As women, we’re well aware that our menstrual cycles aren’t convenient. Actually, not having one sounds very convenient! 

So why, oh why, should we care when she misses a visit?

Our monthly cycles are an asset for many reasons (and the reasons have nothing to do with getting out of high school gym class).

When I learned that assessing my cycle was just as good as using a FitBit to track my health, my entire perspective on what it means to be a woman changed.

Our period tells us all kinds of things about our current health state. In fact, as a woman, the behavior of our period is one of the most unbiased indicators of our health. Let me explain:

When you have a regular, natural period (in other words, you’re not using the birth control pill or an hormonal intrauterine device, also known as an IUD), and your cycle is consistent, this means you’re likely eating, sleeping, exercising, de-stressing and resting enough for your body’s needs.

When you notice inconsistencies in your period, one of those factors above (or a combination of them) may need attention. 

Although our cycles aren’t necessarily convenient, men don’t have this kind of objective sign of a hormonal imbalance. That means we’re pretty darn special, ladies!

Is your period trying to tell you something?


First, let’s talk about ways you can track your cycle and fertility. We have five suggestions below:

1. Fertility Awareness Method (also known as “FAM”) 

The manual, pen-and-paper way to track your cycle is to use the Fertility Awareness Method, “FAM”.

With FAM, you track your own temperature, cervical mucus and cervical position. Using this information, you can chart your own cycles and learn so much about your body. This is possibly the most comprehensive method of cycle tracking that exists.

2. Daysy ($299 USD)

The Daysy is the technology-based way to do FAM. It isn’t just a period tracking app – it’s a piece of hardware, too. It’s a medical device and lifestyle fertility tracker.

To use Daysy, you’ll measure your basal body temperature in the morning under your tongue and enter if you have your period. Daysy automatically calculates and analyzes everything for you.

3. Period Tracker app ($2 USD)

The Period Tracker app has many reviews and is one of the most popular options on the market.

4. Flo Period & Pregnancy Tracker App (free)

If you’re interested in tracking more than just your period, Flo is the perfect female companion. You can also track your sleep, water intake and physical activity.

5. Eve Period Tracking App (free)

This app tracks your cycle but also emphasizes helping women take control of their sex lives. It has a very active community of women, if you’re the social type.

 

Now that you’ve considered some different ways to track your cycle, let’s examine the common signs and symptoms signaling there may be an issue with your period. 

1. Varied time spans between menstruation (aka, the time while you’re not bleeding)

In general, 35 days or more in between a bleed is considered a long cycle, while 21 days or fewer is considered short. The average cycle is 28 days, but everyone is unique.

Getting familiar with your normal cycle is important. Pay attention to your patterns by tracking your period. Notice the months when your cycle runs longer or shorter. Those variations are important information.

2. Varied time spans during the menstruation phase (the time while you are bleeding)

1-3 days of bleeding is considered “short” while 6 or more days is considered “long”. The average menstruation phase is 4-5 days (but, again, the most important thing to consider is what’s normal for you). 

Here’s an example: let’s say you usually bleed for five days, but during one particular month, you only bled for 3 days. If this only occurred during one month, it’s not necessarily something to worry about (we’re humans and our bodies ebb and flow). But that change in your cycle is worth tracking so that you can spot any major changes over time.

3. No period at all (which is more common than you think!)

Are there months where you straight-up don’t get your period? 

This is the biggest red flag of them all. Stop, drop and roll, ladies.

If your period is absent for a month or two, that’s a warning sign. Missing your cycle for three consecutive months, on the other hand, is a problem requiring immediate attention. 

When you’re certain you’re not pregnant, consistently missing your period is called amenorrhea and needs to be taken seriously.

Later in this article, we’ll explain why missing your period is important, as well as the action steps you can take.

4. Changes in cervical mucus color and consistency

That pain-in-the-panties mucus you see is actually a good thing. It changes in consistency and volume throughout the month and indicates the current stage of your monthly cycle.

As your period draws nearer, your mucus will become more voluminous and thicker. It will also change in color and transparency.

Monitoring changes in your cervical mucus is also a useful indicator of your fertility. If that’s something you’re interested in, here's how to do it! (If you want to dive even deeper, we’ve listed several excellent resources at the end of this article for further education on your menstrual cycle).

