Endometriosis and PCOS: Underdiagnosed Conditions, Symptoms, Treatment

Many people live for years with period pain, irregular cycles, or fertility struggles before getting answers. Two common causes are endometriosis and polycystic ovary syndrome (PCOS). Understanding these conditions can help you recognize symptoms sooner, ask the right questions, and get effective care.

Women’s health issues, particularly endometriosis and polycystic ovary syndrome (PCOS), are often underdiagnosed yet significantly impact the lives of millions assigned female at birth. Many individuals endure years of discomfort from period pain, irregular cycles, and fertility challenges before receiving appropriate diagnoses and care. By educating oneself about the symptoms and characteristics of these conditions, individuals can advocate for their health more effectively, leading to earlier treatment and better outcomes. Increased awareness and research in women’s health emphasize the importance of timely intervention, which can alleviate pain, safeguard fertility, and reduce long-term health risks.

Understanding Endometriosis

Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus, causing pain and potential fertility issues. Symptoms can include severe menstrual cramps, chronic pelvic pain, pain during intercourse, and infertility. Diagnosis often involves pelvic exams, ultrasounds, or laparoscopy.

Understanding PCOS

Polycystic Ovary Syndrome (PCOS) is characterized by hormonal imbalances that can disrupt menstrual cycles, cause excessive hair growth, and lead to weight gain. Common symptoms include irregular periods, acne, and ovarian cysts. Diagnosis typically involves blood tests to check hormone levels and an ultrasound of the ovaries.

Frequently Asked Questions (FAQs)

What are the common symptoms of endometriosis?

Common symptoms include severe menstrual cramps, chronic pelvic pain, pain during intercourse, and infertility.

How is PCOS diagnosed?

PCOS is diagnosed through a combination of physical exams, blood tests to measure hormone levels, and possibly an ultrasound of the ovaries.

Can lifestyle changes help manage these conditions?

Yes, lifestyle changes such as diet, exercise, and stress management can help alleviate symptoms and improve overall well-being in individuals with endometriosis and PCOS.

When should I see a doctor?

It's advisable to see a healthcare provider if you're experiencing severe menstrual pain, irregular cycles, or if you have concerns about fertility.

Conclusion

Increasing awareness about endometriosis and PCOS is crucial for timely diagnosis and effective treatment. If you suspect you might have one of these conditions, don’t hesitate to seek medical advice to explore your symptoms and treatment options.

Women’s health research is increasingly highlighting conditions such as endometriosis and polycystic ovary syndrome, which have historically been underdiagnosed. These conditions affect millions of people assigned female at birth, including teens, adults, and people across all races and body types. Timely, accurate information matters because early recognition can reduce pain, protect fertility, and lower long-term risks like diabetes, heart disease, and certain cancers. Knowing what to watch for—and what care options exist—can change health outcomes and quality of life.

Understanding Endometriosis and PCOS

Endometriosis is a chronic, estrogen‑dependent condition where tissue similar to the lining of the uterus grows outside the uterus. These growths can trigger inflammation, scarring, and pain, especially around menstruation. Lesions commonly occur on the ovaries, fallopian tubes, and pelvic surfaces, and can be deep or superficial.

Polycystic ovary syndrome (PCOS) is an endocrine disorder defined by a mix of irregular or infrequent ovulation, signs of excess androgens (male‑type hormones), and characteristic ovarian changes on ultrasound. You do not need ovarian “cysts” to have PCOS, and cysts alone do not diagnose PCOS.

Both conditions can affect hormones, menstrual cycles, fertility, and overall health. Endometriosis tends to present with pain and sometimes infertility, while PCOS often presents with irregular periods, acne, or hair changes and is linked to metabolic issues like insulin resistance.

These conditions can overlap. A person can have both endometriosis and PCOS, making diagnosis and treatment more complex. Shared features include menstrual irregularities, inflammation, and effects on ovulation and fertility, though the mechanisms differ.

Neither condition is caused by anything you did or did not do. They arise from a combination of genetics, hormones, immune and inflammatory pathways, and environmental factors that researchers are still studying.

Getting a clear diagnosis and a tailored care plan is possible. Many people improve with the right mix of medication, procedures when needed, and lifestyle support.

Why These Conditions Are Often Missed

Painful periods are frequently normalized, leading many people—and sometimes clinicians—to dismiss symptoms of endometriosis as “typical cramps.” This cultural barrier delays evaluation and proper pain management.

PCOS symptoms can vary widely, from subtle cycle changes to prominent acne or hair growth. Because there is no single PCOS test, and because body size, race, and age influence presentation, PCOS is sometimes overlooked or misattributed to stress or “just weight.”

