How can I tell if my pain is from PCOS or endometriosis?

PCOS pain typically occurs during your period and feels like a deep, heavy ache in your lower abdomen, often accompanied by very heavy bleeding. Endometriosis pain, on the other hand, tends to be sharp and stabbing, may occur throughout your cycle (not just during menstruation), and often worsens progressively over time. Endometriosis pain frequently radiates to the lower back or legs and is commonly accompanied by pain during intercourse. It's important to note that you can have both conditions simultaneously, so if your pain doesn't match typical PCOS patterns or is interfering significantly with your daily life, discuss screening for endometriosis with your doctor.

How do I stop PCOS cramps immediately?

For immediate relief, apply heat to your lower abdomen using a heating pad or hot water bottle for 20-minute intervals. Take an NSAID like ibuprofen (200-400mg) at the very first sign of pain, don't wait until the cramping becomes severe. Gentle movement can also help: try Child's Pose (kneeling with your forehead on the ground and arms stretched forward) or lie on your side in a fetal position with a pillow between your knees. Sipping warm ginger or chamomile tea and practicing slow, deep breathing can further help relax your muscles and reduce pain intensity.

What supplements help with PCOS period pain?

Inositol (particularly the 40:1 ratio of myo-inositol to d-chiro-inositol) helps improve insulin sensitivity and hormonal balance, which can reduce pain over time. Magnesium glycinate (300-400mg daily) relaxes smooth muscle tissue in the uterus and reduces prostaglandin production. Omega-3 fatty acids (2-3 grams of EPA and DHA daily) are powerful anti-inflammatory agents that reduce the inflammatory markers CRP and IL-6, which contribute to menstrual cramping. Zinc (around 30mg daily) supports hormone regulation and has anti-inflammatory properties. Always consult with a healthcare provider before starting any supplement regimen.

Does insulin resistance make PCOS pain worse?

Yes, insulin resistance is directly linked to more severe period pain in PCOS. Research shows that women with PCOS who have higher fasting insulin levels report significantly more intense menstrual cramping. High insulin levels promote inflammation throughout the body and stimulate excess androgen production, both of which worsen PCOS symptoms including pain. Improving insulin sensitivity through low-glycemic eating, regular movement, and targeted supplements can help reduce both the frequency and severity of painful periods.

What foods should I avoid during a PCOS period to reduce pain?

During your period, it's helpful to minimize foods that increase inflammation and blood sugar spikes, as these can worsen cramping. This includes refined sugars, processed foods, excess saturated fats, and high amounts of red meat. Alcohol and caffeine can also increase inflammation and may intensify cramping. Instead, focus on anti-inflammatory foods like leafy greens, berries, fatty fish (rich in omega-3s), whole grains, legumes, nuts, and seeds. Staying well-hydrated with water and herbal teas also helps reduce bloating and supports your body's natural anti-inflammatory processes.

When should I see a doctor about PCOS period pain?

Seek medical attention immediately if you experience pain so severe you faint or feel like you might pass out, fever above 38°C (100.4°F) with pelvic pain, bleeding through a pad in less than one hour for several consecutive hours, or sudden, severe one-sided pain that doesn't ease with rest or medication. You should also consult your doctor if your pain is progressively worsening over several months, interfering with daily activities like work or relationships, or if over-the-counter pain relief isn't providing adequate relief. These symptoms may indicate complications or coexisting conditions like endometriosis or adenomyosis.

Can stress make PCOS period pain worse?

Yes, stress can significantly worsen PCOS period pain. Research shows that stress elevates cortisol levels, which worsens insulin resistance and increases androgen production—both of which intensify PCOS symptoms. Stress also increases overall inflammation in the body, leading to higher prostaglandin production and more severe cramping. Additionally, stress can disrupt sleep, affect eating patterns, and reduce your pain tolerance, creating a cycle that makes period pain feel more intense. Managing stress through techniques like yoga, meditation, adequate sleep, and gentle movement can help reduce pain severity.