5. Changes in menstrual blood, color and consistency

You’ve probably noticed variances in the brightness and thickness of your bleed. Although everyone is unique, a bright, light red is typically a healthy sign. 

Very dark, almost-brown blood can be residual from a previous bleed (it’s the uterus cleaning itself out – because the uterus is amazing!). That’s generally nothing to worry about.

If you’re seeing a lot of dark blood throughout your period, however, and that's unusual for you – take note.

6. Very heavy flows or very light spotting

Some women have lighter flows and some have heavier flows that require more… ascorbic preparation. Everyone's “normal” is different, and that’s okay.

When your flow suddenly changes its behavior, however, that’s a sign that something may be ‘off’, and it’s time to take action (we’ll outline specific steps to take below).

7. Painful periods: cramping, migraines, nausea, back aches

A little aching and pain are normal period symptoms, right?

Wrong. These symptoms are common but not actually normal. You deserve to have a painless period.

Monitoring how your symptoms vary is a helpful start. If you’re experiencing chronic and/or debilitating pain, pay extra attention and start researching your options (we’re getting there.)

It’s becoming common knowledge that digestive health and stress play a big part in painful periods too.1,2,3,4 Thus, a happy cycle may require healthy shifts in diet and lifestyle. This is something to keep in mind when you’re searching for solutions. 

8. Mood swings, low libido, irritability and difficulty sleeping – or improved mood, libido and sleep

Experiencing emotional highs and lows during your period is worth tracking.

Pay attention to your thoughts and emotions. When do they tend to creep in? This can help you recognize patterns and connections between your emotions and hormonal state.

Noticing that you often feel “this way” at a certain time during your cycle takes the power away from those negative emotions. It’s easier to work through them when you have an explanation for why they’re really happening. Name it to tame it, ladies!

When you notice a major shift in your patterns, that can be valuable information about your hormonal state.

What it means when something is wrong with your period

All of the symptoms above tell you something about your current state of overall health – but what message are they trying to send?

It’s possible that infertility has popped into your mind, and the risk of infertility is definitely enough to wake many women up to the importance of a regular cycle. Even if you aren’t thinking about starting a family, however, missing or irregular periods can be easy to ignore.

 

We strongly encourage you to pay attention to missing or irregular periods. Maybe a few analogies will help explain why.

1. Your reproductive system is not a luxury or an optional extra bodily function. 

It’s a very common misconception to believe that the reproductive system works autonomously outside of the rest of your body – like an optional ‘extra’ on a car.

In truth, its functionality has a ripple effect that is linked to more than just infertility.5

2. Your reproductive system is not Netflix.

It’s not a no-contract monthly subscription that you can opt in or out of at your convenience.

You might be wondering: what about taking birth control to ‘opt out’ of my period? 

Yes, you can take birth control and ‘skip’ your period – but that’s not free of repercussions. 

Birth control has benefits for some people, but it’s important to truly understand all the options and the possible long and short-term effects including: delayed return of fertility, low sex drive, nutrient deficiencies, alterations to the gut microbiome, and an increase in sex hormone binding globulin.6,7,8,9,10,11,12,13

If you’re not on birth control and you’re not getting your period – it’s time to act.

If you’ve recently stopped using birth control, it can take awhile for your body to regulate and your period to return. This is normal (it’s often referred to as “PBCS” or Post-Birth Control Syndrome), but it’s still important for you to take steps to aid the recovery of your cycle.

In addition, there are important reasons besides reproductive health to get your menstruation on track. Annemoreaha, low hormone production and PCOS (which we’ll discuss more below) are linked to low bone density 14,15 and heart disease 16,17,18,19,20,21,22. The good news is that there's evidence supporting the ability of your body to reverse those effects once your period returns.23,24,25,26

Now let’s talk about the potential causes of a problematic period and how to address them.

Potential causes of missing/irregular periods

Variances in your cycle can be caused by any combination of the following circumstances:

  • Low bodyweight
  • Emotional stress (social pressure, breakups, difficult jobs, loss of a loved one, relocations, arguments)
  • Physical stress (lack of sleep, overexercising, undereating, injuries, pre-existing illness, allergies, intolerances and even toxin exposure)
  • Breastfeeding
  • Medications
  • Previous use of contraceptives (the pill, shot, copper IUD)
  • Other more rare causes such as benign tumors and primary amenorrhea 27,28,29,30

Of course, this list isn’t exhaustive. There is a great deal of nuance involved when assessing the cause of a missing period. So, if you’re having issues with your cycle, you absolutely must speak to your healthcare provider. And while discussing these issues with your provider, we want to stress the importance of a proper diagnosis, too.

