Causes and Treatment
PCOS and endometriosis – can I have both?
1 December, 2022
PCOS and endometriosis are two of the most common conditions affecting female fertility. Around one in 10 people in the UK have either PCOS or endometriosis, which is an incredibly large number. Many of us are handling daily discomfort, fertility challenges and severe pain.
But given they’re very different, what’s the recommended approach if you have PCOS and endometriosis together?
Keep reading for a deep-dive on what they are, how to manage both conditions at once, and more specific fertility-related queries and FAQs.
It is absolutely possible, and not uncommon, to have PCOS and endometriosis together. And because these conditions affect so many people who are trying to conceive (TTC), they’re high on the priority list for top fertility clinics and consulting teams.
As one of the world’s most established IVF clinics, IVF Turkey have a huge amount of experience and expertise in conditions right across the fertility spectrum. PCOS and endometriosis are two of the most common disorders among the clinic’s patients, and Professor Doctor Meriç Karacan recently chatted both through in our live deep-dive over on Insta.
Read up on PCOS and endometriosis in IVF Turkey’s expert library covering female factor infertility, and stay with us for their 101 on both conditions, how they impact fertility and treating both together, with expert support.
Let’s start with definitions.
What is PCOS?
Polycystic ovary (ovarian) syndrome (PCOS) is a common condition that affects how the ovaries work. Around one in 10 women in the UK have PCOS, which tallies with our own patient numbers here at IVF Turkey.
What do we mean by ‘polycystic ovaries’?
For the women we treat in-clinic, it can be hard to picture ‘polycystic ovaries’, especially if you have very few external symptoms. Polycystic ovaries are often enlarged, and hold many fluid-filled sacs – follicles – which surround your eggs.
The follicles are harmless – you don’t actually have ‘cysts’ with PCOS, just often these fluid-filled sacs – and can measure up to 8mm. However, these sacs are often unable to release an egg, which means you may have difficulty ovulating.
What causes PCOS?
The exact cause is unknown, but the medical community believe that PCOS may be connected to hormonal anomalies. Insulin resistance, hormonal imbalances and genetics have all been linked to PCOS.
How is PCOS diagnosed?
First, we need to rule out any other possible causes of your PCOS symptoms (see below). So we – or your GP, if you’re earlier in the process, will do a combination of the following to get a diagnosis underway:
- check your blood pressure
- arrange specific hormone tests
- perform an ultrasound scan
- run a blood test
After other rare causes have been ruled out, we’ll usually diagnose PCOS if you meet at least two of the following three criteria:
- your periods are irregular, or infrequent (indicating disrupted ovulation)
- blood tests and/or symptoms indicate you have high levels of ‘male hormones’ (like testosterone)
- scan results show your ovaries are polycystic
What is endometriosis?
Endometriosis is a condition where tissue – similar to uterine tissue – grows outside the uterus. This might be in the fallopian tubes, ovaries and even the upper legs, and can be extremely painful. As with PCOS, endometriosis affects around one in 10 women in the UK, making it another significant cause of female factor infertility.
Why does endometriosis cause fertility problems?
We meet patients on a regular basis who suspect they may have endometriosis – or have an endometriosis diagnosis. Similarly to PCOS, there is still a lot that the medical community does not fully understand about endometriosis. But in terms of fertility, it’s thought that the condition causes infertility through damage to the fallopian tubes or ovaries.
It’s important to bear in mind that, in terms of fertility, not all women with endometriosis will have fertility issues. Some may get pregnant without much of an issue. It’s down to each fertility specialist to treat every patient as an individual, and build a plan that’s tailored to them.
What causes endometriosis?
Unfortunately, and as with PCOS, the exact cause is unknown. However links have been made to:
- immunological issues
- endometrial spread through the bloodstream and lymphatic system
In all likelihood, endometriosis is caused by a combination of these (and potentially other) factors.
How is endometriosis diagnosed?
Frustratingly, it can be difficult to diagnose endometriosis. This is because symptoms can be very different, from person to person, and may be caused by other conditions.
To get to the bottom of what’s happening, your doctor may:
- examine your stomach and vagina
- refer you for further gynecological tests
- perform an ultrasound scan, MRI or laparoscopy
PCOS vs endometriosis symptoms
Endometriosis (often shortened to ‘endo’, if you’re going through it) and PCOS do often share some symptoms. These include:
- heavy periods
- pelvic pain (in endometriosis this is often before your period)
- difficulty getting pregnant
However, PCOS patients may also experience:
- irregular periods
- excess body hair
- hair loss (from head)
- bleeding without ovulation
- oily skin and/or acne
And endometriosis may present with:
- bleeding between periods
- painful periods
- pain during or after sex
- painful urination, or bowel movements
- digestive issues, fatigue and low energy
Patients with IVF Turkey often talk through many of these symptoms, or just one or two. Regardless, PCOS and endometriosis are two of the most common conditions impacting female factor infertility, for our patients.
Can you have PCOS and endometriosis together?
Yes, you can. And a 2015 study by The JCEM (Journal of Clinical Endocrinology & Metabolism) demonstrated that PCOS patients are more likely to suffer from endometriosis.
We also know that increased androgen and insulin levels, often present in pcos, can put patients at greater risk for endometriosis.
If you’re diagnosed with both conditions, we’ll usually address endometriosis first. This is because PCOS treatment can aggravate endometriosis, and PCOS tends to be easier, on the whole, to tackle.
What are the treatment options for both?
In terms of fertility, treatment can vary. For PCOS, IVF Turkey will usually suggest a bespoke treatment plan, based around:
- a comprehensive examination, including blood tests
- progesterone treatment for irregular periods
- Clomid treatment, followed by Clomifene or Metformin/Gonadotropins
- ovarian surgery
- specific Iifestyle factors
We’ve put together a comprehensive guide to all-things PCOS fertility treatment on our Female Factor hub. Have a read-through, and contact our team for next steps with our expert consultants.
For endometriosis, a doctor may build a bespoke plan for your condition around:
- a comprehensive examination, including blood tests
- medication to regulate hormones and slow endometrial tissue growth
- specific lifestyle factors
Can I get pregnant with PCOS and/or endometriosis?
In a word, yes! Our team at IVF Turkey see and treat many, many patients with PCOS or endometriosis – or both – with fantastic success rates. Neither of these conditions disqualify you from having a successful pregnancy. There are never any guarantees, but we, as your team, need to get to the bottom of your fertility history, and work with you to find the right treatment plan.
Before signing off, all of us on the IVF Turkey team want to acknowledge that endometriosis and PCOS can be painful, difficult conditions to live with, whether or not you’re trying to have a baby.
Our specialism is fertility, and supporting you on that journey, but we are a patient-first clinic and committed to your welfare, first and foremost. So every treatment plan will be based around your individual situation, and created in partnership with you.
Patients around the world recommend IVF Turkey for their expertise in PCOS and endometriosis, and world-leading success rates. Book a consultation with the team today.