INS and anovulation: In women with PCOS there is a deficiency in cyclic progesterone production due to chronic anovulation and a relative increase in other substances, such as insulin, cytokines, and growth factors, which results in an imbalance in endometrial hemostasis in these patients, possibly leading to abnormal uterine bleeding, infertility, and an increased risk of developing endometrial hyperplasia [3, 21–25].