If you’ve ever experienced irregular periods, pelvic pain or trouble getting pregnant, you may have wondered if you could have endometriosis or polycystic ovarian syndrome (PCOS). These two common conditions affect many women across Australia (and around the world), and while they’re often mentioned in the same breath, they’re actually quite different.
Understanding the difference between endometriosis and PCOS can help you better recognise symptoms, ask the right questions and get the care you need, without needing to undertake online health courses yourself.
In this guide, we’ll break down what each condition is, how it affects the body, and what to look out for.
What is Endometriosis?
Endometriosis is a chronic condition where tissue similar to the lining of the uterus (called endometrial tissue) grows outside the uterus. This tissue can be found on the ovaries, fallopian tubes, bladder, bowel or even the pelvic wall.
Unlike the uterine lining, this tissue has no way to exit the body during your period. As a result, it can lead to inflammation, scarring and sometimes cysts, causing significant pain and complications over time.
Common symptoms of endometriosis include
- Intense period pain (often described as cramping that interferes with daily life)
- Pain during or after sex
- Pelvic pain outside of your period
- Painful bowel movements or urination, especially around your period
- Heavy bleeding or irregular periods
- Fatigue
- Trouble conceiving
It’s worth noting that some women with endometriosis may have mild or even no symptoms, while others experience debilitating pain. It’s also a condition that can take years to diagnose. Unfortunately, many people are told their symptoms are “normal” or that they've been misdiagnosed with other issues first.
What is PCOS?
PCOS, or polycystic ovarian syndrome, is a hormonal disorder that affects how the ovaries work. It’s often characterised by irregular periods, excess androgen (male hormone) levels and the presence of many small cysts on the ovaries. However, you don’t need to have ovarian cysts to be diagnosed with PCOS.
The exact cause of PCOS isn’t known, but it’s linked to insulin resistance and hormonal imbalances. It’s one of the most common endocrine disorders among women of reproductive age.
Common symptoms of PCOS include
- Irregular or missed periods
- Acne, oily skin or persistent breakouts
- Excess facial or body hair (hirsutism)
- Thinning hair on the scalp
- Weight gain or difficulty losing weight
- Difficulty getting pregnant
- Dark patches of skin (especially around the neck or underarms)
Unlike endometriosis, PCOS doesn’t usually cause pelvic pain. Instead, it often presents with skin changes, weight issues and menstrual irregularities.
How Are They Diagnosed?
Diagnosing Endometriosis
Diagnosing endometriosis can be tricky, as symptoms often overlap with other conditions like IBS or pelvic inflammatory disease. Your doctor may recommend:
- A pelvic exam
- Imaging tests like ultrasound or MRI (though these don’t always detect endometriosis)
- A laparoscopy (a minor surgical procedure that allows a specialist to view the inside of your abdomen and confirm the diagnosis)
Diagnosing PCOS
PCOS is typically diagnosed based on three main criteria (known as the Rotterdam criteria). If you meet at least two out of three, you may be diagnosed with PCOS:
- Irregular or absent ovulation
- Excess androgen levels (either through symptoms like acne or a blood test)
- Polycystic ovaries are visible on an ultrasound
Your doctor will also rule out other possible causes of symptoms before confirming a PCOS diagnosis.
Can You Have Both?
It is possible to have both endometriosis and PCOS, though it’s less common. Having both conditions can complicate symptoms and treatment, so it’s important to work closely with a GP or specialist who can help you manage both holistically.
How They Are Treated
Managing Endometriosis
While there’s no cure for endometriosis, symptoms can be managed with:
- Pain relief medications (like anti-inflammatories)
- Hormonal treatments such as the contraceptive pill or IUD
- Surgery to remove endometrial tissue (often via laparoscopy)
- Lifestyle support, including diet changes and pelvic physiotherapy
Treatment depends on the severity of symptoms and whether you’re trying to get pregnant.
Managing PCOS
PCOS treatment usually focuses on managing hormonal imbalances and insulin resistance. This might include:
- Hormonal birth control to regulate periods
- Medications like metformin for insulin resistance
- Anti-androgen medications to help with acne or hair growth
- Lifestyle changes such as a balanced diet and regular exercise
- Fertility treatments if you're trying to conceive
There’s no one-size-fits-all approach, and treatment should be tailored to your specific symptoms and goals.
When to See a Doctor
If your period symptoms are interfering with your daily life—whether it's pain, irregularity or something else—it’s important to speak to your doctor, regardless of whether you have either condition or not. Both endometriosis and PCOS are common, but that doesn’t mean they should be dismissed or go untreated.
Early detection is important for managing symptoms, so don't be afraid to visit your doctor, gynaecologist or endocrinologist if you think something is not quite right. You deserve answers, and you deserve care that takes your concerns seriously.
You're Not Alone
Endometriosis and PCOS can both be life-altering, but they don’t have to define you. With the right support, management and awareness, many women go on to live healthy, full lives. If you think something’s not right with your body, trust your instincts and reach out for help.
The more we talk openly about these conditions, the easier it becomes for others to recognise symptoms and advocate for their own health. Remember, you’re not alone.