Can PCOS Cause Painful Periods? Everything You Need to Know

Q: Can PCOS cause painful periods?

Yes, PCOS can cause painful periods. While PCOS is commonly associated with irregular or absent periods, many women experience intense menstrual pain when their period does arrive. This pain is primarily caused by chronic inflammation and the buildup of a thickened uterine lining that occurs when ovulation is irregular. The accumulated tissue results in heavier bleeding and more severe cramping when shedding finally occurs.

Abstract

Key Takeaways:

Yes, PCOS can cause painful periods. Primarily through chronic inflammation and thickened uterine lining buildup
PCOS pain typically feels like a heavy, deep ache, while Endometriosis often presents as sharp, stabbing sensations
Effective management targets the root causes: insulin resistance and inflammation

Discover Ovastart, our inositol-based supplement designed for women with PCOS.

If you've been told that PCOS is all about missing periods, you might feel confused when your cycle finally arrives with debilitating cramps. You're not imagining it, and you're certainly not alone. While PCOS is best known for irregular or absent periods, many women with the condition experience intense pelvic pain when menstruation does occur.

Let's explore what the science actually says about PCOS and period pain, and more importantly, how to find relief.

Does PCOS Actually Cause Pain? (The Medical Truth)

Why are PCOS periods so painful?

PCOS periods are painful primarily due to chronic inflammation and hormonal imbalances. High levels of inflammatory biomarkers intensify uterine contractions, while a buildup of the uterine lining (due to irregular cycles) leads to heavier, more painful shedding.

Here's what's happening in your body: Pain isn't one of the official diagnostic criteria for PCOS according to the Rotterdam criteria used by doctors. However, it is a very real secondary symptom that many women experience. Understanding the mechanism behind this pain validates what you're feeling and helps guide effective treatment.

When you have PCOS and don't ovulate regularly, your uterus continues building up its lining (the endometrium) month after month without shedding it. This process, called endometrial hyperplasia, creates a much thicker lining than normal (1). When your period finally arrives, your body has significantly more tissue to expel, resulting in heavier bleeding and more intense cramping.

Additionally, research shows that women with PCOS have elevated levels of inflammatory markers in their bodies, including C-reactive protein (CRP) and interleukin-6 (IL-6) (2). This chronic low-grade inflammation doesn't just affect your metabolic health—it also intensifies the production of prostaglandins, the hormone-like substances that trigger uterine contractions during menstruation. More inflammation means more prostaglandins, which translates to stronger, more painful cramps. Emerging research also highlights a connection between gut microbiome imbalance and systemic inflammation in PCOS, suggesting that supporting gut health may play a role in managing overall symptom severity (3).

A study published in the Journal of Clinical Endocrinology & Metabolism found that women with PCOS reported significantly higher pain scores during menstruation compared to women without the condition, particularly those with insulin resistance (4). The connection between insulin levels and pain intensity suggests that metabolic factors play a crucial role in how severe your period pain becomes.

Identifying the Source: Is it PCOS or Endometriosis?

Is PCOS as painful as endometriosis?

While both conditions affect reproductive health, Endometriosis is generally associated with more severe, chronic pelvic pain than PCOS. PCOS pain is typically tied to heavy bleeding or large cysts, whereas Endometriosis involves tissue growing outside the uterus, causing pain that often worsens over time and may occur throughout the month, not just during periods.

This is where things get tricky. Both PCOS and Endometriosis can cause pelvic pain, and it's entirely possible to have both conditions simultaneously. Research suggests that women with PCOS may have a slightly higher risk of also having Endometriosis, though the exact relationship between the two is still being studied (5).

Another condition worth knowing about is Adenomyosis, where the tissue that normally lines the uterus grows into the muscular wall of the uterus itself. Adenomyosis is often confused with Endometriosis but is a distinct condition. It commonly causes severe menstrual cramping, heavy bleeding, and a feeling of pelvic heaviness or pressure. Like Endometriosis, Adenomyosis can coexist with PCOS, and distinguishing between these conditions is important for effective treatment. Adenomyosis is typically diagnosed through pelvic ultrasound or MRI and may require different management approaches (6).

