According to the World Health Organization (WHO), polycystic ovarian syndrome (PCOS) affects an estimated 8–13% of reproductive-aged women, with up to 70% of affected women remaining undiagnosed worldwide. Similarly, WHO estimates endometriosis affects roughly 10% (190 million) of reproductive age women and girls globally.
Awareness of these chronic gynecological disorders is on the rise, with many women who've been tirelessly searching for an explanation for their painful symptoms finally finding answers and subsequent options for treatment.
Dr. Diana Bitner, MD, MSCP, FACOG, Chief Medical Officer & Co-founder of true. Women's Health, shares that while both PCOS and endometriosis affect fertility and are common in reproductive age women, they are very different from one another.
"PCOS is a metabolic disease that affects the ovaries and menstrual function because of insulin resistance and hormone dysfunction," Dr. Bitner explained. "Endometriosis is a condition where the glands from the inside of the uterus escape and plant on the surface of pelvic organs and the pelvic lining tissue and cause scar tissue, potentially blocked tubes and pelvic pain. PCOS can cause heavy irregular periods which are also painful; endometriosis doesn't affect timing of periods but can cause very painful periods and pelvic pain."
Symptoms of both PCOS and endometriosis are unpleasant and can upend the daily lives of those living with these conditions.
"PCOS symptoms include heavy irregular periods, hormone imbalance causing male pattern hair growth, acne and belly fat weight gain which is difficult to lose," Dr. Bitner shared, adding that signs of PCOS include high cholesterol, blood sugar, testosterone levels and sometimes ovaries with many small cysts, which are cysts that never released their eggs. "Endometriosis causes painful periods, pelvic pain, and bladder and bowel symptoms such as urgency, diarrhea and constipation. Signs can include a painful pelvic exam and endometriosis cysts on the ovaries."
Genetics play a large part in risk factors associated with PCOS and endometriosis.
"PCOS has over 30 genes associated with its development, and it can be a vicious cycle started by early adulthood weight gain," Dr. Bitner said. "Endometriosis is also known to have a genetic component, and in part, the process is caused by a person's immune system not recognizing that tissue from the inside of the uterus is in places it doesn't belong. The tissue then causes inflammation and can act like glue on the inside and lead to infertility and bowel complaints."
The effects on fertility are also important to note.
"PCOS makes it difficult to get pregnant because of the ovary not working well under the metabolic conditions of insulin resistance and also the excess of testosterone and its related hormones," Dr. Bitner explained. "As a result, women have heavy irregular periods and have trouble getting pregnant. Women with endometriosis often at least take longer to get pregnant and sometimes require IVF to get pregnant because of blocked tubes."
Long term, PCOS carries the risks of diabetes, obesity, stroke and dementia, while endometriosis is associated with long-term pain for women who go untreated. It can also be life-altering if pregnancy is not possible.
There are two major misconceptions Dr. Bitner often hears when it comes to PCOS and endometriosis.
"Number one is that they're both ovarian problems, and number two, that there aren't treatment options and women have to suffer," she said, sharing common treatment options. "PCOS is treated with a healthy lifestyle and medication to reduce insulin resistance such as metformin and GLP1 medications such as Saxenda and Wegovy."
Dr. Bitner notes this is not lifelong and as women have their metabolic dysfunction resolved, they can build muscle mass and often start having regular periods again and improved fertility.
"Endometriosis is treated by suppressing the gland from inside the uterus with a progesterone-containing IUD or medication to block the estrogen receptors and shutting off the fertilizer," Dr. Bitner said. "Endometriosis is also treated by surgery to take out as much endometriosis as safely as possible."
Women should know they have options and don't have to simply accept the pain caused by disorders like PCOS and endometriosis. If you think you may have PCOS and endometriosis, talk to your doctor about your symptoms and request more information about options personalized to your individual situation.
Written by Sarah Suydam, Managing Editor for West Michigan Woman.
This article originally appeared in the Oct/Nov '24 issue of West Michigan Woman.
