Can the Keto Diet Reverse PCOS Symptoms?

Key Points

• The ketogenic diet, which entails eating very few carbs and high amounts of protein and fat, is a popular low-carb diet.
• Some evidence indicates reducing carbohydrate intake can help women with PCOS lose weight and manage symptoms, including irregular periods, excess hair growth and infertility.
• While diet can play a role in improving and managing PCOS, work with a team of healthcare providers to find a sustainable and practical dietary solution that works for you.

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Polycystic ovary syndrome (PCOS) can cause a variety of adverse effects, from irregular periods to depression and infertility. While there’s no cure, there are medications, surgery and lifestyle adjustments—including dietary changes—that can help alleviate symptoms and reduce the risk of complications.

Some research indicates the ketogenic diet, or keto diet as it is better known, and similar low-carb plans could be particularly beneficial for people with PCOS due to their impact on hormone levels. Could keto help you?

Is keto good for PCOS?

It’s generally best not to give credence to fad diets of any kind, but despite their trendiness, there may be some merit to low-carb plans, particularly for people with certain health conditions.

While the cause of PCOS is a mystery, most experts believe it stems from genetic and lifestyle factors that disrupt coordination between the brain, pituitary gland and ovaries. Most people with PCOS have some form of hormonal imbalance, which low-carb diets may improve.

For one, women with polycystic ovary syndrome tend to have unusually high androgen levels, according to the United Kingdom’s National Health Service (NHS). Although all people have androgens, this type of hormone is much more prevalent in people designated male at birth.

People with PCOS also tend to have higher levels of luteinizing hormone (LH) and low levels of sex hormone-binding globulin (SHBG), according to the NHS:

• LH usually stimulates ovulation, but too much could have the opposite effect.
• SHGB is a protein that helps keep androgen levels in check.

Additionally, women with polycystic ovary syndrome often have insulin resistance, meaning their body produces sufficient insulin—a hormone responsible for blood sugar regulation and fat storage—but can’t use it effectively, according to the Centers for Disease Control and Prevention (CDC).

Insulin resistance is also a hallmark of type 2 diabetes, which affects more than half of people with PCOS. Between 35 percent and 80 percent of people with PCOS have insulin resistance, according to a 2022 review published in the World Journal of Diabetes.

Evidence suggests low-carb diets, like the keto diet, may benefit people with metabolic syndrome and type 2 diabetes by improving insulin sensitivity and supporting fat loss, indicated a 2018 report.

The latter is important because excess adipose tissue can exacerbate insulin resistance and raise the risk of other health complications. Between 38 percent and 88 percent of women with PCOS are overweight or obese, according to a 2022 review published in the British Medical Bulletin.

Research on PCOS and ketosis have produced similar findings.

Low-carb diets may also help to restore balance in reproductive hormones, including androgens, LH and SHBG, indicated a 2023 meta-analysis published in the Journal of the Endocrine Society.

That may help alleviate several PCOS symptoms, such as irregular menstrual cycles and diminished fertility.

"Notably, there’s no evidence to suggest the keto diet has significant benefits over other low-carb diets, high-protein diets or intermittent fasting—all of which can stimulate ketosis and aid in weight loss," said Tiffany Pham, D.O., an OB-GYN in Houston and a medical advisor for the popular women's health app Flo.

Additionally, in most or all studies on the keto diet for PCOS, participants were asked to reduce carb and calorie intake, suggesting it’s the combination that’s effective, not cutting carbs alone.

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Should I eat less carbs if I have PCOS?

You're probably wondering, "Are carbs bad for me?" Sadly, it’s not that simple.

"Generally, doctors recommend people with PCOS eat fewer carbohydrates," said Meleen Chuang, M.D., a clinical associate professor in the department of obstetrics and gynecology at NYU Grossman School of Medicine in New York City.

"However, no diet or PCOS treatment plan is one-size fits all and not all carbs are created equal," Chuang said.