Let’s discuss two common causes for an abnormal or missing period as example diagnoses: Hypothalamic Amenorrhea (HA) and Polycystic Ovary Syndrome (PCOS).


Hypothalamic Amenorrhea vs. Polycystic Ovary Syndrome


To make things simple, HA can appear as low to normal hormone levels, while PCOS is more likely to present elevated hormones.31

Let’s start by explaining what these two diagnoses are.

What is Hypothalamic Amenorrhea 

Hypothalamic Amenorrhea (HA) is, by definition, the disappearance of your menstrual cycle. It tends to be diagnosed after the third missed cycle. Technically, however, one missed period is considered amenorrhea.

Your reproductive system is sensitive because it’s controlled by the hypothalamus – the part of your brain that coordinates both the autonomic nervous system and the activity of your pituitary gland. The hypothalamus controls body temperature, thirst, hunger, and other homeostatic systems like sleep and hormones.

The hypothalamus doesn’t like a lot of stress because it interrupts homeostasis. You wouldn’t like the hypothalamus when it’s upset. It will look for things to smash.

Ok, that’s not quite how it works. But your hypothalamus is clever and practical. When under stress, it will begin to systematically shut down the functions of the body that are not absolutely vital to short-term survival. We’re talking about things like healthy nails and hair, glowing skin, proper temperature regulation, sustaining bone density – and making babies!

HA is the result of an extremely intelligent mechanism that has kept women alive for hundreds of years (I’m not even mad, I’m just impressed). 

Even though this natural occurrence makes sense, it’s not healthy for prolonged periods of time and can lead to further negative effects.

Getting help with HA: Consult your healthcare professional and consider ways to reduce stress levels (both physical and mental stress). 

This could include reducing or stopping intense exercise, taking a vacation, meditating or increasing your calorie intake with high-quality fats and carbohydrates. These strategies are all recommended across the board to aid in hormonal regulation and rebalancing.32,33,34

What is polycystic ovary syndrome (PCOS)?

PCOS is a condition that affects a woman’s hormone levels. The exact cause of PCOS is unknown, but more than 200,000 cases are reported in the United States each year alone. Blood tests showing generally normal to high levels of certain hormones are an indication of PCOS.35,36,37 External symptoms often include acne, weight gain and increased facial hair.38,39,40,41

Getting help with PCOS: Find a healthcare professional that you trust to help diagnose PCOS and create a recovery plan. PCOS is commonly misdiagnosed, so it’s important to choose the right support. Find a doctor, dietician, functional nutrition therapy practitioner or holistic nutritionist that you trust with women's hormone issues.

We don’t want to downplay the treatment for either HA or PCOS, but the diagnosis and treatment is very individualized. This means it can be challenging to nail down overarching guidelines for recovery. We cannot stress enough the importance of getting a correct diagnosis 

Let’s talk about where to start looking as you seek information and answers around your cycle.


Your Period Repair Initial Protocol


Step 1. Find a healthcare professional you trust.

It’s critical to be an advocate for determining your diagnosis. The first thing to do is talk to your healthcare professional and get lab testing done.  

It’s possible that you’ve been to the doctor about these issues before and were sent away with little to no information. Maybe you got a prescription after just a short conversation about your symptoms. This is a common experience, and it is your job to keep pushing for more help and information. 

Explain your lifestyle in detail to your doctor, including your daily activities, diet, exercise and stress levels. All of these factors play a role when it comes to your cycle.

If your doctor makes assumptions about your lifestyle, they will make assumptions about your diagnosis, too.

Step 2. Immediately evaluate your stress.

Emotional and physical stress play a huge role in your menstrual health. Your body is extremely smart, and it knows when the levels of stress in your life are posing a threat.

Sure, you know that your CrossFit workout is simply a workout, but what your body perceives is an elevated heart rate and a large dump of cortisol and energy expenditure (the equivalent to, for example, running from a saber tooth tiger situation). 

When you combine that physical stress with your looming work deadline and the fact that your in-laws are coming to visit this weekend, it’s very possible that your daily activity is impacting your cycle.

All of your day-to-day stressors added together are called your “Allostatic Load”, and this plays a huge role in hormonal health (or lack thereof).

