Coexistence of Endometriosis and Polyendocrine Metabolic Ovarian Syndrome (PMOS): Pharmacological Challenges and Fertility Outcomes: A Narrative Review

Endometriosis and Polyendocrine Metabolic Ovarian Syndrome (PMOS), previously known as polycystic ovary syndrome (PCOS), are among the most common gynaecological disorders affecting reproductive-aged women. Traditionally, these conditions were considered distinct entities with contrasting hormonal and metabolic profiles. Recent evidence, however, suggests that coexistence of endometriosis and PMOS may occur more frequently than previously recognized, particularly in women presenting with infertility and chronic pelvic pain [1,2]. The overlap creates unique diagnostic and therapeutic challenges because both disorders independently impair fertility through different mechanisms. PMOS primarily affects ovulation, endocrine balance, and metabolic regulation, whereas endometriosis alters pelvic anatomy, inflammatory pathways, and endometrial receptivity. Management becomes increasingly complex when both conditions coexist, as pharmacological therapies beneficial for one disorder may negatively influence the other. This review discusses current evidence regarding the coexistence of endometriosis and PMOS, shared pathophysiological mechanisms, pharmacological management challenges, and fertility outcomes. Emerging evidence regarding inflammatory pathways, insulin resistance, hormonal dysregulation, and individualized reproductive treatment strategies is also explored.