Why pain isn’t always pathological and how biology, environment, and behavior intersect in the story of endometriosis and PCOS?
What is Endometriosis?
Endometriosis is not just “bad periods.” It’s a chronic, inflammatory, estrogen-dependent disorder where tissue similar to the uterine lining grows outside the uterus, often causing pelvic pain, infertility, fatigue, and digestive symptoms. And yet, it takes years to diagnose. This tissue goes through the menstrual period as well, but blood is not meant to go out, therefore it cause pain, bloating, digestion problems, and lowers fertility potential.
Endometriosis affects roughly 1 in 10 women of reproductive age, and despite its impact, it’s still misunderstood, underestimated, and under-researched.
But here’s what’s often missed: endometriosis and PCOS (polycystic ovary syndrome), two of the most common reproductive disorders in women, may be part of the same evolutionary story. And their roots might go deeper than hormones alone.
Moreover, recent work by researchers like May, Duell, and Stone (2021) suggests we look at this condition differently, not as a mistake, but as an evolutionary reproductive syndrome. And I would say, as a person who experienced both, we have to look in personal conditions and specifics of each woman and situation. And take responsibility for our health as well as for everything else in our life.
PCOS vs. Endometriosis: Different Symptoms, Shared Origins?
At first glance, endometriosis and PCOS seem like opposites:
- Endometriosis Driven by estrogen, linked to low fertility and inflammation, and marked by frequent, painful periods, with hypothesis saying that the low testosterone levels were represented in utero, while development of the fetus was ongoing.
- PCOS Often involves androgen excess, irregular or absent periods, and is associated with delayed or reduced ovulation, with hypotheses stating that the levels of testosterone were higher than normal while in utero development.
Yet according to May et al., both disorders may have evolved as part of different reproductive strategies, shaped by ancient environments, and now mismatched/not aligning with the modern world.
Endometriosis: The “Reproductive Investment” Strategy
Evolutionarily, “high reproductive investment” strategy might be present in women with endometriosis, and it may have traits (different genetic, hormonal, digestive predispositions) aligned with early, high reproductive effort, regular ovulation, high estrogen, more uterine lining buildup. This comes at a cost: increased pain, inflammation, and infertility.
PCOS: The “Conservation and Delay” Strategy
In contrast, PCOS has been explored by researchers like Melanie Davies and David Haig as reflecting a “reproductive suppression” or “conservation” strategy. PCOS may have allowed women to delay reproduction in harsh or unpredictable environments, storing energy and delaying ovulation until conditions improved.
Women with PCOS may carry traits suited for energy conservation and delayed reproduction, fewer periods, increased muscle and fat storage, and metabolic resistance. Useful in times of famine or stress, but mismatched in today’s nutrient-rich, low-activity world.
Both conditions reflect reproductive strategies that once helped us survive, but now, under modern conditions, show up as disease.
What still keeps medicine to solve this problem?
Modern medicine often treats reproductive conditions symptomatically, overlooking deeper systemic and environmental causes.
The theory proposed by May et al. is that endometriosis is not a random disease, but a female reproductive syndrome, a package of traits shaped by an ancestral environment that no longer exists. Today’s hormonal, dietary, and reproductive patterns are drastically different.
The Evolutionary Mismatch, what is meant by it?
Researchers like Trevor G. Cooper and Sarah Blaffer Hrdy have long pointed out that the modern reproductive lifestyle is nothing like that of our ancestors.
Our ancestors had more pregnancies, earlier in life, breastfed for longer and experienced fewer than 150 menstrual cycles in a lifetime, as modern women often delay or skip childbirth, breastfeed for shorter periods, experience 400+ cycles, increasing estrogen exposure dramatically.
This mismatch overloads the reproductive system, especially in women genetically predisposed to high estrogen sensitivity or impaired immune clearance, both found in endometriosis.
Meanwhile, PCOS may reflect an opposite mismatch: reproductive delay without energy scarcity.
But we can also think that in a shorter period, regarding our mothers and grandmothers, did they live in different environments while having us, then we live today?
Medical Treatments
Both conditions suffer from fragmented care. Most treatments aim to regulate the menstrual cycle or suppress symptoms, but neither condition has a cure, or long term solutions. Therofe we as woman are left alone in this process of health managment.
For endometriosis medicine offers us
- Hormonal suppression (birth control, GnRH agonists)
- Laparoscopic surgery (excision preferred over ablation)
- NSAIDs and pain therapy
- IVF for fertility
For PCOS we are offered by
- Hormonal contraception (to regulate cycles)
- Metformin (for insulin resistance)
- Ovulation induction
- Lifestyle interventions (diet, weight loss)
But in both cases, the hormonal tools are limited, and many women are left managing symptoms without addressing the root causes. And some of these solutions can cause other problems in woman body.
Lifestyle Plays Role as Well
Women often hear vague advice like “cut gluten” or “try yoga.” But healing these syndromes, especially endometriosis, is about understanding the hormonal environment and systemic inflammation. Therefore this is something I would suggest, but more is there.
Food & Estrogen (Endometriosis focus)
- Limit foods that mimic or increase estrogen like processed soy, non-organic dairy, fatty red meat
- Boost liver detox with for an example cruciferous vegetables (broccoli, kale), citrus, green tea
- Support gut health (where estrogen is recycled): fiber, fermented foods
- Avoid alcohol, BPA plastics, and endocrine disruptors
PCOS requires metabolic balance: reducing insulin resistance and inflammation through low-glycemic foods, protein, and stable blood sugar patterns.
Exercise: Type & Timing Matter
For endometriosis:
- Low-impact, anti-inflammatory movement for an example walking, yoga, swimming
- Avoid overtraining, which can stress the immune and endocrine systems
- Track your cycle, adapt workouts in luteal/menstrual phases
For PCOS:
- Regular strength training and moderate cardio help reduce insulin resistance
- Short HIIT bursts can be effective, but only if stress levels are well-managed
Stress, Sleep, and Cortisol
Both conditions are worsened by chronic stress. But women often overlook how biology interprets stress as a signal to suppress or accelerate reproduction.
- Poor sleep raises cortisol, dysregulates estrogen/progesterone balance
- Skipping meals or over-fasting triggers metabolic panic
- Emotional overdrive (people-pleasing, high-achieving traits) raises inflammatory load
Endometriosis and PCOS may need opposite hormonal support, but both benefit from cycle-aware, nervous-system-friendly living.
Behavior and Mindset
Many women feel defeated when diets, supplements, or protocols “don’t work.” But these are syndromes, not switches. You’re not doing it wrong, you’re working with a complex system.
- Know your cycle and symptoms
- Track your nutrition, mood, sleep, and flare triggers
- Build a support team: medical, nutritional, psychological
- Understand that healing is nonlinear
Conclusion: Endometriosis, PCOS, and the Female Body in Transition
We can say that neither endometriosis nor PCOS are “mistakes.” They are reproductive strategies, shaped by evolution and challenged by modern living. Both show us where biology is struggling to adapt.
But naming these conditions as syndromes, not isolated diseases, opens the door to better understanding, better treatment, and deeper compassion.
It’s time we stop asking women to fix themselves with willpower and vague advice.
It’s time to give these conditions the scientific respect, and the holistic care, hey deserve.
It’s not just about knowledge, it’s about support. Explore Woman in Power coaching program if you’re ready to take the next step.
Natalie Dinsdale, Pablo Nepomnaschy, Bernard Crespi, The evolutionary biology of endometriosis, Evolution, Medicine, and Public Health, Volume 9, Issue 1, 2021, Pages 174–191, https://doi.org/10.1093/emph/eoab008