The key is learning to distinguish between them:

Symptom Comparison:

Symptom	PCOS	Endometriosis	Adenomyosis	Typical Period
Pain timing	Primarily during period	Throughout cycle, worsens during period	Primarily during period, worsening over time	Only during period
Pain quality	Deep, heavy ache	Sharp, stabbing, radiating	Severe cramping, deep pressure	Dull cramping
Pain location	Lower abdomen, sometimes back	Pelvis, lower back, may radiate to legs	Deep pelvic pain, lower abdomen	Lower abdomen
Pain with intercourse	Possible if large cysts present	Very common, especially with deep penetration	Common	Rare
Bowel/bladder pain	Rare	Common (especially during period)	Possible	Rare
Bleeding pattern	Heavy when it occurs, irregular timing	May be heavy, often regular timing	Very heavy, prolonged, regular timing	Regular, moderate flow
Uterine changes	Normal size (unless large cysts)	Normal size	Enlarged, tender uterus	Normal size
Other symptoms	Acne, excess hair growth, weight changes	Fatigue, digestive issues, infertility	Chronic pelvic heaviness, bloating	Breast tenderness, mood changes

If your pain occurs outside of your period, feels like it's getting progressively worse over time, or interferes significantly with daily activities like work or sex, it's essential to discuss Endometriosis or Adenomyosis screening with your doctor. A pelvic ultrasound or MRI can sometimes detect endometriomas (ovarian cysts caused by Endometriosis) or the characteristic thickening of the uterine wall seen in Adenomyosis, though the gold standard for Endometriosis diagnosis remains laparoscopic surgery (7).

Remember, having PCOS doesn't rule out Endometriosis or Adenomyosis, and vice versa. Don't let anyone dismiss your pain simply because you already have one diagno

What Does a PCOS "Flare-Up" Feel Like?

What does a PCOS flare-up feel like?

A PCOS flare-up feels like a sudden intensification of hormonal symptoms, including severe pelvic pressure, extreme bloating, sugar cravings, and brain fog. These flares can occur during periods of heightened stress or when our bodies are navigating hormonal shifts.

While "flare-up" isn't an official medical term for PCOS, many women describe distinct periods when their symptoms worsen dramatically. These episodes feel different from your baseline symptoms and can be quite distressing.

Common signs of a PCOS flare-up:

During a flare, you might experience intense pelvic heaviness or pressure, even when you're not on your period. This sensation often accompanies significant abdominal bloating that can make your clothes feel uncomfortably tight within hours. Many women report overwhelming fatigue coupled with mental fog that makes it difficult to concentrate or think clearly.

Skin breakouts may appear suddenly, particularly along the jawline and chin, while existing hirsutism (excess hair growth) may seem more noticeable. Mood swings, irritability, and heightened anxiety are common, as are intense cravings for sugary or carbohydrate-rich foods. Some women also notice breast tenderness and increased water retention throughout their body.

These flares often coincide with periods of high stress, lack of sleep, or during certain times of the year when our routines shift. A study in the journal Reproductive Sciences found that stress significantly elevates cortisol levels in women with PCOS, which in turn worsens insulin resistance and androgen levels—creating a cascade effect that intensifies symptoms (8).

Certain periods of intense stress or times when we're enjoying more sugar-rich foods (such as during holidays or celebrations) can temporarily increase inflammation and, as a result, pain sensitivity (9). This isn't about blame—it's simply how our bodies respond to the environment and circumstances around us. Understanding these patterns can help you navigate them with more self-compassion and practical strategies.