Access to specialty care, imaging, and minimally invasive surgery can be limited by geography, insurance, or wait times. These systemic barriers contribute to delays in diagnosis, especially for adolescents and marginalized communities.

Diagnostic criteria have evolved. Endometriosis previously required surgery for confirmation; now, clinicians may diagnose based on symptoms and imaging. For PCOS, criteria differ for teens versus adults, and providers must rule out other causes of androgen excess or irregular cycles.

Bias and disparities play a role. Black, Hispanic/Latina, and Indigenous patients, as well as LGBTQ+ patients, are more likely to report being dismissed or to experience longer diagnostic delays, despite similar or higher symptom burdens.

Research gaps are closing but persist. Historically, women’s health received less research funding. As attention grows, newer studies are improving guidelines, but clinical practice changes can lag, which affects timely care.

Signs and Symptoms to Watch For

Symptoms vary, but some patterns are common. Keep a diary of cycles, pain, and any skin or hair changes to spot trends and share with your clinician.

• Endometriosis: severe period cramps that interfere with activities; pelvic or back pain outside periods; pain with sex, urination, or bowel movements; heavy periods; spotting between periods; bloating or bowel changes around menses; infertility.
• PCOS: irregular, infrequent, or absent periods; signs of high androgens such as acne, scalp hair thinning, or excess facial/body hair; weight changes or difficulty losing weight; dark, velvety skin patches (acanthosis nigricans) suggesting insulin resistance; mood changes; infertility.

Adolescents may show early signs: very painful periods not relieved by NSAIDs, school absences due to cramps, cycles more than 90 days apart after two years post‑menarche, or severe acne not responding to standard treatments.

Gastrointestinal or urinary symptoms that flare with periods can suggest deep endometriosis involving the bowel or bladder. These may include constipation, diarrhea, painful bowel movements, or urinary urgency during menses.

Symptoms can wax and wane. Hormonal contraception may mask some signs (lighter or more regular periods) without eliminating the underlying condition, which can complicate recognition.

Any symptom that disrupts daily life, work, school, relationships, or sexual health deserves evaluation. You do not need to “earn” care by being in crisis; earlier assessment often leads to better outcomes.

What Causes These Conditions?

Endometriosis likely develops through several mechanisms working together. The leading theory is retrograde menstruation—menstrual blood flows backward through the fallopian tubes, carrying endometrial‑like cells into the pelvis—combined with immune system changes that allow implants to persist.

Other proposed contributors to endometriosis include coelomic metaplasia (cells in the pelvis transform into endometrial‑like cells), spread through lymphatic or blood vessels, genetic predisposition, and local production of estrogen by lesions that fuels inflammation.

PCOS is driven by hormonal and metabolic factors. Insulin resistance raises insulin levels, which stimulates the ovaries to produce more androgens. High androgens disrupt normal follicle development and ovulation, creating a cycle of irregular periods and symptoms like acne or hirsutism.

Neuroendocrine changes—such as increased luteinizing hormone (LH) relative to follicle‑stimulating hormone (FSH)—also contribute to androgen excess in PCOS. Genetics play a strong role; PCOS often runs in families.

Environmental and developmental factors may influence both conditions. Prenatal exposures, body weight, and chronic inflammation can modify risk or severity, but no single exposure “causes” either condition.

Importantly, both endometriosis and PCOS are heterogenous. Two people with the same diagnosis may have different drivers and respond differently to treatments, which is why individualized care plans are essential.

Risk Factors and Who Is Most Affected

Endometriosis risk is higher with a family history, early menarche, short menstrual cycles, heavy or prolonged bleeding, low body mass index, and never having given birth. Autoimmune conditions and certain pelvic anomalies may also increase risk.

PCOS risk increases with a family history of PCOS or type 2 diabetes, earlier puberty changes such as premature adrenarche, and weight gain, although PCOS affects people across all body sizes, including those with normal BMI.

Both conditions primarily affect people of reproductive age, including adolescents. Symptoms can start soon after the first period, but diagnosis may not occur for years due to normalization of symptoms and access barriers.

Racial and ethnic disparities exist. Black, Hispanic/Latina, and Indigenous patients may experience longer diagnostic delays, less access to specialty care, and undertreatment, despite similar prevalence. Cultural stigma around menstrual and fertility issues can further delay care.

Transgender and nonbinary people assigned female at birth can have endometriosis or PCOS. Gender‑affirming care plans should include menstrual and metabolic health screening tailored to individual goals and therapies.

While you cannot change your genetics or age, knowing your personal and family history can prompt earlier screening, monitoring, and preventive strategies tailored to your risks.

