Does having Polycystic Ovary Syndrome (PCOS) protect against the worsening of endometriosis or vice versa?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: October 7, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

PCOS and Endometriosis: No Protective Relationship Between Conditions

Having PCOS does not protect against the worsening of endometriosis, nor does endometriosis protect against the worsening of PCOS. 1, 2 Both conditions can coexist and independently contribute to reproductive health complications and infertility.

Understanding Both Conditions

PCOS Characteristics

  • PCOS affects approximately 8-13% of reproductive-aged women and is characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology 1
  • It is the leading cause of anovulatory infertility 1
  • PCOS is associated with metabolic disorders including obesity, insulin resistance, dyslipidemia, and increased cardiovascular risk 1

Endometriosis Characteristics

  • Endometriosis affects 2-10% of women of childbearing age and involves the presence of endometrium-like tissue outside the uterus 1
  • It causes chronic inflammation, pelvic pain, dysmenorrhea, and reduced fertility 1
  • Endometriosis is associated with hypercholesterolemia, hypertension, and increased cardiovascular risk 1

Relationship Between PCOS and Endometriosis

Distinct Pathophysiological Mechanisms

  • PCOS is primarily characterized by downregulation of estrogen receptors (ER) and androgen receptors (AR) in the ovaries, leading to abnormal folliculogenesis 2
  • Endometriosis is associated with upregulation of estrogen receptors and downregulation of progesterone receptors 2
  • These opposing receptor expression patterns suggest different pathophysiological mechanisms rather than protective effects between conditions 2

Endometrial Function in PCOS

  • Women with PCOS have altered endometrial function compared to healthy controls 3
  • PCOS features contribute to dysregulation of endometrial sex hormone receptors, increased insulin resistance, chronic inflammation, and abnormal endometrial gene expression 3
  • These endometrial dysfunctions can predispose to miscarriage and pregnancy complications rather than protect against endometriosis 3

Impact on Quality of Life and Psychological Health

  • Both conditions are associated with significant psychological distress 4
  • Approximately 60% of women with either PCOS or endometriosis report moderate to severe psychological distress 4
  • Women with a diagnosis of PCOS or endometriosis have significantly higher odds of psychological distress compared to women without these conditions 4
  • The psychological impact persists even after diagnosis and treatment 4

Endometrial Cancer Risk

  • While PCOS has been associated with risk factors for endometrial cancer (chronic anovulation, obesity, hyperinsulinemia), the evidence for a direct association remains inconclusive 5
  • Women with PCOS may have elevated estrogen levels without the opposing effects of progesterone (due to anovulation), which could contribute to endometrial hyperplasia and potentially endometrial cancer 6
  • There is no evidence suggesting that endometriosis protects against this risk 6, 5

Management Implications

For PCOS

  • Treatment focuses on managing symptoms and preventing long-term complications 1
  • Oral contraceptive pills are commonly used for long-term management, suppressing androgen secretion and increasing sex hormone binding globulin 1
  • Metformin and lifestyle modifications may improve insulin sensitivity and ovulation rates 1

For Endometriosis

  • Management focuses on pain relief, fertility preservation, and preventing disease progression 1
  • Surgical intervention may be required for diagnosis and treatment of endometriosis 1
  • Combined estrogen/progestogen therapy can be effective for vasomotor symptoms in women with endometriosis who required oophorectomy 1

Clinical Considerations for Women with Both Conditions

  • Women with both conditions require comprehensive management addressing both pathologies 2, 3
  • Regular monitoring for metabolic abnormalities, including lipid profiles and glucose tolerance tests, is essential 1
  • Psychological support should be integrated into care plans given the high prevalence of distress 4
  • Fertility concerns should be addressed proactively, as both conditions can contribute to infertility through different mechanisms 1

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Research

Polycystic ovary syndrome and endometrial carcinoma.

Lancet (London, England), 2003

6
Research

Endometrium in PCOS: Implantation and predisposition to endocrine CA.

Best practice & research. Clinical endocrinology & metabolism, 2006

Related Questions

Is polycystic ovary syndrome (PCOS) caused by endometriosis?
Is Prometrium (progesterone) used in the treatment of Polycystic Ovary Syndrome (PCOS)?
What management approach is recommended for a 34-year-old female with Polycystic Ovary Syndrome (PCOS), hypermobile Ehlers-Danlos Syndrome (hEDS), prothrombin mutation (heterozygote), endometritis, and 13 months of infertility, whose partner has 96% sperm head defects?
What are the key recommendations and treatment approaches for common gynaecological issues such as polycystic ovary syndrome (PCOS), endometriosis, and urinary tract infections (UTIs)?
How does fatty tissue contribute to increased unopposed estrogen in Polycystic Ovary Syndrome (PCOS)?
What are the key objectives to cover in an immunology tutorial on fungal and parasitic infections, including hypersensitivity reactions?
What are the recommended treatments for headaches during pregnancy?
What is the management for green discharge from an unused Percutaneous Endoscopic Gastrostomy (PEG) site in a patient with an infective exacerbation of asthma?
What is the significance of squamous epithelial cells in urine?
Why does a patient with liver cirrhosis, ascites, and hydrothorax experience rapid reaccumulation of hydrothorax?
What is the recommended steroid dosing regimen for acute interstitial nephritis (AIN) caused by medication?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question