PCOS and endometriosis are two common conditions that can affect menstrual cycles, pain, and fertility. They are often discussed separately, yet some people have symptoms that do not fit neatly into one diagnosis. Can you have PCOS and endometriosis at the same time? Yes, but the conditions remain distinct and require their own evaluations.
The condition long known as PCOS, short for polycystic ovary syndrome, has been renamed polyendocrine metabolic ovarian syndrome, or PMOS, in an ongoing terminology transition in Western medicine. The new name recognizes that the condition can affect more than the ovaries. This article uses PCOS and PMOS interchangeably (¹).
For people with fertility struggles, recognizing the difference between PCOS and endometriosis can help guide a more complete conversation with a gynecologist, reproductive endocrinologist, or other qualified clinician.
Learn more about hol+ fertility support.
Understanding PCOS (PMOS)
PCOS (PMOS) is one of the most common endocrine conditions affecting people of reproductive age. It is associated with ovulatory dysfunction, signs of androgen excess, and metabolic concerns. The World Health Organization estimates that PCOS affects 10% to 13% of women of reproductive age worldwide, and up to 70% of affected women are undiagnosed (²).
PCOS (PMOS) symptoms vary. Irregular, infrequent, or absent periods can reflect irregular ovulation. Acne, unwanted coarse hair growth, and scalp-hair thinning may point to androgen excess. Insulin resistance and PCOS often occur together. Some people also experience weight changes or difficulty becoming pregnant. PCOS without cysts is possible. Ovarian cysts are not required for diagnosis, despite the older name (²).
Conventional Diagnosis and Treatment for PCOS (PMOS)
An adult PCOS diagnosis generally requires two of the following three features after other causes are excluded:
- Irregular or absent ovulation
- Clinical or biochemical hyperandrogenism
- Polycystic ovarian morphology on ultrasound
In adults, anti-Müllerian hormone may be used as an alternative to ultrasound in some diagnostic pathways. Ultrasound and anti-Müllerian hormone testing are not recommended to diagnose adolescents (³).
Care may include support for nutrition, movement, sleep, and mental health, along with medication when appropriate. Combined oral contraceptives may be used for irregular cycles or androgen-related symptoms. Metformin can be considered for specific metabolic indications. For anovulatory infertility with no other infertility factors, letrozole is generally the first-line medication for ovulation induction (³).
Understanding Endometriosis
Endometriosis affects an estimated 10% of women and girls of reproductive age worldwide. It occurs when tissue similar to the uterine lining grows outside the uterus. The condition is associated with inflammation and can cause significant pain, yet symptoms and disease severity vary widely (⁴).
Endometriosis symptoms often include severe or worsening painful periods, chronic pelvic pain, pain during or after sex, and pain with bowel movements or urination. Some people have heavy bleeding, fatigue, or difficulty becoming pregnant. Pain severity does not reliably correspond to the amount of visible disease (⁴).
General Diagnosis and Treatment for Endometriosis
An endometriosis diagnosis can begin with a symptom history, a pelvic examination when appropriate, and imaging such as transvaginal ultrasound or MRI. Normal imaging does not rule out superficial disease. Laparoscopy may be considered when imaging is negative and empirical treatment has not helped or is not appropriate. It is not required before every patient can begin treatment. There is no blood, menstrual, or tissue biomarker recommended to diagnose endometriosis (⁵).
Treatment may include one or more of the following:
- Pain medicine for symptom relief
- Hormonal therapy to reduce endometriosis-associated pain
- Surgery in selected situations
- Fertility treatment when pregnancy is a current goal
The appropriate plan depends on symptoms, imaging findings, previous care, and pregnancy goals. Hormonal therapy is not a fertility treatment for people attempting to conceive (⁵).
Is It Possible to Have PCOS and Endometriosis?
Yes. PCOS (PMOS) and endometriosis can occur in the same person. Research is still limited, and estimates vary according to the population studied and how each condition was identified. A 2023 study found co-occurrence in about 5% of an operative cohort and about 2% of a population cohort. The study does not show that one condition causes the other (⁶).
“When a patient’s symptoms feel more complicated than one diagnosis explains, I take that seriously instead of forcing everything into a single box.”
For example, irregular periods and acne may lead to a PCOS (PMOS) evaluation, while significant pelvic pain or pain with sex warrants an assessment for endometriosis or another cause. The reverse can also happen. A person receiving endometriosis care may still need an evaluation of ovulation, androgen-related symptoms, and metabolic health.
