Yes, it is entirely possible to have both PCOS and endometriosis at the same time, and a growing number of women are diagnosed with both conditions over the course of their reproductive years. In short, they are two separate diagnoses that can coexist, and each needs assessing and treating in its own right. Although they are separate conditions with different underlying mechanisms, polycystic ovary syndrome and endometriosis share several overlapping symptoms, including pelvic pain, irregular or difficult periods and challenges with fertility. That overlap can delay recognition of one condition when the other has already been diagnosed, which is why a careful, individualised assessment matters. Mr Saurabh Phadnis regularly sees women in London who have lived with unexplained symptoms for years before both diagnoses are made.
Mr Saurabh Phadnis is a Consultant Gynaecologist and Gynaecological Oncology Surgeon based in London, with subspecialty training completed at the Barts Gynaecological Cancer Centre. Alongside complex cancer surgery, his practice covers general gynaecology, including PCOS and endometriosis, colposcopy, hysteroscopy and minimally invasive pelvic surgery. Updated for 2026, this article explains how the two conditions differ, why they are sometimes confused, how each is diagnosed and what treatment options may be considered when both are present.
Understanding the difference between the two conditions is the first step to making sense of your symptoms. One is primarily a hormonal and metabolic condition affecting ovulation, while the other is an inflammatory condition involving tissue growth outside the womb. They can, however, coexist quite comfortably in the same body.
Polycystic ovary syndrome is a common hormonal condition affecting how the ovaries work. According to the NHS guidance on polycystic ovary syndrome, the three main features are irregular or absent ovulation, higher levels of androgens (sometimes called male hormones) and ovaries containing multiple small follicles seen on ultrasound. The NHS notes that PCOS affects about 1 in every 10 women in the UK, which makes it one of the most common hormonal disorders seen in gynaecology clinics. Many women also have insulin resistance, which can affect weight, skin and long term metabolic health.
Typical features of PCOS may include:
Endometriosis occurs when tissue similar to the lining of the womb grows outside the uterus, most often on the ovaries, pelvic peritoneum, ligaments, bowel or bladder. This tissue responds to hormonal changes across the menstrual cycle, causing inflammation, scarring and adhesions. The NHS information on endometriosis notes that it can cause significant pain and that symptom severity does not always reflect how extensive the disease is. Endometriosis is thought to affect around 1 in 10 women of reproductive age in the UK, a similar proportion to PCOS.
Common symptoms of endometriosis may include:
You can. There is no biological reason why one condition would protect against the other, and both are common enough that coexistence is expected in a proportion of women. PCOS affects a significant number of women of reproductive age, and endometriosis is also common, so overlap is far from rare in a busy gynaecology clinic. With each condition affecting roughly 10 per cent of women of reproductive age, a meaningful number will live with both.
What sometimes happens is what clinicians call diagnostic overshadowing. Once PCOS has been diagnosed, ongoing pelvic pain may be attributed to it, even though pain is not a typical feature of PCOS itself. Equally, a woman known to have endometriosis may have her irregular cycles blamed on hormonal treatment rather than an underlying ovulatory disorder. Where PCOS and endometriosis exist together, symptoms can be more complex and may need a broader treatment plan than either condition alone.
Recognising this possibility early matters, because the treatments that suit one condition are not always ideal for the other. For example, an approach focused entirely on ovulation induction may leave pelvic pain unaddressed, while long term ovarian suppression may not suit someone actively trying to conceive.
Both conditions can disrupt periods, affect fertility and influence mood, energy and body image. The result is that women often move between clinicians for several years before a full picture emerges.
Certain patterns point more strongly towards one diagnosis. Severe cyclical pain, pain during sex and bowel or bladder symptoms that flare with menstruation are more suggestive of endometriosis. Signs of raised androgens, such as persistent acne or excess hair growth, alongside very infrequent periods, point more towards PCOS. On ultrasound, the multiple small follicles of polycystic ovaries look quite different from an endometrioma, the chocolate cyst associated with endometriosis. A careful history remains the single most valuable diagnostic tool.
Diagnosis relies on a combination of symptom history, examination, blood tests and imaging. No single test confirms both conditions, and each is assessed differently.
PCOS is usually diagnosed when at least two of three features are present: irregular or absent ovulation, clinical or biochemical evidence of raised androgens, and polycystic ovarian appearance on ultrasound. Other conditions that can mimic PCOS, including thyroid disorders and raised prolactin, are normally excluded with blood tests first. Because PCOS is associated with insulin resistance, assessment of blood glucose, cholesterol and blood pressure may also be recommended for long term health.