How These Conditions Can Affect Overall Health

Endometriosis often causes chronic pelvic pain, fatigue, and reduced quality of life. Pain can disrupt sleep, mood, relationships, and productivity. Deep endometriosis can affect bowel or bladder function.

PCOS is linked to metabolic complications: insulin resistance, prediabetes, type 2 diabetes, dyslipidemia, fatty liver disease, hypertension, and sleep apnea. These raise long‑term cardiovascular risk.

Both conditions can affect mental health. Rates of anxiety and depression are higher, likely due to chronic pain, body image concerns, fertility worries, and hormonal effects. Integrated mental health support improves outcomes.

Endometriosis is associated with a small increase in certain ovarian cancer subtypes (clear cell and endometrioid). The absolute risk remains low. PCOS increases risk of endometrial hyperplasia and cancer due to unopposed estrogen from infrequent ovulation.

Sexual health can be impacted. Pain with penetration (dyspareunia) is common in endometriosis. PCOS‑related hair and skin changes can affect self‑esteem and intimacy. Addressing pain and body image openly is part of comprehensive care.

Long‑term medication use requires monitoring. For example, prolonged GnRH therapy for endometriosis can reduce bone density without “add‑back” hormones, and some PCOS treatments affect potassium or lipids. Regular lab checks and follow‑up are important.

How Doctors Diagnose Endometriosis and PCOS

Endometriosis is often a clinical diagnosis based on history and exam, supported by imaging. Pelvic ultrasound can identify endometriomas (ovarian cysts related to endometriosis), and MRI can help map deep infiltrating disease, especially before surgery.

Definitive diagnosis of endometriosis historically required laparoscopy with biopsy. Today, many clinicians start treatment based on symptoms and imaging to avoid surgical delays, reserving surgery for unclear cases, severe symptoms, or fertility reasons.

PCOS diagnosis uses the Rotterdam criteria for adults: two of three—ovulatory dysfunction (infrequent or absent ovulation), clinical or biochemical hyperandrogenism, or polycystic ovarian morphology on ultrasound—after excluding other causes.

For adolescents, diagnosis requires caution: persistent menstrual irregularity two or more years after menarche plus clear hyperandrogenism, with ultrasound used cautiously. Other conditions (thyroid disorders, high prolactin, nonclassic congenital adrenal hyperplasia, Cushing syndrome) must be excluded.

Blood tests may include hormones (total/free testosterone, DHEA‑S, LH/FSH), prolactin, TSH, and 17‑hydroxyprogesterone, plus metabolic screening (fasting glucose or A1c, lipid panel, liver enzymes). Sleep apnea screening may be advised in PCOS.

A thorough history—including pain patterns, family history, medication use, and fertility goals—guides testing. Shared decision‑making helps balance benefits and risks of imaging, labs, and potential procedures.

Treatment Options: Medications, Procedures, and Lifestyle

Treatment depends on symptoms, goals, and other health conditions. Plans often combine medications, procedures when needed, and lifestyle strategies.

• Endometriosis options: NSAIDs for pain; hormonal suppression with combined oral contraceptives, progestins (oral, injection, or levonorgestrel intrauterine device), GnRH agonists/antagonists with add‑back therapy; aromatase inhibitors in select cases; laparoscopic excision or ablation for pain or infertility; pelvic floor therapy and pain management.
• PCOS options: combined oral contraceptives to regulate cycles and lower androgens; metformin for insulin resistance and cycle regulation; anti‑androgens (e.g., spironolactone) with reliable contraception; letrozole or clomiphene for ovulation induction if pregnancy is desired; lipid and blood pressure management; dermatologic treatments for acne/hirsutism.

Lifestyle interventions support both conditions. A balanced eating pattern emphasizing whole foods, fiber, lean proteins, and healthy fats can improve insulin sensitivity. Regular physical activity improves cycles, mood, and metabolic health.

Weight loss of 5–10% in those with higher BMI can restore ovulation in PCOS and reduce metabolic risks. However, effective care is possible at any size; weight‑neutral strategies focusing on behaviors, sleep, stress, and fitness also help.

Procedures are tailored. For endometriosis, experienced laparoscopic surgeons can remove lesions and adhesions. For PCOS‑related infertility, ovulation induction is first‑line; assisted reproductive technologies are considered if needed.

Supportive therapies matter. Pelvic floor physical therapy, cognitive behavioral therapy for chronic pain, sleep optimization, and treatment of anxiety or depression improve quality of life and treatment success.

Fertility and Family Planning Considerations

Endometriosis can affect fertility by causing inflammation, scarring, and altered pelvic anatomy. Some people conceive naturally; others benefit from surgery to remove lesions or from assisted reproduction, depending on disease severity and age.

