PCOS vs Endometriosis: Understanding the Key Differences

PCOS and Endometriosis Symptoms

Some symptoms of PCOS and endometriosis overlap, particularly changes to periods and difficulties conceiving. This is one reason why symptoms alone cannot always indicate which condition is responsible.

At the same time, each condition has features more commonly associated with it.

Common Symptoms of PCOS

PCOS can disrupt regular ovulation, so changes to the menstrual cycle are among its most common features. Some people have infrequent periods, while others may go for several months without a period.

Symptoms associated with PCOS can include:

• irregular or absent periods
• irregular or absent ovulation
• acne or oily skin
• excess facial or body hair
• thinning hair on the scalp
• weight changes or difficulty managing weight in some patients
• difficulty conceiving due to irregular ovulation

Symptoms vary considerably between individuals. It is also possible to have PCOS without experiencing all of these features, and the condition can affect people at any body weight.

Common Symptoms of Endometriosis

Pain is more characteristic of endometriosis, although both the type and severity of symptoms can vary significantly. Some people experience severe symptoms, while others have relatively mild symptoms despite having endometriosis.

Common symptoms can include:

• painful periods
• chronic or cyclical pelvic pain
• pain during or after sex
• pain during bowel movements or urination, particularly around menstruation
• heavy menstrual bleeding in some women
• fatigue
• difficulty conceiving

Pain severity does not necessarily reflect the extent of endometriosis. Some people with extensive endometriosis experience relatively little pain, while others with less extensive disease may experience significant symptoms.

​How Does Treatment Differ for PCOS and Endometriosis?

Treatment for PCOS and endometriosis is tailored to the individual rather than the diagnosis alone. Your symptoms, their impact on everyday life, your general health, lifestyle and whether you are currently trying to conceive can all influence which approach is most appropriate.

PCOS treatment often focuses on managing menstrual cycles and the effects of hormonal changes as well as metabolic health where appropriate. Depending on your symptoms and priorities, this may include hormonal treatments to regulate periods, treatment for androgen-related symptoms such as acne or excess hair growth, and lifestyle or metabolic support where appropriate. Fertility treatment may be considered when irregular ovulation is making it difficult to conceive.

Nutrition, regular physical activity, sleep and stress management can also form part of an individualised approach to PCOS and overall metabolic health. PCOS can affect women of any body weight, however, and its management should not simply be reduced to advice about losing weight.

Diagnosis usually involves discussing your symptoms and menstrual history, along with appropriate investigations. Blood tests may be used, where appropriate, to assess hormone levels and metabolic health and to exclude other possible causes, while an ultrasound may be recommended to assess the ovaries. Importantly, having polycystic-appearing ovaries on an ultrasound does not by itself mean that you have PCOS.

Endometriosis treatment usually aims to control symptoms and reduce their impact on daily life. Pain relief and hormonal treatments may be appropriate for some women, while surgery may be considered when symptoms are severe, other treatments have not provided sufficient relief, or there are particular clinical indications such as an ovarian endometrioma or deep endometriosis. Fertility support may also form part of treatment when required.

Clinicians usually assess endometriosis using your symptoms and medical history, along with appropriate examinations and imaging, such as an ultrasound or MRI scan. In some circumstances, doctors may recommend laparoscopy to diagnose and treat endometriosis. A normal scan does not necessarily exclude the condition, particularly when endometriosis is superficial.

No single treatment works for everyone. Management should therefore be based on your individual symptoms, priorities and fertility plans, with treatment reviewed as these change over time.

It is also important to look beyond medication and surgery. PCOS and endometriosis can affect sleep, energy levels, relationships, sexual wellbeing, work, exercise and emotional wellbeing. Depending on the individual, attention to nutrition, physical activity, sleep, metabolic health and psychological wellbeing can form part of a broader management plan.

For women living with chronic pain, approaches such as mindfulness, relaxation techniques, pelvic physiotherapy and strategies for managing stress may also be helpful. These approaches do not remove endometriosis or replace appropriate medical treatment, but they can help some women manage the wider impact of living with a chronic condition.