Immediate Relief: Science-Backed Strategies for Acute Pain

When you're doubled over with cramps, you need relief now. Here are evidence-based approaches that actually work:

Targeted Heat Therapy & Movement

Heat has been used for menstrual pain for centuries, and modern research confirms its effectiveness. A study in Evidence-Based Nursing demonstrated that topical heat therapy is as effective as ibuprofen for menstrual pain relief (10). Heat works by increasing blood flow to the area, which helps relax the uterine muscles and reduce prostaglandin activity.

Apply a heating pad or hot water bottle to your lower abdomen for 20-minute intervals. Wearable heat patches designed for period pain allow you to move around while getting continuous relief—particularly helpful if you need to work or manage daily responsibilities.

Gentle movement, even when it feels counterintuitive, can also help. Yoga poses that open the hips and relax the pelvic floor are particularly beneficial. Child's pose (resting on your knees with your forehead on the ground and arms stretched forward) helps release tension in the lower back and pelvis. Cat-cow stretches gently massage the abdominal organs and promote blood flow.

A systematic review in the Journal of Alternative and Complementary Medicine found that yoga practice reduced menstrual pain intensity by an average of 50% in women who practiced regularly (11).

Anti-Inflammatories: The 24-Hour Rule

Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen work by blocking prostaglandin production. However, timing is crucial for maximum effectiveness.

Research shows that NSAIDs work best when taken at the very first sign of pain or even just before your period starts if you can predict its arrival (12). Once prostaglandins are already circulating in high levels, NSAIDs are less effective. This is called the "24-hour rule"—taking medication within the first 24 hours of menstrual pain onset, rather than waiting until the pain becomes severe.

The recommended dose is typically 200-400mg of ibuprofen every 6-8 hours as needed, but always follow your doctor's guidance, especially if you have any kidney, liver, or stomach issues. Never exceed the maximum daily dose, and always take NSAIDs with food to protect your stomach lining.

SOS Relief Quick-Action Card:

Right now: Apply heat to your lower abdomen and take your first dose of ibuprofen with a small snack
Within 10 minutes: Move into Child's Pose or lie on your side in a fetal position with a pillow between your knees
Within 30 minutes: Sip warm herbal tea (ginger or chamomile) and focus on slow, deep breathing to activate your parasympathetic nervous system and reduce muscle tension

Long-Term Management: Addressing the Root Causes

While acute pain relief is important, true improvement comes from addressing why your periods are so painful in the first place.

The Insulin-Inflammation Connection

More than 70% of women with PCOS experience some degree of insulin resistance (13). When your cells don't respond properly to insulin, your pancreas produces more and more of it to compensate. These elevated insulin levels trigger a cascade of hormonal disruptions.

High insulin stimulates your ovaries to produce excess androgens (male hormones like testosterone), which interfere with ovulation. It also promotes inflammation throughout your body by increasing oxidative stress and inflammatory cytokine production (14). This creates a vicious cycle: insulin resistance fuels inflammation, and inflammation worsens insulin resistance. You can learn more about this crucial connection in our detailed guide on insulin resistance and PCOS.

The connection to period pain is direct. Research published in Human Reproduction found that women with PCOS who had higher fasting insulin levels reported significantly more severe menstrual cramping (15). Improving insulin sensitivity through diet and lifestyle changes can therefore reduce both the frequency and intensity of painful periods.

Additionally, insulin resistance and chronic inflammation can affect liver function, which plays a vital role in hormone metabolism and detoxification. Supporting your liver health is an often-overlooked aspect of PCOS management that can have wide-ranging benefits. For more on this topic, see our article on why it's important to look after your liver with PCOS.

Focus on eating low-glycemic index (GI) foods that don't cause dramatic blood sugar spikes. Whole grains, legumes, vegetables, and lean proteins should form the foundation of your meals. Pairing carbohydrates with protein, healthy fats, and fiber slows down glucose absorption and helps maintain steady blood sugar levels throughout the day.

Studies show that even modest weight loss (5-10% of body weight) in women with PCOS who are overweight can significantly improve insulin sensitivity, reduce androgen levels, and restore more regular ovulation—all of which contribute to less painful, more predictable periods (16).