Once you have this awareness, perhaps you can see how self-care practices like rest days, meditation and socializing are equally as beneficial as a tough workout.

Step 3. Talk to everyone about it.

No such thing as TMI here, ladies!

Talk to your partner, best friend, coach, teammates and anyone who is working on your diet with you.

Whether they’re sport, gym or nutrition coaches, telling them about your menstrual health is extremely important – especially if they think all is well and healthy with you.

You don’t have to get specific about what’s wrong if that makes you uncomfortable, but it’s important to let them know that you’re experiencing health issues that could be attributed to high stress levels.

Your coaches need to know this so they can program accordingly for you and make adjustments that help you heal.

Step 4. Consider your workout regimen.

This might be hard to hear, but if you’re experiencing issues with your menstrual health, it might be best for you to turn down the volume and intensity of your training.

This is a scary thought for some people, especially if exercise is something you enjoy and a way you burn off steam. It is important to keep in mind that the shifts you make to exercise as you restore your period aren’t necessarily lifelong shifts. You may be able to get back to “regularly scheduled programming” once you’ve recovered your cycle, added in some rest days, brought a bit more intentionality to your programming, and developed other lifestyle habits that keep overall stress down.

This is also a great chance to try some new, more restorative types of movement (yoga anyone?) and to learn how to communicate with (and listen to) your body. That’s a skill that will come in handy for the rest of your life!

Step 5. Address nutrition.

If you’re trying to lose body fat and your nutrition coach is guiding you through a caloric deficit when your period disappears, you’ll likely need to shift your body composition goals for a period of time while you focus on restoring your cycle. This may mean eating at maintenance calories or in a surplus. 

This can be a scary shift for many women, so it’s important to remind yourself of the impacts a missing period can have on your long-term health. Your nutrition coach can help guide and support you through the protocol that your healthcare professional and/or your research prescribes in a way that keeps you feeling strong and confident.

There are so many ways to get support from those around you to regain your cycle, so communication (with your support systems and with your body) is key.

Additional resources

Here are some excellent resources to get educated on period health:

Sources cited:

  1. Bernstein, Matthew T, et al. Gastrointestinal Symptoms before and during Menses in Healthy Women. 22 Jan. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC3901893/.

  2. Heitkemper, M M, and M Jarrett. “Pattern of Gastrointestinal and Somatic Symptoms across the Menstrual Cycle.” Gastroenterology, U.S. National Library of Medicine, Feb. 1992, www.ncbi.nlm.nih.gov/pubmed/1732122.

  3. Whitehead, W E, et al. “Evidence for Exacerbation of Irritable Bowel Syndrome during Menses.” Gastroenterology, U.S. National Library of Medicine, June 1990, www.ncbi.nlm.nih.gov/pubmed/2338190.

  4. Khalili, Hamed, et al. “Oral Contraceptives, Reproductive Factors and Risk of Inflammatory Bowel Disease.” Gut, U.S. National Library of Medicine, Aug. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3465475/.

  5. Hassan, M A M, and S R Killick. “Is previous use of hormonal contraception associated with a detrimental effect on subsequent fecundity?.” Human reproduction (Oxford, England) vol. 19,2 (2004): 344-51. doi:10.1093/humrep/deh058.

  6. Zimmerman, Y et al. “The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis.” Human reproduction update vol. 20,1 (2014): 76-105. doi:10.1093/humupd/dmt038.

  7. Battaglia, Cesare et al. “Clitoral vascularization and sexual behavior in young patients treated with drospirenone-ethinyl estradiol or contraceptive vaginal ring: a prospective, randomized, pilot study.” The journal of sexual medicine vol. 11,2 (2014): 471-80. doi:10.1111/jsm.12392.

  8. Sirakov, M, and E Tomova. Akusherstvo i ginekologiia vol. 54,5 (2015): 34-40.

  9. Mikkelsen, Kathleen et al. “The Effects of Vitamin B in Depression.” Current medicinal chemistry vol. 23,38 (2016): 4317-4337. doi:10.2174/0929867323666160920110810.

  10. Li QL;Ding L;Nan J;Liu CL;Yang ZK;Chen F;Liang YL;Wang JT; “[Relationship and Interaction Between Folate and Expression of Methyl-CpG-Binding Protein 2 in Cervical Cancerization].” Zhonghua Liu Xing Bing Xue Za Zhi = Zhonghua Liuxingbingxue Zazhi, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/27453110/.