PCOS‑related infertility is often due to anovulation. Many people conceive with ovulation‑inducing medications like letrozole, with or without metformin. If these are not successful, gonadotropins or in vitro fertilization (IVF) may be used.

Planning ahead helps. Discuss ovarian reserve testing, the potential impact of endometriomas and prior ovarian surgery on egg supply, and the timing of interventions relative to your age and goals.

Pregnancy risks differ. PCOS is linked to higher rates of gestational diabetes, hypertensive disorders, and preterm birth; careful prenatal monitoring helps. Endometriosis has been associated with higher risks of placenta previa, preterm birth, and cesarean delivery in some studies.

Contraception is part of comprehensive care when pregnancy is not desired. For PCOS, hormonal contraceptives protect the endometrium from unopposed estrogen. For endometriosis, continuous hormonal methods can reduce pain and bleeding.

Fertility preservation may be considered in select cases, such as repeated ovarian surgery or severe disease. Options include egg or embryo freezing after counseling on benefits, costs, and success rates.

Prevention and Risk Reduction Strategies

There is no guaranteed way to prevent endometriosis or PCOS, but you can reduce risks and complications by focusing on modifiable factors and early detection.

• Maintain regular preventive care: annual visits, blood pressure and weight checks, and timely screening for diabetes and lipids if you have PCOS or risk factors.
• Support insulin sensitivity: regular movement, balanced meals with fiber and protein, adequate sleep, and stress management techniques like mindfulness or yoga.
• Use hormonal therapies as advised: continuous or cyclic hormonal suppression can reduce endometriosis pain and lower endometrial hyperplasia risk in PCOS.
• Avoid tobacco and limit alcohol; both can worsen cardiovascular and metabolic risks.
• Track symptoms and cycles to catch changes early, especially in adolescence and postpartum periods.
• Seek care early for severe period pain, persistent irregular cycles, or signs of high androgens to prevent complications like anemia, endometrial overgrowth, or entrenched pain pathways.

Discuss supplement use with your clinician. Some people try inositols for PCOS or anti‑inflammatory strategies for endometriosis; evidence varies, and safety and interactions should be reviewed.

Possible Complications and Long-Term Outlook

Untreated endometriosis can lead to chronic pelvic pain, adhesions, ovarian endometriomas, and rare complications like bowel or ureteral obstruction. Pain can become centralized over time, making early management important.

PCOS can progress to prediabetes and type 2 diabetes, dyslipidemia, hypertension, fatty liver disease, and sleep apnea. Unopposed estrogen from infrequent periods can cause endometrial hyperplasia and increase endometrial cancer risk.

Fertility challenges may arise in both conditions but are not universal. Many people build families with timed intercourse, medications, procedures, or assisted reproduction, depending on their situation.

Cancer risks remain relatively low but merit attention. Endometriosis slightly raises risk of certain ovarian cancers; PCOS raises endometrial cancer risk. Regular gynecologic care and cycle regulation reduce these risks.

With appropriate treatment and follow‑up, most people achieve good symptom control and reduce long‑term risks. Multidisciplinary care—gynecology, endocrinology, primary care, mental health, nutrition, and physical therapy—often yields the best outcomes.

Education and self‑advocacy improve prognosis. Understanding your condition, knowing when to escalate care, and monitoring metabolic health help you stay ahead of complications.

When to Seek Medical Attention

Schedule a routine appointment if you have period pain that interferes with school, work, or daily activities, or if over‑the‑counter pain relievers no longer help. Persistent symptoms deserve evaluation.

See your clinician if your periods are consistently irregular (cycles shorter than 21 days or longer than 35 days in adults, or more than 90 days apart), or if you have signs of high androgens like worsening acne or increased facial hair.

Seek prompt care for heavy bleeding soaking a pad or tampon every one to two hours for several hours, passing large clots, or symptoms of anemia such as dizziness, shortness of breath, or palpitations.

Urgent care is needed for sudden, severe pelvic pain with fever, vomiting, or fainting, which could signal ovarian torsion, ruptured cyst, or other emergencies. Do not wait for symptoms to pass if they are severe.

If you have been trying to conceive for 12 months (or 6 months if age 35 or older) without success, or sooner if you suspect endometriosis or PCOS, seek a fertility evaluation.

Contact your clinician if you are on medications like spironolactone, metformin, or GnRH analogs and develop side effects such as muscle weakness, severe fatigue, irregular heartbeat, or mood changes.

Preparing for Your Appointment: Questions to Ask

Bring a detailed symptom and cycle diary. Ask how your history aligns with possible diagnoses like endometriosis or PCOS and what other conditions should be ruled out.

