Painful, irregular periods a possible sign of endometriosis or PCOS

Painful and irregular periods indicate something is wrong in a woman’s body, but pinpointing the actual reason is not always straightforward. While these are key symptoms of gynaecological disorders such as endometriosis and polycystic ovary syndrome (PCOS), most individuals will find it difficult to distinguish between the two because of the overlapping symptoms.

Since March is the Endometriosis Awareness Month, Dr Farah Leong Rahman and Dr Ashley Chung Soo Bee, both consultant obstetrician and gynaecologist, share their insights into the distinguishing factors of endometriosis and PCOS, and treatment options for patients to improve their quality of life.

According to Farah, the two disorders are extremely different, with PCOS being linked to abnormal hormone levels in the body, particularly excessive insulin levels. “Infrequent or irregular periods, weight gain, oily facial skin, hair in unwelcome places, or acne caused by excessive male hormone production are some of the main signs of PCOS.”

Endometriosis, on the other hand, is a disorder in which the endometrial tissue begins to grow in other places, such as the ovaries, uterus, fallopian tubes, bowels, and, in rare cases, the lungs. Painful periods, agony during or after sex, or a chronic pain in the lower tummy or back are some of the symptoms that women may experience, said Farah.

Chung noted that endometriosis is rather common, occurring in one-in-10 women worldwide. It also tends to affect women during their reproductive age. PCOS has a strong genetic linkage with 25–30 percent of women with the disease having a mother or sister with PCOS as well. “Family members of a woman with PCOS are at a higher risk of developing the same metabolic abnormalities in the family,” Chung said.

In some cases, patients can develop both disorders at the same time. This emphasizes the importance of seeking competent medical advice and assistance to find and receive the right treatment balance for both endometriosis and PCOS.

Both PCOS and endometriosis can interfere with a woman’s chances of conceiving. In those with PCOS, a woman’s ability to conceive may be affected due to the irregular or infrequency of ovulation, thus rendering it difficult to determine their fertility window. On the other hand, those with endometriosis may develop a distorted pelvic anatomy, and scarring of the tissues around the ovaries and fallopian tubes, said Farah.

In severe cases, endometriosis may lead to cyst formation in or on the fallopian tubes, bowels, and on, behind or around the area between the vagina and rectum. Subsequently, any bleeding that occurs may cause pain, inflammation, scarring, and possibility of organ damage. PCOS varies from woman to woman, with some experiencing milder symptoms and others experiencing more severe ones. Chung said: “Once you have a PCOS diagnosis, you will be at higher risk of getting long term health problems such as diabetes, high blood pressure, depression and psychological issues, and cancer of the womb. If you have not had period for over 4 months, it is advisable to see a gynaecologist for further assessment.”

Treatment for PCOS is predominantly based on lifestyle modifications which include striving for optimal weight, eating a healthy diet and exercising regularly. Endometriosis sufferers will usually require personalized treatment according to the severity of disease and whether the condition interferes with the patient’s pregnancy plans. Sometimes, surgery may be necessary when medications fail.