Understanding your condition is also an important part of treatment. Recognising symptom patterns, understanding treatment choices and knowing which aspects of your health you can influence can help you take a more active role in managing your health.​

Is PCOS or Endometriosis More Painful?

Endometriosis is more commonly associated with significant pain. Painful periods, pelvic pain and pain during or after sex are among its characteristic symptoms.

PCOS is not generally considered a primarily painful condition. However, individual experiences vary, and experiencing pelvic pain should not be used on its own to determine whether you have either condition.

Persistent or significant pelvic pain should therefore be appropriately assessed rather than automatically being attributed to PCOS.

Which Is More Likely to Cause Irregular Periods?

PCOS is more strongly associated with irregular or absent periods because it can interfere with regular ovulation. Some people with PCOS may have long gaps between periods or experience only a small number of periods each year.

Women with endometriosis can have regular menstrual cycles, although periods may be particularly painful or heavy. Changes in bleeding can occur, but irregular cycles are not as characteristic of endometriosis as they are of PCOS.

Can Having One Increase the Chances of Having the Other?

PCOS and endometriosis can coexist, but having one condition does not mean that you will necessarily develop the other. Research into the relationship between the two is ongoing, and they have different underlying mechanisms and risk factors.

An existing diagnosis should not automatically be assumed to explain every new or persistent symptom. If your symptoms do not fit the expected pattern of your diagnosed condition, further assessment can help determine whether another cause may be contributing.

​When Should You See a Gynaecologist?

Occasional changes to periods do not always indicate an underlying gynaecological condition. However, persistent or significant symptoms are worth discussing with a healthcare professional.

You may wish to arrange a gynaecological assessment if you experience:

• persistently irregular or absent periods
• severe or worsening period pain
• persistent or cyclical pelvic pain
• pain that interferes with work, sleep or everyday activities
• pain during or after sex
• difficulty conceiving
• symptoms that do not seem to fit an existing diagnosis

You do not need to determine for yourself whether your symptoms are caused by PCOS, endometriosis or another condition before seeking help. A gynaecological assessment can look at your symptoms as a whole and identify which investigations, if any, may be appropriate.

The London Women’s Centre Approach to PCOS and Endometriosis Treatment

At London Women’s Centre, our experienced gynaecologists provide specialist assessment and personalised care for patients with PCOS, endometriosis and other conditions affecting menstrual and reproductive health.

We believe that the ideal women’s healthcare begins with listening to the individual woman rather than simply treating a diagnosis. PCOS and endometriosis can present very differently from one woman to another, so we take the time to understand your symptoms, menstrual and reproductive history, general and metabolic health, fertility plans, lifestyle and, importantly, what you would like to achieve from treatment.

Our experienced gynaecologists combine specialist expertise with appropriate investigations to establish as clear a diagnosis as possible and develop an individual management plan. This may involve medical or hormonal treatment, specialist imaging, surgery or fertility support where appropriate. However, we do not believe that treatment necessarily begins and ends with medication or an operation.

Our approach also considers the aspects of health that women can influence themselves. Where appropriate, this may include nutrition, physical activity, sleep, metabolic health, stress management and mindfulness alongside conventional medical treatment.

We believe that knowledge is an important part of treatment. Understanding your condition, recognising your symptom patterns, and knowing the options available can help you make informed decisions and take an active role in managing your health.

For some women, lifestyle and self-management strategies alongside appropriate medical treatment can make a meaningful difference. For others, specialist hormonal treatment, fertility support or surgery may be necessary. No single solution is right for everyone.

Our role is not simply to diagnose PCOS or endometriosis, but to provide the expertise, knowledge and individualised care that allows each woman to understand her condition and find the combination of medical treatment and self-management strategies that is most appropriate for her.

If you are experiencing irregular periods, pelvic pain, fertility difficulties or symptoms that you think may be related to PCOS or endometriosis, a consultation at London Women’s Centre can provide specialist assessment, clear information about your options and a personalised plan for the next steps.​