometriosis experiencing infertility (where the endometriosis has not caused a blockage of your fallopian tubes), treatments like combining fertility drugs with intrauterine insemination (IUI) or in vitro fertilization (IVF) may offer a chance to conceive. If your tubes are blocked, whether that is from endometriosis or other reasons, IVF would be your only option for treatment.

How Is PCOS Treated?

Managing PCOS involves addressing symptoms such as irregular periods, hirsutism, and infertility and minimizing the risk of long-term complications like type 2 diabetes and heart disease. Treatment strategies include:‍

• ‍Lifestyle Changes: Weight management through diet and exercise can significantly improve symptoms, reduce insulin resistance, and in some women restore regular menstrual cycles without the need for fertility treatments.‍
• Medications to Induce Ovulation: For women trying to conceive, medications like clomiphene citrate (Clomid) or letrozole (Femara) can stimulate ovulation.This is the treatment you most likely would start with, assuming other factors are normal (male factor/fallopian tubes).‍
• Insulin-Sensitizing Drugs: Metformin, used primarily to treat type 2 diabetes, can also help improve insulin resistance and ovulatory function in women with PCOS who don’t have diabetes.N ot every patient with PCOS will need to take metformin, but your doctor may recommend it if there is evidence that you do have insulin resistance.‍
• Hormonal Contraceptives: Birth control pills can regulate menstrual cycles, reduce androgen levels, and alleviate symptoms like acne and excess hair growth. You might be placed on the birth control pill for several months to try and regulate your cycles before starting fertility treatments. If you are not trying to get pregnant, being on hormonal contraceptives long term can help treat many of the symptoms you experience with PCOS.
• Androgen-Blocking Medications: Drugs such as spironolactone can reduce hirsutism and acne by blocking the effects of androgens. These medications are not ones that you can take while undergoing fertility treatment or during pregnancy.

It's important to work closely with your healthcare provider to create a personalized treatment plan. Factors such as symptom severity, age, overall health, and reproductive goals should guide treatment decisions.Regular follow-ups and adjustments to the treatment plan can help manage these conditions effectively over time.

Coping with PCOS or endometriosis can also be emotionally challenging. Seek support from friends, family, or support groups where you can connect with others who understand what you're going through. Additionally, consider consulting a mental health professional if you're struggling with anxiety, depression, or other emotional difficulties related to your condition.

The journey to parenthood can be complex for those with conditions like endometriosis or PCOS, but with the right treatment plan and support, you can manage symptoms and pursue your goals, including starting a family. At Advanced Fertility Care, we are committed to providing personalized, compassionate care to help our patients navigate their fertility journey, offering hope and expert guidance every step of the way. 

Our dedicated team of specialists is here to offer you personalized care, from diagnosis to treatment, helping you navigate your fertility journey with compassion and expertise. Whether you're just starting to explore fertility treatment options, or you've been on this path for awhile, reach out to us today– we're here to support you every step of the way.