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I was diagnosed with PCOS about 5 years ago and take Metformin for it (although the symptoms are still at large). But lately, despite taking birth control, my period causes me an immense amount of fatigue both the week before and during, causes an extreme amount of heavy bleeding that last for about 7 days, and of course comes with abdominal pains (cramping, bloating, diarrhea), but the worst is the vicious nausea and vomiting. Occassionally, I get two periods a month, which means I'm sick the entire month. Are these symptoms of PCOS or could it also be related to endometriosis?

If you have PCOS are you more likely to have endometriosis?

How do you know if your pain is atypical? Because all women suffer from their periods, and it's a pain for everyone so I don't want to appear like a hypochondriac if I approach my doctor about this (because I do have a lot of other conditions).

While doing an ultrasound for something else, they did note that I had an anteverted uterus (but I don't think that's worrisome), but also that I had a 2.2 x 2 cm cyst on my right ovary. The report said it was benign, but that seems awfully large and could be causing me a lot of pain? Is that normal? And how do they know it's benign? Is this all PCOS stuff or is it endometriosis too?

  • Oh, and I'm 28 years old. – Pills N Pillows Aug 22 '16 at 0:39
  • And not sure if this matters, but I have hypothyroidism. – Pills N Pillows Aug 22 '16 at 0:47
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I think your question contains many personal parts which I can't answer and should be addressed by your gynaecologist. However, I will try to bring some clarifications to some of your raised issues:

If you have PCOS are you more likely to have endometriosis?

Actually, two studies have investigated this.

The first study was conducted in 1989 and included 91 women. Here the results:

Pelvic endometriosis was observed in 15 of 91 women (16.5%) with laparoscopically confirmed polycystic ovary syndrome. There were no significant clinical differences among those with and those without endometriosis. The groups were of similar age, parity, and ponderal indices and had similar incidences of oligomenorrhea, hirsutism, and infertility; the serum concentrations of LH, FSH, LH/FSH, prolactin, testosterone, and dehydroepiandrosterone sulfate were also similar in each group. However, women with polycystic ovaries and endometriosis presented more frequently with regular menses (40 versus 14.5%; P = .05) and less frequently with secondary amenorrhea (0 versus 38.2%; P = .05) and galactorrhea (0 versus 9.2%; P = .05) than the women with polycystic ovaries alone.

The authors concluded:

Endometriosis appears to be a coincidental finding in polycystic ovary syndrome, and its development does not modify significantly the clinical picture or biochemical profiles of these patients. However, menstrual patterns seem to be affected.

Similarly, a second study, conducted in 2014, reported *a significant association between endometriosis and women with PCOS with pelvic pain and/or infertility.

So to conclude: while a causal link has still to be determined, presence of endometriosis and PCOS is not uncommon. The latter study showed an odds ratio of 19.7 (95% CI, 9.6-40.2) of finding endometriosis in PCOS (p<0.0001)


Now the diagnosis of PCOS relies on the Rotterdam criteria ie two out of three of the following are required to make the diagnosis: oligomenorrhea, hyperandrogenism, and polycystic ovaries on ultrasound.

While the diagnosis of endometriosis relies on histologic evaluation of a lesion biopsied during surgery (typically laparoscopy).

As a side note, according to uptodate:

Definitive diagnosis of endometriosis is often delayed because the symptoms of endometriosis are vague, the symptoms overlap with a number of gynecological and gastrointestinal processes, and a surgical diagnosis entails risk. Studies have reported an average diagnostic delay of 7 to 12 years in women with endometriosis.

You may wish to consider reading following websites on endometriosis and PCOS: http://www.uptodate.com/contents/endometriosis-the-basics?source=related_link http://www.uptodate.com/contents/polycystic-ovary-syndrome-the-basics?source=related_link


Sources:

Barbieri et al. Diagnosis of polycystic ovary syndrome in adults. Uptodate. Aug 2016

Schenken et al. Endometriosis: Pathogenesis, clinical features, and diagnosis. Uptodate. Aug 2016

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