PCOS and endometriosis are two of the most common women's health conditions, and both significantly impact reproductive health, fertility, and overall quality of life. Despite being distinct disorders, they often share overlapping symptoms—making accurate diagnosis challenging. Many women endure years of unanswered questions, ineffective treatments, and worsening health because their symptoms are attributed to the wrong condition.

This confusion has serious consequences. Misdiagnosis delays proper treatment, increases long-term complications, and can intensify hormonal imbalances, chronic pelvic pain, and emotional stress. Understanding the similarities and differences between PCOS symptoms and endometriosis symptoms is crucial for better management, earlier detection, and improved outcomes for millions of women worldwide.

Distinguishing PCOS Symptoms from Those of Endometriosis

Although PCOS (Polycystic Ovary Syndrome) and endometriosis are separate conditions, they frequently get confused due to overlapping reproductive symptoms. However, several key distinctions can help differentiate them:

PCOS symptoms typically include:

  • Irregular or absent menstrual cycles
  • Weight gain or difficulty losing weight
  • Acne and oily skin
  • Excess hair growth on the face or body (hirsutism)
  • Thinning hair or hair loss on the scalp
  • Ovarian cysts visible on ultrasound
  • Difficulty ovulating or conceiving

PCOS is primarily a hormonal and metabolic disorder. Pain is not usually a dominant symptom.

Endometriosis symptoms often include:

  • Severe pelvic pain, especially before or during menstruation
  • Painful intercourse
  • Heavy, irregular, or prolonged bleeding
  • Painful bowel movements or urination
  • Gastrointestinal distress (bloating, nausea, constipation)
  • Chronic lower back or abdominal pain
  • Difficulty getting pregnant

Unlike PCOS, pain is the hallmark of endometriosis. It occurs because endometrial-like tissue grows outside the uterus, causing inflammation and scarring.

According to the Office on Women's Health (U.S. Department of Health & Human Services), PCOS affects approximately 1 in 10 women of reproductive age, while endometriosis affects around 1 in 10 as well—yet their symptoms manifest very differently. Understanding these distinctions is key to properly identifying PCOS symptoms and distinguishing them from the pelvic-pain-driven nature of endometriosis.

Read more

Reasons Why PCOS and Endometriosis Are Frequently Misdiagnosed

Despite their differences, PCOS and endometriosis are frequently mistaken for one another. Several major factors contribute to this ongoing diagnostic challenge:

1. Overlapping Symptoms

Both conditions can present with:

  • Irregular periods
  • Infertility or difficulty conceiving
  • Heavy or inconsistent bleeding patterns

Because menstrual irregularities are common to both, many women are initially diagnosed with one condition based on limited symptoms.

2. Limited Awareness and Provider Training

Many healthcare professionals receive minimal specialized training on the nuanced differences between these two complex disorders. According to the Centers for Disease Control and Prevention, conditions like PCOS are frequently misunderstood, leading to delays in adequate treatment.
Endometriosis is similarly under-recognized. Based on a study conducted by the National Institutes of Health, patients often wait 7 to 10 years for an accurate diagnosis because symptoms are dismissed as "normal period pain."

3. Diagnostic Challenges and Limitations

The diagnostic process differs significantly between the two conditions:

  • For PCOS: Diagnosis often relies heavily on ultrasounds showing ovarian cysts, but not all women with PCOS have cysts—and women without PCOS may still have benign cysts. Blood tests evaluating hormones are also essential but frequently overlooked.
  • For endometriosis: The only definitive diagnostic method is laparoscopic surgery, an invasive procedure. Many women avoid or postpone this, leading to partial or incorrect diagnoses based on symptoms alone.

Because endometriosis requires surgical confirmation, healthcare providers may diagnose patients with PCOS instead when symptoms overlap, especially if hormonal issues or irregular cycles are present.

4. Symptoms Can Evolve Over Time

PCOS may start with mild hormonal issues and progress into metabolic complications.
Endometriosis, meanwhile, typically worsens over the years as lesions spread or deepen. This evolution can blur the diagnostic picture even further.

5. Coexistence of Both Conditions

A complication rarely discussed is that some women actually have both PCOS and endometriosis. Because their symptoms can mask one another, this dual diagnosis often goes unrecognized without thorough evaluation.

Conclusion

Understanding the differences between PCOS symptoms and endometriosis symptoms is essential for improving diagnosis, treatment, and long-term health outcomes. Misdiagnosis remains common because both conditions share reproductive and hormonal symptoms, yet they stem from fundamentally different physiological processes. With greater public awareness, improved clinical training, and more comprehensive evaluations, women can receive accurate diagnoses sooner—reducing complications and enhancing quality of life.

As awareness grows, it becomes increasingly important for healthcare providers and patients to recognize the complexity of these women's health conditions. Early detection and proper medical support offer the best chance at relieving symptoms, managing fertility concerns, and restoring overall well-being. By staying informed, advocating for thorough evaluations, and understanding the distinctions between the two disorders, women can take proactive steps toward better health and more effective treatment.

Frequently Asked Questions

1. Can someone have both PCOS and endometriosis?

Yes. Many women experience overlapping symptoms because both conditions affect hormones and reproductive function. Having both can make diagnosis more complex and may exacerbate pain, infertility, or cycle irregularities.

2. What diagnostic tests differentiate PCOS from endometriosis?

PCOS is typically diagnosed through a combination of blood tests to check hormone levels, a pelvic ultrasound to identify ovarian cysts, and an assessment of menstrual history. In contrast, endometriosis is diagnosed by evaluating symptoms like pelvic pain, conducting a pelvic exam, and confirming with laparoscopic surgery, which remains the gold standard. These tests help differentiate the two conditions despite overlapping symptoms.

3. How do treatment approaches vary between these conditions?

PCOS treatment focuses on hormone regulation, metabolic support, and ovulation management. Endometriosis treatment prioritizes pain management, hormonal suppression, and sometimes surgery to remove lesions.

4. Are these conditions curable?

Neither PCOS nor endometriosis has a permanent cure, but both can be effectively managed through lifestyle changes, hormone therapy, pain control, and individualized medical treatment.

Read more