Endometriosis vs PCOS: The Key Differences, How They Can Coexist, and Why Both Can Affect Fertility

Endometriosis vs PCOS: Why It’s Not Always One or the Other

If you’ve ever wondered whether your symptoms are PCOS or endometriosis, you’re not alone.

Women are constantly told things like:

• “It’s just PCOS.”

• “Pain is normal.”

• “Your ultrasound looks fine.”

• “Come back when you’re trying to conceive.”

And for many women, that leads to years of confusion, dismissal, and fertility fear.

Here’s what I want you to know upfront: PCOS and endometriosis are not the same condition.They can look completely different… but they can also overlap. And yes, you can have both at the same time.

This is important, because if endometriosis is missed and everything is blamed on PCOS (or vice versa), the real driver of symptoms and fertility struggles can be overlooked.

Women holding a rose

What PCOS Actually Is

PCOS (Polycystic Ovary Syndrome) is a hormonal and metabolic condition.

It’s typically driven by:

• insulin resistance

• androgen excess

• disrupted ovulation

Common PCOS symptoms include:

• irregular periods or missing cycles

• acne and oily skin

• unwanted facial/body hair

• scalp hair thinning

• weight gain or difficulty losing weight

• fertility struggles linked to irregular ovulation

• fatigue, cravings, mood changes

PCOS is mostly about hormone signalling and metabolism.

Painful periods are not usually a hallmark symptom of PCOS.

What Endometriosis Actually Is

Endometriosis is an inflammatory condition where tissue similar to the lining of the uterus grows outside the uterus.

This tissue responds to hormonal changes throughout the cycle and can cause inflammation, scarring, adhesions and pain.

Common endometriosis symptoms include:

• painful periods (often severe)

• pain during ovulation

• pain with sex

• bowel pain or bladder pain (especially around your cycle)

• heavy bleeding or clotting

• fatigue and inflammation

• fertility struggles (even when cycles appear regular)

Here’s the tricky part: Endometriosis doesn’t always show up on ultrasound.Many women are told “everything looks normal,” while their symptoms continue.

Diagnosis often requires a specialist review and, in some cases, laparoscopy.

Endometriosis vs PCOS: The Key Differences

A simple way to think about it is: When considering PCOS vs Endometriosis is that

PCOS is mainly a hormonal/metabolic condition. Endometriosis is mainly an inflammatory/pelvic condition.

PCOS tends to look like:

• irregular ovulation

• longer cycles or missed periods

• elevated androgens

• insulin resistance

• acne, hair changes, weight changes

Endometriosis tends to look like:

• painful periods

• pelvic pain outside the period

• pain with sex

• bowel symptoms

• fatigue linked to inflammation

Of course, every woman is different, but these patterns matter.

Can You Have Both PCOS and Endometriosis?

Yes. And this is where a lot of women get stuck.

Because when you’ve already been diagnosed with PCOS, symptoms like pain, bowel changes or heavy bleeding can easily be dismissed as:“Just hormones.”

But endometriosis may be present underneath.

When PCOS and endometriosis coexist, symptoms can feel more complex:

• irregular cycles + painful periods

• ovulation issues + pelvic inflammation

• fatigue from metabolic dysfunction + fatigue from chronic inflammation

• 
  

And fertility struggles can also become more layered, because there may be more than one barrier present.

PCOS, Endometriosis, and Fertility: How Each Condition Can Contribute

This is one of the biggest areas I support women in, because both conditions can affect fertility, but in different ways.

How PCOS impacts fertility:

PCOS fertility struggles are typically caused by:

• irregular or absent ovulation

• poor egg maturation due to hormone disruption

• insulin resistance affecting reproductive hormones

• inflammation and nutrient depletion impacting egg quality

In many cases, once ovulation becomes consistent and insulin resistance improves, fertility outcomes can improve significantly.

How endometriosis impacts fertility:

Endometriosis affects fertility differently, including:

• inflammation affecting egg quality and implantation

• scarring and adhesions interfering with anatomy

• tubal dysfunction

• altered pelvic environment that reduces conception success

• immune changes affecting implantation or early pregnancy

Some women ovulate regularly and still struggle to conceive because inflammation and pelvic changes are the primary barrier.

How having BOTH can affect fertility:

When PCOS and endometriosis coexist:

• ovulation may be irregular

• egg quality may be impacted

• inflammation is often higher

• implantation may be more difficult

• pregnancy complication risk may increase

This is why the “just take ovulation meds” approach doesn’t work for everyone.

For some women, it’s not just about ovulating it’s about addressing inflammation and the pelvic environment too.

How I Help Naturopathically (Without Replacing Medical Investigation)

This is where naturopathic care can be incredibly supportive.

Because even while you’re waiting for specialist appointments, scans, results or surgery… your symptoms still matter.

And your body can still be supported.

Here’s how I approach support for women with suspected or diagnosed PCOS and/or endometriosis:

1) Supporting further investigation (so you’re not dismissed)

A big part of my role is helping women:

• understand what symptoms mean

• track cycles and pain patterns

• identify red flags

• request the right tests

• feel confident advocating for themselves

• seek specialist referral when needed

You deserve to be taken seriously.

2) Reducing inflammation (a fertility priority for both conditions)

Inflammation plays a role in both PCOS and endometriosis, and it’s one of the biggest fertility barriers.

Support may include:

• anti-inflammatory nutrition foundations

• gut health support

• liver support (hormone clearance)

• omega-3 strategies

• regulating blood sugar to reduce inflammation load

Reducing inflammation can improve:

• pain

• cycle symptoms

• fatigue

• implantation environment

• egg quality markers

3) Supporting hormone balance

For PCOS, hormone support often includes:

• insulin sensitivity strategies

• androgen balance support

• ovulation and progesterone support

• cycle regularity

For endometriosis, hormone support is more nuanced and often focused on:

• supporting estrogen metabolism

• reducing inflammatory hormone signalling

• supporting liver clearance

4) Personalised nutrition (not restriction)

Every woman has different drivers.

Some need strong insulin support.Others need gut and inflammation support. Many need both.

Personalised nutrition is where we stop guessing and start working with your body, including:

• blood sugar balancing

• reducing inflammatory triggers

• ensuring adequate protein and nutrients for fertility

• supporting energy and resilience

5) Herbs and nutritional supplements

This is never a one-size-fits-all list.

Herbs and supplements can support:

• insulin resistance

• androgen excess

• inflammation

• stress resilience

• cycle regulation

• egg quality and nutrient status

But the right approach depends on your testing, symptoms and fertility timeline.

6) Lifestyle change that supports fertility and nervous system regulation

When fertility is the goal, lifestyle matters deeply.

This includes:

• sleep support

• stress reduction strategies

• nervous system regulation

• sustainable movement

• reducing burnout and overtraining

Because when the body is under stress, hormones and inflammation worsen.

Final Thoughts

PCOS and endometriosis are different conditions, but they can both contribute to fertility struggles.

And many women have both.

If your symptoms don’t fit neatly into one diagnosis, trust that instinct.

You deserve support that looks deeper. You deserve investigation when needed. And you deserve a plan that supports your whole body, not just symptoms.

If you’re feeling confused by your symptoms, struggling with fertility, or suspect you may have PCOS, endometriosis, or both I can help you get clarity.

Ready to feel better? Book a FREE Naturopathic PCOS Assessment Call and we’ll map out what could be driving your symptoms, what further investigation may be needed, and the most supportive next steps to reduce inflammation, support hormones, and improve fertility outcomes.