Endometriosis can be more difficult to confirm. NICE advises that a diagnosis should be considered on the basis of symptoms even when examination and imaging appear normal, because a normal scan does not exclude the condition. UK surveys have repeatedly reported an average delay of around eight to nine years between first symptoms and a confirmed diagnosis. Transvaginal ultrasound can identify endometriomas and signs of deep disease, and MRI may be used to map involvement of the bowel or bladder. Laparoscopy, a keyhole procedure allowing direct inspection of the pelvis, remains the definitive way to confirm and often treat the disease at the same time. The Royal College of Obstetricians and Gynaecologists provides patient information on what such surgery involves.
Treatment is guided by your main priority at that stage of life, whether that is pain relief, cycle regulation, fertility or long term metabolic health. When PCOS and endometriosis coexist, the plan often needs to be revisited as circumstances change.
Options that may be considered include:
Fertility can be affected by two separate mechanisms, unpredictable ovulation from PCOS and anatomical or inflammatory changes from endometriosis. Ovulation induction medication may be recommended for PCOS, while surgical treatment of endometriosis can improve the chance of conception for some women. Assisted conception is another route, and referral to a fertility service is often appropriate. Ovarian reserve is a consideration if surgery to an ovary is being planned, and this is always discussed carefully beforehand.
Lifestyle measures do not cure either condition, but they can support symptom control and overall wellbeing. Regular physical activity, a balanced diet, attention to sleep and stress, and stopping smoking may all help. For PCOS specifically, improving insulin sensitivity can support more regular cycles and reduce longer term cardiovascular and diabetes risk. It is worth noting that persistent pelvic symptoms should never simply be attributed to a known benign condition without review, and other causes of pelvic pain, including fibroids and their management, are considered as part of a thorough assessment.
It is sensible to seek a specialist consultation if period pain regularly stops you working or studying, if pelvic pain persists between periods, if your cycles have become very irregular, or if you have been trying to conceive without success for twelve months (or six months if you are over 35). New symptoms such as bleeding after sex, bleeding between periods or unexplained abdominal swelling should always be assessed promptly rather than assumed to be part of PCOS and endometriosis. Persistent bloating and swelling are also covered in this guide to understanding gynaecological cancers, because such symptoms occasionally have another cause. Mr Saurabh Phadnis offers assessment in London, with access to ultrasound, hysteroscopy, colposcopy and minimally invasive surgery where needed.
Yes. The two conditions are unrelated in cause, so having one does not prevent the other. Because both are common, a proportion of women will have PCOS and endometriosis together, which can make symptoms more complex and may require a combined treatment approach.
Endometriosis is far more commonly associated with significant pelvic and period pain. PCOS is primarily a hormonal and metabolic condition and does not usually cause severe pain. If you have PCOS and are experiencing marked pelvic pain, further assessment is generally advisable.
No. The small follicles seen in polycystic ovaries are quite different from endometriomas, the cysts caused by endometriosis. Ultrasound can usually distinguish between them, and your clinician will explain what the scan findings mean for you.
Many women with PCOS and endometriosis conceive, sometimes with help. Treatment may include ovulation induction, surgical treatment of endometriosis or assisted conception. A fertility focused assessment can clarify which factor is having the greatest effect in your case.
PCOS can often be diagnosed within weeks using blood tests and ultrasound. Endometriosis frequently takes longer, as imaging may appear normal and laparoscopy is sometimes needed. UK data suggest an average wait of close to nine years for an endometriosis diagnosis. Keeping a symptom and pain diary can significantly speed up the process.
Not usually, but treatments need thoughtful selection. Hormonal options often help both conditions, while fertility treatments may need adjusting. Your clinician will discuss the balance of benefits and risks for your particular combination of symptoms and priorities.
PCOS and endometriosis are distinct conditions that can, and often do, occur together. Recognising both matters because treating one in isolation may leave important symptoms unaddressed. With a careful history, appropriate imaging and, where indicated, laparoscopy, a clear plan can usually be built around your priorities, whether that is pain relief, more predictable cycles, fertility or long term health.
If you are experiencing symptoms that could relate to PCOS and endometriosis, or you have one diagnosis and suspect the other, a specialist consultation with Mr Saurabh Phadnis in London can provide clarity and a personalised management plan. Appointments can be arranged through his practice.
