PCOS & Endometriosis: What’s The Connection?
Early in my naturopathic training, I held a very common misconception about PCOS – that period pain was a normal part of the condition.
Obviously having PCOS myself, I dug deep into this particular symptom to really understand how pelvic pain related to PCOS. Much to my surprise, I learned that pelvic pain is not a normal or characteristic symptom of PCOS at all.
I found this very confusing, as hundreds of my patients, as well as thousands of women online in the PCOS forums I frequented were complaining of significant period pain.
To help better understand this connection, today we’re going to be uncovering the link between PCOS, period pain, and endometriosis. More importantly, we’re going to be answering the question, if you have PCOS and are also experiencing significant period pain, what does this mean and what can you do?
A Quick Summary of Pelvic Pain
Theoretically, if you have PCOS and as a result are dealing with inflammation, microbiome imbalances, or hormone imbalances it’s possible you may experience mild to moderate period pain that should be easily managed through effective naturopathic treatments.
If you have PCOS and are simultaneously experiencing period pain, you can check out my blog discussing when period pain is not normal, to better understand how to classify your pain.
If you have PCOS and you classify your pain as significant or severe, then we need to strongly consider endometriosis as a possible comorbid diagnosis.
You Can Have Both PCOS & Endometriosis
A comorbid condition means that you can have two different conditions present at the same time. Shockingly, research is now starting to uncover that PCOS and endometriosis may co-occur at high rates together.
In a 2011 study, 102 women with PCOS and infertility underwent a laparoscopic procedure. A laparoscopy is a surgical procedure that allows access to the abdominal and pelvic regions. Its currently the gold standard for diagnosing endometriosis. Of those 102 women, 73 were found to also have endometriosis in addition to their PCOS. That’s 71.5% of the women with PCOS in this study.
In a 2014 study, 104 patients with PCOS and pelvic pain or infertility underwent a laparoscopy and were compared to 111 fertile women undergoing tubal ligation. Researchers found endometriotic lesions in 77% of women with PCOS, compared to only 14% of the fertile controls.
And finally, in a 2015 retrospective cohort study looking at 2566 women with PCOS who had been hospitalized compared to age-matched controls, women with PCOS were found to be at higher risk for a diagnosis of endometriosis (36.4%) compared to the controls (4.4%). This means that in this study women with PCOS were 8 times more likely to be diagnosed with endometriosis compared to the average woman.
Taken together, it seems that there can be anywhere from a 36-77% comorbidity rate between the two conditions. Although these are only a few studies, and much more research is needed to confirm these findings, this provides great preliminary evidence that if you have PCOS, you are more likely to also have endometriosis.
Other Signs That Your Period Pain May Be Endometriosis-Related
In addition to having severe period pain, here are some possible warning signs that endometriosis may be present in addition to PCOS:
If the pain is still a 6+/10 on the pain scale after changing your diet, working on stress levels, exercising, taking supplements, and adopting a healthy lifestyle
If the pain is unresponsive to pain medications like Advil
If the pain is getting worse as you get older
If the pain isn’t necessarily related to flow and is experienced outside of your periods
Painful intercourse, painful bowel movements or painful urination during or outside of your periods
Rectal bleeding during periods
Finally, if you have been trying to conceive unsuccessfully for a full year, and are experiencing significant period pain, this certainly warrants further investigation
What To Do If You Have Both PCOS & Endometriosis
fertility preservation
First and foremost, we need to review your long-term goals. If starting a family is a goal of yours currently, or even in the very distant future, we need to focus on primarily controlling endometriosis for fertility preservation. This is because once endometriosis progresses to advanced stages, fertility becomes much more challenging to treat.
We also know that PCOS is much more responsive to fertility interventions than endometriosis, so we absolutely need to get our ducks in a row with endometriosis first!
endometriosis & naturopathic treatment
If you’re concerned you might have endometriosis in addition to your PCOS, not all hope is lost! There are still many naturopathic treatments we can incorporate to help manage your symptoms. Luckily, naturopathic treatment for endometriosis can also greatly complement any conventional endometriosis treatments such as birth control or hormone suppression methods.
For more information on our approach to endometriosis treatment, you can check out our resource page here, and learn more about the underlying factors of endometriosis on our blog here.
treating both conditions simultaneously
The most challenging part of having both PCOS and endometriosis is that the treatments for each condition do not necessarily align with one another. For example, in PCOS we often recommend consuming large quantities of animal protein. However in endometriosis, consumption of animal proteins and therefore fats may increase dioxin exposure, which has been associated with poorer outcomes. Conversely, one of the most effective strategies at preserving fertility in endometriosis is going on the pill (or other hormone suppressive medications). Obviously this does not align with good quality PCOS care either.
If you are struggling with both conditions, you need to find a Naturopathic Doctor who is extremely well versed in both conditions. This is because you will need extremely individualized and customized treatment to comprehensively support both PCOS and endometriosis.
A Final Word
To sum up – is period pain a typical symptom of PCOS? If it’s just PCOS, then no, it’s not a characteristic symptom. However, now that we understand that endometriosis seems to be more likely in PCOS, clearly women with PCOS are experiencing a much higher rate of period pain than originally believed. Most importantly, period pain with PCOS should certainly not be ignored or dismissed.
Ready to make a change?
If you want to learn more about how Naturopathic Medicine can support your PCOS, endometriosis, or both, feel free to reach out to the clinic, or book a complimentary consult with me here.
With loving compassion,
Dr. Alessia Milano, ND