  11. Palmery, M et al. “Oral contraceptives and changes in nutritional requirements.” European review for medical and pharmacological sciences vol. 17,13 (2013): 1804-13.

  12. Khalili, Hamed et al. “Oral contraceptives, reproductive factors and risk of inflammatory bowel disease.” Gut vol. 62,8 (2013): 1153-9. doi:10.1136/gutjnl-2012-302362.

  13. Baker, James M et al. “Estrogen-gut microbiome axis: Physiological and clinical implications.” Maturitas vol. 103 (2017): 45-53. doi:10.1016/j.maturitas.2017.06.025.

  14. Kalyan, Shirin, et al. “Competing Factors Link to Bone Health in Polycystic Ovary Syndrome: Chronic Low-Grade Inflammation Takes a Toll.” Nature News, Nature Publishing Group, 13 June 2017, www.nature.com/articles/s41598-017-03685-x.

  15. Leonetti, H B et al. “Transdermal progesterone cream for vasomotor symptoms and postmenopausal bone loss.” Obstetrics and gynecology vol. 94,2 (1999): 225-8. doi:10.1016/s0029-7844(99)00266-5.

  16. Merz, C Noel Bairey, et al. “Hypoestrogenemia of Hypothalamic Origin and Coronary Artery Disease in Premenopausal Women: a Report from the NHLBI-Sponsored WISE Study.” Journal of the American College of Cardiology, Elsevier, 1 Feb. 2003, www.sciencedirect.com/science/article/pii/S0735109702027638.

  17. Emma O'Donnell, Jack M. Goodman, Paula J. Harvey, Cardiovascular Consequences of Ovarian Disruption: A Focus on Functional Hypothalamic Amenorrhea in Physically Active Women, The Journal of Clinical Endocrinology & Metabolism, Volume 96, Issue 12, 1 December 2011, Pages 3638–3648, https://doi.org/10.1210/jc.2011-1223.

  18. Scott, Erin et al. “Estrogen neuroprotection and the critical period hypothesis.” Frontiers in neuroendocrinology vol. 33,1 (2012): 85-104. doi:10.1016/j.yfrne.2011.10.001.

  19. Khosla, Sundeep et al. “The unitary model for estrogen deficiency and the pathogenesis of osteoporosis: is a revision needed?.” Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research vol. 26,3 (2011): 441-51. doi:10.1002/jbmr.262.

  20. Clarke, Bart L, and Sundeep Khosla. “Female reproductive system and bone.” Archives of biochemistry and biophysics vol. 503,1 (2010): 118-28. doi:10.1016/j.abb.2010.07.006.

  21. Scott, Erin et al. “Estrogen neuroprotection and the critical period hypothesis.” Frontiers in neuroendocrinology vol. 33,1 (2012): 85-104. doi:10.1016/j.yfrne.2011.10.001.

  22. Vegeto, Elisabetta et al. “Estrogen anti-inflammatory activity in brain: a therapeutic opportunity for menopause and neurodegenerative diseases.” Frontiers in neuroendocrinology vol. 29,4 (2008): 507-19. doi:10.1016/j.yfrne.2008.04.001.

  23. Gibson, J H et al. “Determinants of bone density and prevalence of osteopenia among female runners in their second to seventh decades of age.” Bone vol. 26,6 (2000): 591-8. doi:10.1016/s8756-3282(00)00274-x.

  24. Karen K. Miller, Ellen E. Lee, Elizabeth A. Lawson, Madhusmita Misra, Jennifer Minihan, Steven K. Grinspoon, Suzanne Gleysteen, Diane Mickley, David Herzog, Anne Klibanski, Determinants of Skeletal Loss and Recovery in Anorexia Nervosa, The Journal of Clinical Endocrinology & Metabolism, Volume 91, Issue 8, 1 August 2006, Pages 2931–2937, https://doi.org/10.1210/jc.2005-2818.

  25. Karen K. Miller, Ellen E. Lee, Elizabeth A. Lawson, Madhusmita Misra, Jennifer Minihan, Steven K. Grinspoon, Suzanne Gleysteen, Diane Mickley, David Herzog, Anne Klibanski, Determinants of Skeletal Loss and Recovery in Anorexia Nervosa, The Journal of Clinical Endocrinology & Metabolism, Volume 91, Issue 8, 1 August 2006, Pages 2931–2937, https://doi.org/10.1210/jc.2005-2818.

