Your period isn’t normal. Maybe it’s too heavy. Too painful. Too unpredictable. Maybe you’ve been told it’s stress, age, or “just how it is.”
When you finally search online or talk to a doctor, two words keep popping up: PCOS and endometriosis.
But what’s the difference? And how do you know which one you might have?
Both conditions are common. Both affect your fertility. Both are underdiagnosed. But they are not the same—and confusing them can delay proper care.
In this guide, you’ll learn:
- The major differences between PCOS and endometriosis
- How each condition shows up in the body
- What tests are used to diagnose them
- What questions to ask your doctor
Let’s clarify the confusion.
PCOS vs Endometriosis: A Quick Overview
| Feature | PCOS | Endometriosis |
| Hormones | Excess androgens (testosterone) | Normal hormones; displaced endometrial tissue |
| Main symptoms | Irregular periods, acne, hair growth, weight changes | Severe cramps, pain with sex, heavy bleeding |
| Cause | Hormonal imbalance | Tissue growing outside the uterus |
| Pain | Not always | Often severe |
| Fertility impact | Irregular ovulation | Blocked tubes, inflammation |
| Diagnosed via | Blood tests, ultrasound | Laparoscopy (surgery) |
➡️ TLDR: PCOS is primarily hormonal. Endometriosis is primarily inflammatory and anatomical. But yes—you can have both.
What Is PCOS?
Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that affects how the ovaries function.
It’s characterized by:
- Irregular or missing periods
- High androgen levels (leading to acne or excess hair)
- Cysts on the ovaries (visible via ultrasound)
It affects about 1 in 10 women and is a leading cause of infertility due to anovulation (not releasing eggs regularly).
Other common symptoms:
- Weight gain or difficulty losing weight
- Fatigue
- Insulin resistance or blood sugar issues
- Scalp hair thinning
PCOS is diagnosed through:
- Hormone blood tests
- Pelvic ultrasound
- Symptom review (using the Rotterdam criteria)
➡️ Read: How to Get an Accurate PCOS Diagnosis
What Is Endometriosis?
Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus—on the ovaries, fallopian tubes, bladder, or pelvic walls.
This tissue:
- Responds to monthly hormones
- Bleeds internally during your cycle
- Causes inflammation, scarring, and chronic pain
It affects around 1 in 10 women, yet takes 7–10 years on average to get diagnosed.
Common symptoms include:
- Debilitating cramps (not just “bad period pain”)
- Pain during or after sex
- Painful bowel movements or urination (especially during periods)
- Bloating and pelvic heaviness
- Fatigue and fertility struggles
Diagnosis is typically done via laparoscopy, a minor surgery that allows doctors to view and biopsy the tissue.
➡️ Explore: What Is Endometriosis and How It Affects Fertility
Key Symptom Differences
Let’s break it down by what you might feel:
| Symptom | PCOS | Endometriosis |
| Irregular or missed periods | ✅ Common | ❌ Rare |
| Painful periods | ❌ Not a main feature | ✅ Primary symptom |
| Acne, facial/body hair | ✅ Linked to high androgens | ❌ Not typical |
| Fatigue & brain fog | ✅ Due to insulin imbalance | ✅ Due to chronic inflammation |
| Pain with sex or bowel movements | ❌ Not common | ✅ Hallmark symptoms |
| Ovulation issues | ✅ Common | ✅ Common |
| Infertility | ✅ Related to hormone imbalance | ✅ Related to anatomy & inflammation |
How They’re Diagnosed
PCOS Diagnosis Includes:
- Blood tests (testosterone, DHEA-S, LH:FSH ratio)
- Pelvic ultrasound
- Period history
- Ruling out thyroid/adrenal issues
Endometriosis Diagnosis Includes:
- Symptom review
- Imaging (MRI or ultrasound can suggest it, but not confirm)
- Laparoscopy: only definitive diagnosis
➡️ Not sure where to start? Book a Care Navigator call
Expert Insight
“We see so many patients who’ve been told they have PCOS when they’re really dealing with endometriosis—or vice versa. Both require completely different treatments. The key is understanding your symptoms and pushing for proper evaluation.”
Can You Have Both PCOS and Endometriosis?
Yes. And it’s more common than most people realize.
A 2021 study showed that 5–10% of women diagnosed with PCOS also had surgically confirmed endometriosis. The hormonal and inflammatory overlaps can make diagnosis especially challenging.
If you have:
- Irregular periods + acne
- Severe pain + bloating
- Trouble conceiving
→ You deserve a thorough workup for both conditions.
Treatment Paths: PCOS vs Endo
| Focus | PCOS Treatment | Endometriosis Treatment |
| Hormonal regulation | ✅ Birth control, metformin, spironolactone | ✅ Birth control may reduce flares |
| Fertility support | ✅ Ovulation induction (e.g., letrozole) | ✅ Surgery, IVF, anti-inflammatory protocols |
| Pain management | ❌ Usually not needed | ✅ NSAIDs, hormonal suppression |
| Surgical intervention | ❌ Rare | ✅ Laparoscopy often recommended |
| Lifestyle changes | ✅ Weight, insulin, inflammation | ✅ Anti-inflammatory diet, stress reduction |
➡️ Learn about fertility treatment options
Real-Life Story
“I was diagnosed with PCOS in my 20s, but my cramps kept getting worse. No one believed me until I saw a specialist who suspected endometriosis. After surgery, they found stage 3 lesions. Now I’m finally getting the treatment I need—for both.”
— Amanda, 34
Myth vs Reality
| Myth | Reality |
| “PCOS and endometriosis are the same.” | They’re completely different—PCOS is hormonal; endo is inflammatory. |
| “If you don’t have cysts, it’s not PCOS.” | You can have PCOS without cysts. |
| “Endometriosis always causes heavy periods.” | Some people have light bleeding but severe pain. |
| “Only surgery can treat endo.” | Not always—some find relief with medication and lifestyle. |
Final Thoughts
Both PCOS and endometriosis can make you feel like your body is working against you.
But knowledge is power—and the sooner you understand what’s really going on, the sooner you can get targeted care that works.
You don’t have to guess. You don’t have to wait. You can feel better—with the right diagnosis.
Call to Action
👉 Wondering whether your symptoms are PCOS, endometriosis—or both?
Take our free 5-minute reproductive health quiz to find out what your symptoms suggest and what your next step should be.
👉 https://zorahealth.co/quiz/reproductive-health
Sources
- Endocrine Society – PCOS Guidelines
- Johns Hopkins – Endometriosis Overview
- CDC – PCOS vs Endometriosis
- NIH – Overlap in PCOS and Endometriosis
Anna Haotanto is the Founder of Zora Health and a passionate advocate for women’s empowerment. Anna’s personal experiences with egg-freezing, PCOS, perimenopause and the challenges of fertility have fueled her mission to provide high-quality information, financing, and support to help women and couples navigate their fertility journeys with confidence. She is also recognised for her achievements in finance, entrepreneurship, and women’s empowerment, and has been featured in various media outlets. You can also follow her on Linkedin or Instagram.
