Understanding PCOS vs Endometriosis | A Functional Medicine Approach

Let’s dive into some conditions affecting women’s health that I frequently address in my office. Two of the most frustrating diagnoses that women can experience in their reproductive health are PCOS (Polycystic Ovary Syndrome) and Endometriosis. While they share similar symptoms, these distinct conditions may differ in causes and treatments. To make things more complicated, women can experience both simultaneously.

PCOS is a hormonal disorder caused by multiple small cysts on the ovaries, which can affect ovulation. It affects approximately 8–13% of women of reproductive age worldwide, with some studies suggesting rates as high as 15–20% when including undiagnosed cases. The cause of PCOS can be associated with improper or imbalanced diet, genetic factors, and high amounts of stress. Most often, we see labs that have insulin resistance and macronutrient imbalances, which leads to further hormone dysfunction, such as higher levels of estrogen and/or testosterone. They may also have symptoms associated with irregular periods, weight gain, acne, excessive facial hair growth (aka hirsutism), hair loss, and infertility. In a rare case, these same symptoms appeared in my office with the patient having one very large cyst rather than multiple small cysts. (1,2,3,4)

When women appear in our office with a diagnosis of PCOS, they have often had an ultrasound confirming the presence and size of the cysts (5). We will consider further testing, including:

• Serum testing – our broad overview of bloodwork includes analysis of certain nutrients, sex hormones, and their precursors (such as cholesterol and vitamin D), thyroid hormones, metabolic hormones, and immune system responses (such as white blood cells and inflammatory markers).

• Organic acid testing – this is a great way to dig into the biochemical pathways for the metabolism of your carbohydrates, proteins, and fats, evaluate your energy production and detoxification abilities, certain nutrient levels and toxins, and check for certain pathogens.

• Testing we consider, depending on the patient, is the use of a fertility monitor, a DUTCH test, GI-Mapping of the microbiome, food sensitivities, and genetic testing.

Our Functional Medicine approach to PCOS therapies includes the following:

• Therapeutic Dieting

• Macronutrient management to help stabilize blood sugar (6)

• Addressing gut health and improving nutrient absorption

• Removal of inflammatory foods, toxins, processed foods, and food sensitivities (5,6)

• Therapeutic supplementation

• Nutrient deficiencies, such as B vitamins, vitamin D, magnesium

• Herbs that increase insulin sensitivity, such as berberine or inositol (7)

• Hormone optimization, such as maca, ashwagandha, or black cohosh

• Liver and gut detoxification pathways, such as milk thistle or NAC

• Reduction of inflammatory pathways, such as turmeric or omegas (8)

• Lifestyle recommendations

• Mindfulness activities to reduce stress

• Increase body movement and sweating

• Infrared sauna

• Removal of household toxins

Endometriosis is a chronic condition where tissue similar to the uterine lining grows on the outside of the uterus. It affects approximately 10% of women of reproductive age, though the percentage may be higher due to underdiagnosis and misdiagnosis. Some estimates suggest up to 20–25% of women with chronic pelvic pain may have endometriosis. It is caused by inflammatory processes driven by immune dysfunction, hormone imbalance, and disturbances of the microbiome (gut health issues). The severity of endometriosis is categorized into different stages, and the development of the abnormal tissue can lead to adhesion and scar tissue. The symptoms associated with this disease can become debilitating if not addressed. Our patients who present with endometriosis often experience severe pelvis pain, heavy periods, painful intercourse, digestive issues, bloating, and inflammation. (9,10,11,12,13)

When women appear in our office with a diagnosis of endometriosis, they may have already been through a surgical procedure called laparoscopy. We will consider further testing including:

• Serum testing – our broad overview of bloodwork includes analysis of certain nutrients, sex hormones, and their precursors (such as cholesterol and vitamin D), thyroid hormones, metabolic hormones, and immune system responses (such as white blood cells and inflammatory markers).

• Organic acid testing – this is a great way to dig into the biochemical pathways for the metabolism of your macronutrients, evaluate your energy production and detoxification abilities, certain nutrient levels and toxins, and check for certain pathogens.

• GI-Mapping - the microbiome (microorganisms in the gut) can be disrupted by other pathogens, toxins, preservatives, or medications, leading to an immune response that triggers excess inflammation.

• Other testing we consider depending on the patient is food sensitivity testing, mycotoxin testing, heavy metal testing, a DUTCH test, use of a fertility monitor, and genetic testing.

