Painful Periods With PCOS? Here’s Why It Might Not Be PCOS (And What To Investigate Instead)

Understanding PCOS Pain: Why Your Symptoms May Not Be What You Think

One of the most common things I hear from women is: “I’ve been told painful periods are part of PCOS.”

And I completely understand why people assume this, because PCOS is a hormonal condition, and painful periods are common in general… so it seems logical that the two go together.

But here’s the truth: PCOS doesn’t usually cause painful periods.

So if you have PCOS and you experience significant period pain, pain that stops you functioning, makes you dread your cycle, affects work, sleep or intimacy that deserves deeper investigation.

Because your pain may be coming from something else.

And the last thing you want is for your symptoms to be blamed on PCOS when there’s another condition underneath that needs proper care.

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What PCOS Is (and What It Isn’t)

PCOS (Polycystic Ovary Syndrome) is a hormonal and metabolic condition.

It’s commonly characterised by:

• irregular or absent periods

• signs of androgen excess (acne, hair growth, scalp hair thinning)

• polycystic ovaries on ultrasound (in some cases)

• insulin resistance (very common)

Symptoms can include:

• irregular cycles

• acne and oily skin

• excess facial/body hair

• weight gain or difficulty losing weight

• fertility challenges

• fatigue and cravings

PCOS impacts ovulation and hormone regulation.

But it does not typically cause the type of uterine changes that create severe period pain.

In fact, many women with PCOS experience:

• light periods

• painless periods

• long cycles

• missing periods

• 
  

So if your periods are painful it’s important to ask why.

Why Painful Periods Aren’t Usually Caused by PCOS

Period pain (dysmenorrhea) usually comes from:

• uterine contractions

• inflammation

• underlying pelvic conditions

Because PCOS is mainly a condition of ovulation disruption and hormonal imbalance, it usually doesn’t create the same mechanisms that cause severe cramping.

That’s why painful periods often point to something else, including:

Endometriosis

This is one of the most commonly missed causes of period pain.

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, often causing:

• severe period pain

• heavy bleeding

• pain with bowel movements

• pain with sex

• fertility challenges

Adenomyosis

Adenomyosis occurs when the uterine lining grows into the muscle wall of the uterus.

It can cause:

• painful, heavy periods

• deep pelvic aching

• clotting

• pressure and fatigue

Fibroids

Fibroids are non-cancerous growths in the uterus.

They can cause:

• heavy periods

• pelvic pressure

• pain

• bloating and discomfort

Pelvic Inflammatory Disease (PID)

Infection or inflammation in the reproductive organs can cause pain, including:

• pelvic pain

• pain during sex

• abnormal discharge

• fever (in some cases)

Ovarian cysts (not PCOS follicles)

PCOS follicles are not the same as ovarian cysts.

Some ovarian cysts can cause:

• sharp one-sided pelvic pain

• pain mid-cycle

• pain during sex

• 
  

The Most Important Message: Don’t Let Your Pain Be Dismissed as “Just PCOS”

This is where I get passionate.

Because it happens too often: A woman has PCOS on her file… and suddenly every symptom is blamed on PCOS.

That can lead to:

• delayed diagnosis of endometriosis or adenomyosis

• being told to “lose weight and come back”

• only being offered the pill instead of investigation

• feeling dismissed, unheard and exhausted

• 
  

I want you to know:Pain is not normal.And you deserve proper answers.

Signs Your Pain Needs Further Investigation

If any of these feel familiar, it’s worth exploring deeper causes:

• pain that makes you miss work/school/social events

• pain that doesn’t respond to basic pain relief

• pain that worsens over time

• pain during sex

• bowel pain during your cycle

• heavy bleeding or clotting

• pain outside of your period

What To Do If You Have PCOS and Painful Periods

Here are the practical steps I recommend:

1) Track your pain and cycle symptoms

Keep notes on:

• timing (before/after period, ovulation, daily pain)

• intensity (out of 10)

• bleeding patterns

• clots, bowel changes, fatigue, nausea

• pain during sex or bowel movements

Tracking gives you evidence and clarity and helps you advocate for yourself.

2) Request proper investigation

Depending on symptoms, your GP or specialist may recommend:

• pelvic ultrasound

• internal ultrasound

• MRI (especially for adenomyosis)

• bloods (to rule out other causes)

  
  

If endometriosis is suspected, diagnosis may require:

• laparoscopy (keyhole surgery)

3) Seek the right practitioner

If you feel dismissed, it is okay to seek another opinion.

A gynaecologist with experience in:

• endometriosis

• pelvic pain

• fertility and hormone conditions can make a huge difference in getting the right support.

4) Support inflammation and hormone balance (without ignoring the root cause)

Lifestyle support can still be beneficial:

• anti-inflammatory whole food nutrition

• nervous system regulation and stress support

• blood sugar balancing

• gut support

But I want to be clear: Lifestyle change doesn’t replace investigation if pain is severe. It should support your body while you pursue answers.

When to Seek Urgent Medical Help

Seek urgent care if you experience:

• sudden severe pelvic pain

• heavy bleeding soaking through pads/tampons within an hour

• fever, vomiting, or signs of infection

• fainting or dizziness with pain

These can indicate an emergency.

Final Thoughts

PCOS does not usually cause painful periods.

So if you have been told your pain is “just PCOS,” please know:You are allowed to question that. You are allowed to investigate further.And you deserve proper care.

Pain is a sign and not something to normalise.

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If you have PCOS and painful periods and you feel unsure whether your symptoms are being properly investigated, I can help you get clarity.

Book a FREE Naturopathic PCOS Assessment Call and we’ll map out what your symptoms may be pointing to, what testing or referrals are worth considering, and how to support inflammation and hormone balance alongside medical investigation.