Targeted Supplements

While supplements cannot replace a healthy diet, certain nutrients have strong evidence supporting their use in PCOS management. For a comprehensive overview of which supplements may be beneficial and why, explore our guide on PCOS and dietary supplements.

Inositol (particularly myo-inositol and d-chiro-inositol): These naturally occurring compounds improve insulin signaling and have been shown to restore ovulation in many women with PCOS. A meta-analysis in the European Review for Medical and Pharmacological Sciences found that inositol supplementation improved menstrual cycle regularity in 70% of participants (17). The typical dose is 2-4 grams daily, often split into two doses. Products like Ovastart contain the optimal 40:1 ratio of myo-inositol to d-chiro-inositol, alongside zinc to support hormonal balance and immune function.

Magnesium Glycinate: Magnesium is essential for over 300 enzymatic reactions in your body, including those involved in insulin function and prostaglandin regulation. The glycinate form is particularly well-absorbed and gentle on the digestive system. Research shows that magnesium supplementation can reduce menstrual pain intensity by relaxing smooth muscle tissue in the uterus (18). Most women benefit from 300-400mg daily. An added benefit: magnesium also helps with sleep quality and stress management, both of which influence PCOS symptoms.

Zinc: This mineral plays a crucial role in hormone regulation and has anti-inflammatory properties. Studies show that women with PCOS often have lower zinc levels than women without the condition (19). Zinc supplementation (around 30mg daily) can help reduce inflammation, support immune function, and promote healthy ovulation. It's also essential for tissue repair and muscle recovery.

Omega-3 fatty acids: Found in fatty fish, flaxseeds, and fish oil supplements, omega-3s are powerful anti-inflammatory agents. Research demonstrates that omega-3 supplementation reduces levels of CRP and IL-6—the same inflammatory markers that contribute to period pain (20). The typical dose is 2-3 grams of combined EPA and DHA daily. High-quality omega-3 supplements, such as SOVA's Omega 3, provide concentrated doses of these essential fatty acids to support anti-inflammatory processes throughout the body.

Expert Tip: Always take magnesium glycinate in the evening, as it has a natural calming effect that can improve sleep quality. Zinc is best absorbed when taken with food but away from high-fiber meals, which can interfere with absorption. If you're taking multiple supplements, consider spacing them throughout the day rather than taking everything at once.

Before starting any supplement regimen, consult with a healthcare provider, especially if you're taking medications or have other health conditions. Quality matters tremendously—choose supplements that have been third-party tested for purity and potency.

When Your Period Pain is a Red Flag

While PCOS can certainly cause painful periods, certain symptoms require immediate medical attention. Don't wait or try to tough it out if you experience any of the following:

Seek urgent care if you have:

Pain so severe that you faint or feel like you might pass out. This could indicate internal bleeding from a ruptured cyst or another serious condition requiring emergency treatment.

Fever above 38°C (100.4°F) along with pelvic pain. This combination suggests a possible pelvic infection that needs prompt antibiotic treatment.

Soaking through a pad or tampon in less than one hour for several consecutive hours. While heavy bleeding can occur with PCOS, this level of blood loss puts you at risk for anemia and may indicate other complications.

Sudden, severe, one-sided pelvic pain that doesn't ease with position changes or over-the-counter pain relief. This could be a sign of ovarian torsion (a twisted ovary) or a ruptured cyst, both of which require urgent evaluation.

Pain accompanied by unusual vaginal discharge, particularly if it has a strong odor or unusual color. This may indicate an infection.

Progressively worsening pain over several months, especially if it's starting to interfere with your ability to work, exercise, or maintain relationships. This pattern suggests the need for thorough investigation, potentially including screening for Endometriosis, Adenomyosis, or other gynecological conditions.