Our Functional Medicine approach to endometriosis therapies includes the following:

• Therapeutic Dieting

• Anti-inflammatory focused on organic plant foods and meat proteins (14)

• Elimination Diet with the removal of inflammatory foods, toxins, processed foods, and food sensitivities (16)

• Addressing gut health and improving nutrient absorption (15)

• Therapeutic supplementation

• Nutrient deficiencies, such as B vitamins, vitamin D, magnesium

• Reduction of inflammatory pathways, such as turmeric, omegas, or ashwagandha

• Hormone optimization, such as maca or chasteberry

• Liver and gut detoxification pathways, such as DIM or calcium-D-glucarate (14)

• Lifestyle recommendations

• Mindfulness activities to reduce stress

• Increase body movement and sweating

• Infrared sauna

• Removal of household toxins (16)

• Optimizing sleep and circadian rhythm

Reproductive health conditions can be challenging, but once addressed, many of these women feel empowered to live a lifestyle that keeps their symptoms under control and prevents further disease processes. Since PCOS and Endometriosis can co-exist, some research suggests that 5–10% of women with PCOS may also have Endometriosis. However, more studies are needed to fully understand the overlap. It is important to remember that everyone is unique, so these processes and recommendations are tailored to each individual based on their history, lab results, and responses to care. The length of recovery for these conditions will depend on the severity, chronicity, compliance, and participation of the patient in achieving lifestyle and nutrition protocols. (17)

 References:

1. Escobar-Morreale HF. (2018). “Polycystic ovary syndrome: Definition, aetiology, diagnosis and treatment.” Nature Reviews Endocrinology, 14(5), 270-284. https://doi.org/10.1038/nrendo.2018.24

2. Centers for Disease Control and Prevention (CDC). (2020). PCOS (Polycystic Ovary Syndrome). Retrieved from https://www.cdc.gov/reproductivehealth/

3. National Institutes of Health (NIH). (2020). Polycystic Ovary Syndrome (PCOS) Overview. Retrieved from https://www.nichd.nih.gov/

4. Azziz R, et al. (2016). “Epidemiology and pathogenesis of polycystic ovary syndrome.” Nature Reviews Endocrinology, 12(4), 219-231. https://doi.org/10.1038/nrendo.2016.20

5. Legro RS. (2016). “Evaluation and treatment of polycystic ovary syndrome.” The Journal of Clinical Endocrinology & Metabolism, 101(11), 3967-3981. https://doi.org/10.1210/jc.2016-2309

6. Wu XY, et al. (2019). “Effects of diet on insulin resistance and hormone balance in PCOS.” Reproductive Biology and Endocrinology, 17, 30. https://doi.org/10.1186/s12958-019-0464-y

7. Unfer V, et al. (2017). “Myo-inositol in the treatment of polycystic ovary syndrome: A meta-analysis of randomized controlled trials.” Endocrine Connections, 6(8), 647-658. https://doi.org/10.1530/EC-17-0250

8. Kazemi M, et al. (2021). “The effect of omega-3 fatty acids on PCOS: A systematic review and meta-analysis.” Journal of Human Nutrition and Dietetics, 34(2), 322-330. https://doi.org/10.1111/jhn.12843

9. Zondervan KT, et al. (2020). “Endometriosis.” Nature Reviews Disease Primers, 6, 9. https://doi.org/10.1038/s41572-020-0145-2

10. World Health Organization (WHO). (2021). Endometriosis: Key Facts. Retrieved from https://www.who.int/

11. American College of Obstetricians and Gynecologists (ACOG). (2019). Endometriosis and Pelvic Pain. Retrieved from https://www.acog.org/

12. Agarwal SK, et al. (2019). “Pathogenesis and management of endometriosis.” Journal of Clinical Endocrinology & Metabolism, 104(11), 5111-5127. https://doi.org/10.1210/jc.2019-00207

13. Viganò P, et al. (2018). “Endometriosis: Pathogenesis and treatment.” Nature Reviews Endocrinology, 14(5), 325-336. https://doi.org/10.1038/nrendo.2018.80

14. Krishnamoorthy K, et al. (2021). “Anti-inflammatory diet and its impact on endometriosis.” Reproductive Sciences, 28(3), 695-710. https://doi.org/10.1007/s43032-020-00423-w

15. Sinaii N, et al. (2019). “The role of gut microbiota in endometriosis.” Current Opinion in Obstetrics and Gynecology, 31(4), 195-202. https://doi.org/10.1097/GCO.0000000000000544

16. Horne AW, et al. (2020). “The role of environmental toxins and diet in endometriosis.” Reproductive Biomedicine Online, 40(1), 23-32. https://doi.org/10.1016/j.rbmo.2019.10.002

17. Riestenberg, C., et al. (2021). Coexistence of Polycystic Ovary Syndrome and Endometriosis: A Systematic Review and Meta-analysis. Journal of Clinical Endocrinology & Metabolism. DOI: 10.1210/clinem/dgab567

Disclaimer

This document is for informational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always consult with a qualified healthcare professional before making any changes to your health regimen.