  26. Misra, Madhusmita et al. “Weight gain and restoration of menses as predictors of bone mineral density change in adolescent girls with anorexia nervosa-1.” The Journal of clinical endocrinology and metabolism vol. 93,4 (2008): 1231-7. doi:10.1210/jc.2007-1434.

  27. Schulze, U.M., Schuler, S., Schlamp, D. et al. Bone mineral density in partially recovered early onset anorexic patients - a follow-up investigation. Child Adolesc Psychiatry Ment Health 4, 20 (2010). https://doi.org/10.1186/1753-2000-4-20.

  28. Catherine M. Gordon, Kathryn E. Ackerman, Sarah L. Berga, Jay R. Kaplan, George Mastorakos, Madhusmita Misra, M. Hassan Murad, Nanette F. Santoro, Michelle P. Warren, Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 5, 1 May 2017, Pages 1413–1439, https://doi.org/10.1210/jc.2017-00131.

  29. Gordon, Catherine M et al. “Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline.” The Journal of clinical endocrinology and metabolism vol. 102,5 (2017): 1413-1439. doi:10.1210/jc.2017-00131.

  30. “Too Much of a Good Thing - Exercise Associated Amenorrhea.” Epigee.org, www.epigee.org/exercise-associated-amenorrhea-late-period.html.

  31. Black, Ryan. “Endocrine Society Releases Guidelines for Functional Hypothalamic Amenorrhea.” HCP Live, 23 Mar. 2017, www.mdmag.com/conference-coverage/endo-2017/endocrine-society-releases-guidelines-for-functional-hypothalamic-amenorrhea.

  32.  Rinaldi, Nicola, et al. “A Guide to Diagnosing Hypothalamic Amenorrhea vs. PCOS.” By the Authors of No Period. Now What?, edrdpro.com/wp-content/uploads/2018/01/Diagnosing_PCOS_vs_HA.pdf.

  33. Gordon, Catherine M et al. “Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline.” The Journal of clinical endocrinology and metabolism vol. 102,5 (2017): 1413-1439. doi:10.1210/jc.2017-00131.

  34. Catherine M. Gordon, Kathryn E. Ackerman, Sarah L. Berga, Jay R. Kaplan, George Mastorakos, Madhusmita Misra, M. Hassan Murad, Nanette F. Santoro, Michelle P. Warren, Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 5, 1 May 2017, Pages 1413–1439, https://doi.org/10.1210/jc.2017-00131.

  35. Bearden, Caroline Young. “Clinical Nutrition: Functional Hypothalamic Amenorrhea - Today's Dietitian Magazine.” Today's Dietitian, Aug. 2017, www.todaysdietitian.com/newarchives/0817p12.shtml.

  36. Barbieri, Robert L, and David A Ehrmann. “Patient Education: Polycystic Ovary Syndrome (PCOS) (Beyond the Basics).” UpToDate, Mar. 2020, www.uptodate.com/contents/polycystic-ovary-syndrome-pcos-beyond-the-basics.

  37. Harrar, Sari. “Polycystic Ovary Syndrome (PCOS): How Is It Diagnosed?” EndocrineWeb, www.endocrineweb.com/conditions/polycystic-ovary-syndrome-pcos/polycystic-ovary-syndrome-pcos-how-it-diagnosed.

  38. De Leo, V et al. “Genetic, hormonal and metabolic aspects of PCOS: an update.” Reproductive biology and endocrinology : RB&E vol. 14,1 38. 16 Jul. 2016, doi:10.1186/s12958-016-0173-x

  39. Watson, Stephanie. “Polycystic Ovary Syndrome (PCOS): Symptoms, Causes, and Treatment.” Healthline, Healthline Media, 29 Mar. 2019, www.healthline.com/health/polycystic-ovary-disease.

  40. “Polycystic Ovary Syndrome.” Womenshealth.gov, Office on Women's Health, 1 Apr. 2019, www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome.

  41. Department of Health & Human Services. “Polycystic Ovarian Syndrome (PCOS).” Better Health Channel, Department of Health & Human Services, 28 Feb. 2015, www.betterhealth.vic.gov.au/health/conditionsandtreatments/polycystic-ovarian-syndrome-pcos.