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Endometriosis vs. PCOS

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Endometriosis and PCOS are common gynecological conditions that affect many of the female population. Read the article to know more about it.

Medically reviewed by

Dr. Richa Agarwal

Published At March 27, 2023
Reviewed AtMarch 27, 2023


Menstrual disorders are a common gynecological problem among women. Females often complain of disorders like pain during periods, severe abdominal cramps, and abnormal or irregular period cycles. Such conditions often relate to common pathological disorders, endometriosis, and polycystic ovarian syndrome (PCOS). Similar characteristic features often make differentiating between these two common conditions difficult. That is why understanding these conditions are necessary.

What Is Endometriosis?

Around 10 to 15 percent of women of reproductive age suffer from endometriosis worldwide. Around 190 million females are affected by this estrogen-dependent menstrual dysfunction globally. This is characterized by endometrium-like (lining of the uterus) tissue outside the uterus. These tissue-like structures can be found in genital structures like fallopian tubes, vagina, uterosacral ligament (tissue that connects the lower part of the uterus to the ligament), and the outer surface of the uterus. These tissues can also be found in extragenital structures like the pleura, the pericardium, the rectum, the bowl, or the central nervous system.

What Are the Causes of Endometriosis?

The causes associated with these conditions are unknown. According to some researchers, genetic factors are crucial in this condition. Genes such as WNT4 and GERB 1 are associated with this condition. Several others have put forward different hypotheses. These are:

  • Retrograde Menstruation - According to this theory, blood products and cells of the menstrual cycle flow backward from the Fallopian tubes to the peritoneum during menstruation. These cells are implanted and grow and form endometrial tissues.

  • Lymphatic and Vascular Metastasis Theory - According to this theory by Meyer, the parietal peritoneum epithelium (layer of the abdominal cavity) is stimulated by several factors like cytokines and growth factors. These cells differentiate and form endometrial cells. Stem cells of bone marrow may give rise to endometriosis.

As a result of these factors, the body's systemic response is altered. Persons suffering from endometriosis show higher levels of estrogen. The body's inflammatory mediators level is also on the higher side.

What Are the Symptoms of Endometriosis?

The clinical manifestation of endometriosis are:

  1. Dysmenorrhea, in which patients complain of severe lower back pain during periods. Pain may persist even before or after the period days. Sometimes it is associated with severe cramping.

  2. Menorrhagia, in which patients often suffer from abnormally heavy bleeding during period days.

  3. Dysuria is pain during urination, and bowel movement is a common complication.

  4. Pain during intercourse is also associated with this.

  5. Patients suffer from mental disorders like depression, anxiety, and fatigue.

  6. Common complications include constipation (dyschezia), diarrhea, or blood in the urine.

What Are the Complications of Endometriosis?

The most common complication associated with endometriosis is infertility. Apart from this is also associated with an increased risk of cardiovascular disorders. Though it is a benign entity, the malignant transformation of endometriosis to ovarian cancer is sometimes reported. Also, there has been a strong association between breast cancer, melanoma (a type of skin cancer), and non-Hodgkin’s lymphoma (cancer of the lymphatic system) with endometriosis.

What Is PCOS?

PCOS, or polycystic ovary syndrome, is a hormonal disorder characterized by excessive production of male hormones in the female body. It is also one of the common causes of infertility among women. Around 5 million women alone in the united state of America is suffering from this condition. 4 to 20 percent of women of reproductive age worldwide suffer from this condition. The name is derived from cyst-like structures (fluid-filled sacs) in ovaries, though these structures are not seen in every case.

What Are the Causes of PCOS?

The actual cause of PCOS is unknown, but this is associated with a defect in the hypothalamic–pituitary–ovarian (HPO) axis. This axis is influenced by internal factors (like hormones and genetic factors) and external factors (food habits and physical exercise). Due to these factors, the androgen level (the male reproductive hormone) is high. This disrupts the menstrual cycle. Neuroendocrine abnormalities are also associated with this condition. This causes an elevated level of luteinizing hormone (LH) and gonadotropin-releasing hormone (GnRH). But the level of follicular-stimulating hormone (FSH) remains unchanged or decreased. As a result, the ratio between luteinizing hormone (LH) and follicular-stimulating hormone (FSH) is altered. In response to these events, ovulatory events may decrease, and the amount of circulating progesterone is decreased. The metabolic function associated with altered insulin function is also associated with PCOS. Insulin-mediated glucose transport is responsible for a higher insulin level in such cases. Insulin helps to regulate ovarian function, but a higher level of insulin is associated with the excessive production of androgens.

What Are the Symptoms of PCOS?

The clinical features associated with PCOS are:

  1. Amenorrhea - Absence of period, irregular, periodic cycle, and abnormal period are common clinical presentations.

  2. Hirsutism - Abnormal hair growth in unusual body parts like arms and chest can be seen. The presence of facial hair is also commonly seen.

  3. Acne - The presence of acne on the back, chest, and face can also be observed.

  4. Alopecia - Thinning of hair and excessive hair loss is also associated with this.

  5. Acanthosis Nigricans - This is a clinical condition characterized by the dark appearance of skin in the skin folds, specifically in the armpits, groin, and neck.

  6. Skin Tags - A common type of growth on the skin can also be seen.

What Are the Complications of PCOS?

The most common complication associated with PCOS is the absence of release of the eggs. Excessive levels of androgen cause anovulation (no release of eggs), which is responsible for developing multiple fluid-fill sacs in the ovary. This causes infertility. Also, PCOS is associated with excessive weight gain, type 2 diabetes, high blood pressure, cardiovascular disorder, and uterine cancer.

How to Diagnose?

As these two conditions are, the principal diagnosis of such cases is important. Due to similarities in clinical presentations, diagnostic tests are necessary. PCOS can be diagnosed with the help of hormonal assays. transvaginal ultrasound can also be done to detect the presence of cysts. Endometriosis can be diagnosed using transvaginal ultrasound or magnetic resonance imaging. Transabdominal ultrasound or laparoscopy may sometimes be needed to diagnose endometriosis. Cyst-like structures are also visible in ovarian endometriomas. The only difference with the cyst of PCOS is that these cysts contain blood inside the sack.


Menstrual problems are common gynecological problems for women of reproductive age. If ignored, this may cause serious problems like infertility. Endometriosis and polycystic ovary syndrome have similar clinical presentations. But careful examination, history taking, and proper diagnostic methods can be useful to cure such conditions.

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Dr. Richa Agarwal
Dr. Richa Agarwal

Obstetrics and Gynecology


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