One is due to a hormonal imbalance & one to abnormal endometrial tissue growth: both endometriosis and PCOS can cause infertility

When thinking about starting a family, it’s essential to understand the potential challenges that certain health conditions may pose on female fertility. Two reproductive health disorders, endometriosis and polycystic ovary syndrome (PCOS), are some of the more common conditions I see women for or answer questions about.

The confusion people have about the two conditions can result from their symptoms both potentially having a negative impact on fertility. While there may be some overlap in how they present, they are very distinct conditions with different causes and treatments that women should know about.

The PCOS hormone disorder disrupts the menstrual cycle

PCOS is a hormone disorder that may disrupt the regularity of menstrual cycles. Affecting approximately 10% of women of reproductive age, PCOS is characterized by hormonal imbalances that can lead to a range of symptoms. These may include irregular or absent periods, excess hair growth, acne and weight gain. The presence of multiple small cysts (polycystic) on the ovaries is also common but not universally experienced.

The hormonal upheaval associated with PCOS primarily stems from elevated androgens – the  “male hormones” that can wreak havoc on the menstrual cycle. This irregular ovulation can make conception challenging, and studies suggest that women with PCOS may face a higher risk of miscarriage once they do conceive.

PCOS and fertility

Polycystic ovary syndrome can make getting pregnant more challenging, but it’s important to know that many women with PCOS go on to have successful pregnancies. The most common issue with PCOS is that it often disrupts regular ovulation, making it harder to conceive. Furthermore, women with PCOS face a higher lifetime risk of various health concerns, including obesity, diabetes and cardiovascular diseases.

When it comes to treatment, lifestyle changes like diet and exercise can be beneficial in managing weight and regulating hormonal balance. Medications, including hormonal contraceptives and fertility drugs, may help regulate periods and/or stimulate ovulation.

Some cases call for more aggressive fertility treatments like intrauterine insemination (IUI) and in vitro fertilization (IVF).  Unfortunately, there often isn’t a definitive cure for PCOS, but rather interventions that help improve symptoms associated with PCOS.

Endometriosis: a chronic condition involving endometrial tissue

Endometriosis, on the other hand, is a chronic condition affecting about 11% of women during their reproductive years. It occurs when tissue similar to the uterine lining grows outside the uterus, often on the ovaries, fallopian tubes and other organs within the pelvis. The result? A host of symptoms including debilitating pelvic pain, particularly during menstruation, painful intercourse and gastrointestinal distress.

Endometriosis and infertility

Endometriosis is notorious for its impact on female fertility. The pain during intercourse associated with the condition can make intimacy difficult. And the formation of scar tissue can block fallopian tubes or distort reproductive organs, often causing infertility.

There isn’t a cure for the condition. Managing endometriosis often focuses on alleviating pain and addressing the growth of endometrial tissue. Treatment options may include over-the-counter pain relievers, hormonal therapies and, in more severe cases, surgical intervention to remove abnormal tissue.

PCOS vs endometriosis: key differences

While both conditions can lead to pain, heavy periods or infertility, they otherwise present differently. Some key distinctions:

• PCOS is caused by hormonal disorders; endometriosis is caused by a specific anatomic issue with misplaced endometrial tissue.
• Menstrual irregularities. PCOS often leads to irregular or absent menstrual cycles, while endometriosis is associated with painful periods.
• Women with PCOS may experience symptoms related to androgen excess and irregular periods, while endometriosis is characterized by pelvic pain, especially during menstruation.
• Diagnosis and management. For PCOS, healthcare providers typically assess medical history and symptoms, often accompanied by blood tests to check hormone levels and rule out similarly presenting disorders (like thyroid dysfunction). An ultrasound may reveal the presence of cysts on the ovaries, further confirming the diagnosis. Endometriosis diagnosis is more complex, often requiring imaging tests such as ultrasounds or MRIs. In some cases, a laparoscopy, an outpatient surgical procedure, may be necessary to visualize and treat endometriosis directly.

Proper evaluation can help distinguish between the two conditions and ensure that appropriate treatment plans are put in place for managing both.

Infertility, endometriosis and PCOS: What should you do?

If you’re planning to conceive, or are having trouble conceiving, and suspect you might have endometriosis or PCOS, consider the following steps:

• Consult a specialist. Schedule an appointment with a fertility specialist or an OB/GYN to discuss your symptoms.
• Get diagnosed. Early diagnosis can lead to better management of both conditions. Blood tests, ultrasounds and other diagnostic tools can provide clarity.
• Explore treatment options. Depending on your diagnosis and if you are actively trying to have a family, treatment may include lifestyle changes, hormonal therapies or surgical interventions. Your healthcare provider can recommend the best course of action tailored to your needs.

You are your best advocate

When it comes to fertility, both PCOS and endometriosis can feel like roadblocks – but the key to getting ahead is knowing your body and taking charge of your health.

These conditions can present unpleasant obstacles, from irregular cycles to frustrating pain and difficulty getting pregnant. But remember: You have options. Whether it’s finding the right doctor, exploring treatments or making lifestyle changes, being proactive puts you in the driver’s seat.