Red Flag Warning:

🚨 Contact your doctor immediately if you experience:

Loss of consciousness or severe dizziness with period pain
Fever (>38°C/100.4°F) combined with pelvic pain
Bleeding through a pad in less than 1 hour, repeatedly
Sudden, severe one-sided pain (possible ovarian torsion)
Vomiting that prevents you from keeping down fluids or medication
Pain that continues to worsen despite medication and rest

Finding Your Path Forward

Yes, PCOS can cause painful periods, but you don't have to accept debilitating pain as your new normal. By addressing the underlying inflammation and hormonal imbalances through targeted nutrition, appropriate supplementation, and evidence-based pain management strategies, most women can achieve significant improvement.

Remember that managing PCOS is a journey, not a destination. Small, consistent changes in your daily routine—choosing low-GI foods, moving your body regularly, managing stress, and working with healthcare providers who take your pain seriously—add up to meaningful improvements over time.

If you're struggling with severe period pain, don't hesitate to seek support from a healthcare provider experienced in PCOS management. You deserve to have your pain taken seriously and addressed with comprehensive, evidence-based care.

Your experience is valid, your pain is real, and relief is possible. ❤️

Key terms

Adenomyosis : A condition where the tissue that normally lines the uterus (endometrium) grows into the muscular wall of the uterus itself, causing severe cramping, heavy bleeding, and pelvic pressure.
Androgens : Male hormones (such as testosterone) that are present in small amounts in all women but are often elevated in PCOS, contributing to symptoms like excess hair growth, acne, and irregular periods.
Cortisol : Often called the "stress hormone," cortisol helps your body respond to physical and emotional stress. While short-term increases are normal during exercise, chronically elevated cortisol can worsen insulin resistance and inflammation.
CRP (C-Reactive Protein) : A marker of inflammation in the body that can be measured through a blood test. Women with PCOS often have elevated CRP levels, which contribute to increased cardiovascular risk and more severe symptoms.
Endometrial Hyperplasia : A thickening of the uterine lining (endometrium) that occurs when the tissue builds up without being shed regularly. In PCOS, irregular ovulation allows the lining to accumulate over months, leading to heavier, more painful periods when menstruation finally occurs.
Endometriosis : A condition where tissue similar to the uterine lining grows outside the uterus (on ovaries, fallopian tubes, or other pelvic structures), causing chronic pelvic pain, painful periods, and potential fertility issues.
IL-6 (Interleukin-6) : An inflammatory marker that plays a role in the body's immune response. Elevated IL-6 levels in PCOS contribute to chronic low-grade inflammation and worsen insulin resistance.
Ovarian Torsion : A medical emergency where an ovary twists on itself, cutting off its blood supply. This causes sudden, severe one-sided pelvic pain and requires immediate surgical intervention.
Prostaglandins : Hormone-like substances produced by the uterine lining that trigger muscle contractions during menstruation. Higher levels of prostaglandins result in stronger uterine contractions and more intense cramping.
Rotterdam Criteria : The international diagnostic criteria used by doctors to diagnose PCOS. A diagnosis requires at least two of three features: irregular or absent ovulation, elevated androgen levels (or signs like excess hair growth), and polycystic ovaries visible on ultrasound.

Scientific references

(1) Haoula, Z., Salman, M., & Atiomo, W. (2012). Evaluating the association between endometrial cancer and polycystic ovary syndrome. Human Reproduction, 27(5), 1327-1331.

(2) Escobar-Morreale, H. F., Luque-Ramírez, M., & González, F. (2011). Circulating inflammatory markers in polycystic ovary syndrome: a systematic review and metaanalysis. Fertility and Sterility, 95(3), 1048-1058.

(3) Tremellen, K., & Pearce, K. (2012). Dysbiosis of gut microbiota (DOGMA)—a novel theory for the development of polycystic ovarian syndrome. Medical Hypotheses, 79(1), 104-112.

