PCOS and Endometriosis: Can You Have Both? What Patients Need to Know
Polycystic Ovary Syndrome (PCOS) and Endometriosis are two of the most common gynecologic conditions affecting people of reproductive age. They are often misunderstood, misdiagnosed, or mistaken for one another. Some patients are even diagnosed with both—but how is that possible? And what does it mean for your health, your fertility, and your treatment plan?
Let’s break down what each condition is, how they differ, how they can co-exist, and what to do if you suspect you’re dealing with both.
What Is PCOS?
PCOS is a hormonal disorder that affects how the ovaries function. It’s typically diagnosed when at least two of the following three criteria are met:
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Irregular or absent ovulation (leading to missed or unpredictable periods)
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Excess androgen levels (causing acne, facial hair, or hair thinning)
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Polycystic ovaries seen on ultrasound (many small follicles, not cysts)
PCOS is associated with insulin resistance, weight fluctuations, and increased risks for type 2 diabetes and metabolic syndrome. Fertility struggles are common, not because of anatomical blockages but due to hormonal imbalances that interfere with ovulation.
What Is Endometriosis?
Endometriosis is a chronic inflammatory disease where tissue similar to the uterine lining grows outside the uterus. It often leads to:
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Severe menstrual cramps and pelvic pain
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Pain during sex, bowel movements, or urination
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Infertility due to distorted pelvic anatomy
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Fatigue, bloating, and chronic inflammation
Unlike PCOS, endometriosis is not a hormonal disorder at its core. It is considered an estrogen-sensitive, immune-mediated condition that can progressively worsen if left untreated. Diagnosis usually requires imaging and/or surgery.
Can You Have PCOS and Endometriosis at the Same Time?
Yes—and many patients do. While they are fundamentally different diseases, they can co-occur. This overlap is often underrecognized because they present so differently and can mask one another.
Key overlaps include:
| Symptom | PCOS | Endometriosis | Both Can Cause |
|---|---|---|---|
| Irregular periods | Common | Sometimes | Yes |
| Pelvic pain | Rare or mild | Common and severe | Yes (in dual cases) |
| Infertility | Due to lack of ovulation | Due to anatomical damage | Yes, by different paths |
| Hormonal imbalances | Core issue | Secondary feature | Possible |
| Bloating/“endo belly” | Less common | Very common | Yes |
In patients with both conditions, PCOS may mask the pain of endometriosis (due to anovulation), or endometriosis may delay the diagnosis of PCOS. That’s why it’s important to work with a provider who understands both conditions.
Diagnosing Both Conditions
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PCOS is diagnosed using clinical signs, lab tests (testosterone, LH:FSH ratio), and ovarian ultrasound.
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Endometriosis is suspected based on symptoms and confirmed via imaging or laparoscopic surgery.
If your provider is only looking for one, they may miss the other. Be proactive about discussing all your symptoms, even if they seem unrelated.
Not Sure Where to Start?
Endometriosis Surgical Specialists International (ESSI) provides expert care for patients navigating complex gynecologic conditions like PCOS and endometriosis—especially when both may be at play. Our team is trained to recognize overlapping symptoms, uncover missed diagnoses, and build a plan that addresses your pain, hormones, and long-term goals.