Spotting the Differences Between PCOS and Endometriosis
PCOS vs. endometriosis is not a matter of one condition being more serious than the other. The main distinction is the pattern of symptoms and the clinical findings that support each diagnosis.
| More often associated with PCOS (PMOS) | More often associated with endometriosis |
| Infrequent, irregular, or absent ovulation | Severe menstrual pain or pain that worsens over time |
| Acne, excess coarse hair growth, or scalp-hair thinning | Pain with sex or bowel and bladder pain around menstruation |
| Metabolic concerns, including glucose and cholesterol risks | Chronic pelvic pain, including pain outside menstruation |
The table is a starting point, not a diagnostic test. Heavy bleeding, painful periods, and difficulty getting pregnant can occur with either condition and with other gynecologic concerns.
As Dr. Taz Bhatia explains, “On the surface, they can look alike. Underneath, they’re two very different conditions.”
Symptoms of Endometriosis vs. PCOS (PMOS)
PCOS and endometriosis symptoms overlap enough that one diagnosis can distract from another. A short record of cycle timing, bleeding, pain location, pain with sex, bowel or bladder symptoms, skin or hair changes, and pregnancy goals can help a clinician recognize the pattern. It can also help a clinician decide on an appropriate next step, including further evaluation or referral.
Underlying Patterns
Both conditions can affect menstrual health, but their underlying biology differs. PCOS (PMOS) is an endocrine and metabolic syndrome that often involves ovulation changes and androgen excess. Endometriosis is a chronic inflammatory disease involving endometrium-like tissue outside the uterus. Its precise cause remains unknown (²,⁴).
Why an Accurate Diagnosis Matters
The connection between PCOS, endometriosis, fertility, and treatment choices looks different for each person. An accurate diagnosis changes the care plan.
PCOS and infertility often involve irregular or absent ovulation. Endometriosis infertility can reflect inflammation or changes to the pelvic anatomy, although the reason is not always clear for an individual patient. A fertility evaluation can also consider age, partner factors, tubal status when relevant, and how long pregnancy has been attempted.
PCOS (PMOS) also carries longer-term metabolic considerations. Long-standing irregular or infrequent periods may raise the risk of endometrial hyperplasia or endometrial cancer. Clinicians may assess glucose status, blood pressure, cholesterol, mood, and sleep as part of ongoing care. Routine insulin measurements do not reliably diagnose insulin resistance in clinical practice (²,³).
Challenges in Diagnosis and Management
A PCOS and endometriosis diagnosis can take time for valid clinical reasons. The World Health Organization reports an average endometriosis diagnosis delay of 4 to 12 years (⁴).
Diagnosis and treatment planning can take longer because:
- PCOS (PMOS) requires other causes of irregular cycles and androgen excess to be excluded
- Endometriosis may not be visible on imaging
- Symptoms can resemble other gynecologic, gastrointestinal, or urinary conditions
Medical evaluation is appropriate for:
- Periods that are consistently very painful, unusually heavy, irregular, or disruptive to daily life
- Pain with sex or recurring bowel and bladder symptoms that follow the cycle
- Fertility concerns after trying to conceive
Severe sudden pelvic pain, fainting, heavy bleeding with dizziness or shortness of breath, or pain and bleeding in a possible pregnancy need urgent medical attention.
“‘Normal’ periods do not stop your life. If yours do, get evaluated.”
How hol+ Supports Whole-Person Hormone and Reproductive Care
hol+ provides whole-person support for patients with concerns related to PCOS (PMOS), endometriosis, or both. Care begins with a detailed health history and symptom review. Clinically appropriate testing may help assess metabolic health, nutrient status, or hormone patterns, but it does not replace established PCOS (PMOS) criteria or a gynecologic evaluation for suspected endometriosis.
Dr. Taz Bhatia notes, “At hol+, we build the plan around each patient’s health history, biochemistry, and goals, rather than handing every woman the same protocol.” hol+ can coordinate care with gynecologists, reproductive endocrinologists, and other specialists while supporting sleep, nutrition, movement, and stress management.
Patients can learn more about hol+ care for PCOS (PMOS), endometriosis, and women’s health. A free 15-minute consultation can help patients decide if hol+ is the right next step.
FAQs
Is PCOS now called PMOS?
Yes. The transition to polyendocrine metabolic ovarian syndrome is underway. PCOS remains familiar to many patients and clinicians, which is why hol+ uses PCOS (PMOS) during the transition (¹).
Can PCOS (PMOS) cause pelvic pain?
Some people with PCOS (PMOS) have painful or heavy periods. Persistent pelvic pain, pain with sex, or cyclical bowel and bladder pain warrants evaluation for endometriosis and other possible causes.
Can endometriosis cause irregular periods?
Endometriosis can occur with regular or irregular cycles. Irregular bleeding does not confirm endometriosis, so clinicians consider the full symptom history and other possible causes.
What to Remember
PCOS (PMOS) and endometriosis are not interchangeable, and one diagnosis does not rule out the other. A clear record of symptoms and a careful clinical evaluation can help people move toward care that addresses pain, menstrual health, metabolic concerns, and reproductive goals.