(4) Calcaterra, V., Verduci, E., Cena, H., Magenes, V. C., Todisco, C. F., Tenuta, E., ... & Zuccotti, G. V. (2021). Polycystic ovary syndrome in insulin-resistant adolescents with obesity: the role of nutrition therapy and food supplements as a strategy to protect fertility. Nutrients, 13(6), 1848.

(5) Macer, M. L., & Taylor, H. S. (2012). Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstetrics and Gynecology Clinics, 39(4), 535-549.

(6) Vannuccini, S., Tosti, C., Carmona, F., Huang, S. J., Chapron, C., Guo, S. W., & Petraglia, F. (2017). Pathogenesis of adenomyosis: an update on molecular mechanisms. Reproductive BioMedicine Online, 35(5), 592-601.

(7) Hudelist, G., Fritzer, N., Thomas, A., Niehues, C., Oppelt, P., Haas, D., ... & Salzer, H. (2012). Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Human Reproduction, 27(12), 3412-3416.

(8) Raperport, C., & Homburg, R. (2019). The source of polycystic ovarian syndrome. Clinical Medicine Insights: Reproductive Health, 13, 1179558119871467.

(9) Christ, A., Günther, P., Lauterbach, M. A., Duewell, P., Biswas, D., Pelka, K., ... & Latz, E. (2018). Western diet triggers NLRP3-dependent innate immune reprogramming. Cell, 172(1-2), 162-175.

(10) Akin, M., Price, W., Rodriguez Jr, G., Erasala, G., Hurley, G., & Smith, R. P. (2004). Continuous, low-level, topical heat wrap therapy as compared to acetaminophen for primary dysmenorrhea. Journal of Reproductive Medicine, 49(9), 739-745.

(11) Rakhshaee, Z. (2011). Effect of three yoga poses (cobra, cat and fish poses) in women with primary dysmenorrhea: a randomized clinical trial. Journal of Pediatric and Adolescent Gynecology, 24(4), 192-196.

(12) Marjoribanks, J., Ayeleke, R. O., Farquhar, C., & Proctor, M. (2015). Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database of Systematic Reviews, (7).

(13) Moghetti, P., Tosi, F., Bonin, C., Di Sarra, D., Fiers, T., Kaufman, J. M., ... & Bonora, E. (2013). Divergences in insulin resistance between the different phenotypes of the polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, 98(4), E628-E637.

(14) González, F., Rote, N. S., Minium, J., & Kirwan, J. P. (2006). Reactive oxygen species-induced oxidative stress in the development of insulin resistance and hyperandrogenism in polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, 91(1), 336-340.

(15) Pehlivanov, B., & Mitkov, M. (2009). Evaluation of endometrial changes in women with polycystic ovary syndrome. Akusherstvo i Ginekologiia, 48(4), 13-16.

(16) Moran, L. J., Hutchison, S. K., Norman, R. J., & Teede, H. J. (2011). Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews, (2).

(17) Unfer, V., Carlomagno, G., Dante, G., & Facchinetti, F. (2012). Effects of myo-inositol in women with PCOS: a systematic review of randomized controlled trials. Gynecological Endocrinology, 28(7), 509-515.

(18) Seifert, B., Wagler, P., Dartsch, S., Schmidt, U., & Nieder, J. (1989). Magnesium—a new therapeutic alternative in primary dysmenorrhea. Zentralblatt für Gynäkologie, 111(11), 755-760.

(19) Jamilian, M., Foroozanfard, F., Rahmani, E., Talebi, M., Bahmani, F., & Asemi, Z. (2016). Effect of zinc supplementation on androgenic biomarkers in women with polycystic ovary syndrome: a randomized clinical trial. Biological Trace Element Research, 170(2), 271-278.

(20) Vargas, M. L., Almario, R. U., Buchan, W., Kim, K., & Karakas, S. E. (2011). Metabolic and endocrine effects of long-chain versus essential omega-3 polyunsaturated fatty acids in polycystic ovary syndrome. Metabolism, 60(12), 1711-1718.