Gynecological disorders that commonly affect about 5 to 10 % of women, especially teenagers and those of childbearing age are PCOS and Endometriosis. Though clinical presentation is significantly different from each other, it is often difficult to detect these disorders as both can cause infertility, can disrupt menstrual periods, can trigger mood swings, can be troublesome and uncomfortable to cope with. Timely diagnosis is particularly a challenging aspect of these conditions. For many years, women with PCOS or Endometriosis may experience feelings of confusion, frustration and distress as a result of not being able to identify the root cause of the problem. Though there are crossovers between PCOS and Endometriosis, they affect the reproductive system in varying ways with symptomatic manifestation that are widely different from each other.
Polycystic Ovarian Syndrome (PCOS) is a chronic hormonal condition characterized by Androgen dominance presenting with enlarged ovaries that contain many small, fluid-filled cysts. It happens when a woman’s ovaries or adrenal glands produce more than normal amounts of male hormones such as Testosterone and other derivatives. Increased Androgen levels are linked to increased blood sugar levels and thus PCOS is often associated with unstable blood sugar in the body. Insulin resistance, also known as carbohydrate sensitivity results as an effect of long term unstable blood sugar levels in PCOS.
Adrenal gland function is a priority to support reproductive system as they produce many of the precursors to sex hormones. So, PCOS is also commonly associated with dysfunctional adrenal glands. High testosterone in PCOS is also linked to a compensation for low progesterone due to stress, environmental and genetic factors.
Endometriosis is a chronic condition where Oestrogen dominance causes abnormal menstrual tissue to grow outside the uterus. Every menstrual cycle, there is a surge in oestrogen level, which after being used up by the reproductive system is processed by the liver and excreted. On exposure to toxins, there may be a large volume of xenoestrogens that mimic oestrogen in the body. The liver, when unable to detoxify these excess hormones, they re-circulate through the body, resulting in oestrogen dominance. As the natural function of oestrogen is to stimulate reproductive cell growth, constant excess levels in the body can trigger unnatural growth of tissues in the form of endometriosis.
Similar to PCOS, another contributing factor in endometriosis could be low levels of Progesterone. Progesterone functions to counterbalance the action of oestrogen and there is a need for a harmonious balance between the two hormones for a healthy reproductive system. Research indicates that when the ratio between oestrogen and progesterone is disproportionate, the unopposed high levels of oestrogen circulating in the body can be linked to endometriosis.
Like any other hormonal condition, PCOS has physical as well as emotional implications such as :
Irregular periods – Women with PCOS may have a period every two to three months or even a period just once or twice a year. The time lag between periods may vary, but when the period does happen, it can be heavy bleeding.
Infertility – Irregular periods indicate absence of ovulation on regular basis. This make it harder to conceive in women with PCOS.
Unexplained weight gain – Hormonal issues in PCOS can cause weight gain. Overweight or obesity are more common in women with PCOS and can mainly be attributed to insulin resistance.
Excess facial hair growth – High amounts of male hormone can trigger Hirsutism, where male-pattern hair growth on the face, upper lip, chin, neck, back, abdomen and chest is prominent. Male pattern baldness is also a common symptomatic feature of PCOS.
Acne – Hormonal shifts can lead to oily skin and outbreak of pimples.
Psychological impact – PCOS often leads to depression, anxiety and other mental health issues in adolescents as well as in women planning a family.
National Institutes of Health states that pain is the main symptom of endometriosis. This can be explained due to the growth of cells from the lining of the uterus in other areas of the body, like the ovaries, bowel, rectum, bladder and pelvic area. Unlike in PCOS, Symptoms of endometriosis revolve around pain and signs to watch out for may include:
- Intensely painful periods
- Pain in the lower abdomen before menstruation
- Cramps for a week or two before menstruation and during menstruation may be steady or range from dull to severe in intensity. Very severe painful cramps can disrupt normal day to day activities.
- Pain during or following sexual intercourse otherwise known as dyspareunia is typical of endometriosis
- Pain often pangs up during urination and bowel movements
- Pelvic or low back pain may persist through out the menstrual cycle
Infertility – In endometriosis, trouble getting pregnant is a bothersome feature just like with PCOS. Uncontrolled, abnormal growth of tissues of the uterus interferes with conception and achieving pregnancy.
Emotional disturbance – Living with endometriosis can affect a woman’s emotional health. Having difficulties managing the problem, coping with pain and inability to conceive makes the woman always sad and often anxious, giving a strong sense that everyday life has changed.
Symptoms of PCOS vary depending on the particular phase of the reproductive years. PCOS at any given stage of a girl/woman can be typically diagnosed with the presence of at least two of three symptoms of high androgen levels, irregular menstrual cycles and cysts in the ovaries. A pelvic exam, blood tests and ultrasound can confirm the diagnosis.
Symptoms of endometriosis can vary between women, can change over time and is often confused with other conditions. Hence, it can take as long as many years to get a correct diagnosis of endometriosis resulting in a long time of suffering and not knowing the problem and thereby to not have access to the correct treatments. The time it takes to get diagnosed will contribute to the perception of the problem. The only definitive and conclusive way to diagnose endometriosis is through laparoscopy.
PCOS treatment involves weight management, regularizing menstrual cycle, bringing down androgen levels and inducing ovulation. A combination of life style changes, medications and reproductive techniques in a step by step progressive manner targeted at specific individual needs forms a package of PCOS management.
Endometriosis treatment will depend on how severe signs and symptoms are and whether the woman desires to become pregnant. Depending on the personal situation, pain medication, hormone therapy, conservative surgery, fertility treatments and hysterectomy may be best decided in managing endometriosis.