Discuss testing plans. Ask which labs or imaging are recommended, what each test will show, and how results could change your treatment plan.

Review treatment options and trade‑offs. Ask about medication benefits, side effects, and monitoring needs; for endometriosis, ask when surgery is considered and the experience of the surgical team.

Clarify fertility implications. Ask how your diagnosis may affect getting pregnant now or later, what options exist for ovulation induction or assisted reproduction, and whether fertility preservation makes sense for you.

Address whole‑person health. Ask about screening for diabetes, cholesterol, blood pressure, sleep apnea, mood, and bone health, and how often you should be re‑checked.

Plan follow‑up and support. Ask what improvements to expect and when, how to reach your care team if symptoms worsen, and what credible resources or support groups they recommend.

Ongoing Care, Support, and Self-Advocacy

Regular follow‑up is key. For PCOS, periodic checks of A1c or fasting glucose, lipids, liver enzymes, blood pressure, and weight trends guide adjustments. For endometriosis, visits track pain control, medication tolerance, and recurrence.

Protect long‑term health. Ensure cycle regulation to protect the endometrium in PCOS. If using GnRH therapies for endometriosis, confirm “add‑back” hormones and monitor bone density if treatment is prolonged.

Integrate supportive therapies. Pelvic floor physical therapy, nutrition counseling, sleep hygiene, and mental health care can meaningfully improve symptoms and quality of life.

Advocate for yourself. If symptoms are dismissed, seek a second opinion, ideally with a gynecologist experienced in endometriosis or an endocrinologist familiar with PCOS. Bring your symptom logs and specific goals to visits.

Build a care network. Include primary care, gynecology, endocrinology, dermatology (for acne/hirsutism), reproductive medicine if needed, and pain specialists. Share information across the team.

Use credible resources and community support. Patient groups, educational websites, and peer networks can offer practical tips for daily living, workplace or school accommodations, and emotional support.

FAQ

• Can someone have both endometriosis and PCOS? Yes. They are separate conditions that can coexist. Overlap can complicate symptoms and treatment, but care can be tailored to address both pain and metabolic/ovulatory issues.

• Do ovarian cysts mean I have PCOS? Not necessarily. Functional cysts are common and usually harmless. PCOS diagnosis requires a combination of ovulatory dysfunction and/or high androgens, not cysts alone.

• Does pregnancy cure endometriosis or PCOS? No. Symptoms may improve during pregnancy for some, but the conditions do not “disappear.” Postpartum symptoms can return and should be managed long‑term.

• Can PCOS occur at a normal weight? Yes. Many people with PCOS have normal BMI. Insulin resistance and androgen excess can occur at any body size, so screening and treatment should not depend on weight alone.

• What diet is best for PCOS or endometriosis? No single diet fits all. For PCOS, patterns that improve insulin sensitivity (high fiber, lean proteins, healthy fats, fewer refined carbs) are helpful. For endometriosis, some find benefit from anti‑inflammatory patterns, but evidence is mixed; personalize with a clinician or dietitian.

• Is an IUD safe if I have endometriosis or PCOS? The levonorgestrel IUD is often used to reduce bleeding and pain in endometriosis and to protect the endometrium in PCOS. Suitability depends on individual health factors—ask your clinician.

• Does surgery cure endometriosis? Surgery can remove lesions and improve pain and fertility, but recurrence is possible. Combining high‑quality excision with postoperative hormonal suppression reduces recurrence risk.

More Information

• Mayo Clinic – Endometriosis: https://www.mayoclinic.org/diseases-conditions/endometriosis
• Mayo Clinic – Polycystic ovary syndrome (PCOS): https://www.mayoclinic.org/diseases-conditions/pcos
• MedlinePlus – Endometriosis: https://medlineplus.gov/endometriosis.html
• MedlinePlus – Polycystic Ovary Syndrome: https://medlineplus.gov/polycysticovarysyndrome.html
• CDC – PCOS: https://www.cdc.gov/diabetes/basics/pcos.html
• CDC – Endometriosis: https://www.cdc.gov/reproductivehealth/womensrh/conditions/endometriosis.htm
• Healthline – PCOS Overview: https://www.healthline.com/health/polycystic-ovary-disease
• WebMD – Endometriosis Health Center: https://www.webmd.com/women/endometriosis/default.htm

If this article helped you better understand endometriosis and PCOS, consider sharing it with someone who might be struggling. Your symptoms are valid—talk with your healthcare provider about a plan that fits your goals, and don’t hesitate to seek a second opinion if needed. For related topics and supportive resources, explore more content on Weence.com.