Women on keto typically consume fewer than 50 grams of carbohydrates per day. By contrast, most Americans eat more than 250 grams of carbs daily, which is too high for people with insulin resistance, according to Johns Hopkins Medicine.

There’s no standardized definition of a low-carb diet, but it’s generally considered to be anything below 130 grams per day—the Recommended Dietary Allowance (RDA) as defined by the Food and Nutrition Board.

"Rather than aiming for a specific number, however, it’s better to focus on the types of foods you’re consuming," said Chhaya Makhija, M.D., endocrinologist, founder of Unified Endocrine and Diabetes Care and assistant clinical professor at the University of California San Francisco in Fresno.

"Carbohydrates are found in several different foods, including grains, noodles, bread, vegetables, certain dairy products and fruit," Pham said. "These foods contain different types of carbs and are not all inherently 'bad.' Demonizing an entire food group can create more fear around eating and can promote restrictive eating behaviors that can be quite common within the PCOS patient population."

Restrictive behaviors can contribute to eating disorders, such as binge eating disorder (BED) and bulimia, which are prevalent among women with polycystic ovary syndrome, she said.

Additionally, complex carbs, such as fiber, are a crucial part of a healthy diet. These are present in fruits, vegetables, whole grains, nuts, seeds, beans and legumes.

When sugar is accompanied by its inherent fiber (as in whole fruits and vegetables), up to 30 percent of it is metabolized by microbes in the gut rather than being absorbed in the bloodstream, according to the Royal Society of New Zealand.

There, it can help to improve microbial diversity and prevent disease. Also, because complex carbs take longer to digest, they don’t cause the same spike in blood sugar as simple carbs, such as processed sugars and flour.

"Plus, diets high in animal fat, including some variations of keto, raise levels of harmful LDL cholesterol, which can increase the risk of conditions such as heart disease and high blood pressure," Makhija said.

"Many women with polycystic ovary syndrome are already more vulnerable to these conditions due to [being] overweight or obesity," Makhija added.

"Moreover, research indicates severely restrictive diets aren’t sustainable in the long-term," Pham said.

"For those interested in losing weight and keeping it off, trying a low-carb diet for a few weeks—alongside exercise—can be an effective, safe way to jumpstart progress," Makhija said.

"After that, it’s best to adopt a more flexible eating method focusing on nourishment and healing. Ideally, this should include a variety of nutrient-dense foods—primarily plants, healthy fats and lean proteins—with minimal ultra processed foods (UPFs) and other sources of simple carbs and trans fats. Plans such as the Mediterranean diet and plant-based diet embody this approach."

Throughout the process, it’s essential to work with a healthcare professional who can tailor a plan to your individual needs, Makhija emphasized.

Does the keto diet mess with female hormones?

"Higher insulin levels can lead to increased LH and follicle-stimulating hormone (FSH) production," Pham said.

FSH stimulates follicles on the ovaries to grow and prepare eggs for ovulation.

"When the body produces significantly more LH than FSH, hormone dysfunctions that cause irregular periods and a lack of ovulation can occur," she added.

"By reducing insulin levels and improving insulin sensitivity," Chuang said. "A diet low in refined, processed carbs may help to restore balance in reproductive hormones, including LH, FSH, SHGB and testosterone."

Fat loss may also help to regulate estrogen levels, which may be abnormally high in postmenopausal people with obesity, according to a 2020 review published in Pulmonary Circulation. Excess estrogen may contribute to certain cancers, including breast and uterine cancer, among other conditions.

How does keto help PCOS?

Research suggests eating a low-carb diet for PCOS could help in a few ways, including supporting a healthy body composition, reducing insulin resistance and balancing reproductive hormone levels.

Here are the top four potential benefits of a diet low in carbs:

1. Boosts insulin sensitivity

"When you eat, your digestive system breaks down carbohydrates into glucose, or sugar, which enters the bloodstream," Pham said. "When blood sugar levels rise, the pancreas produces insulin which acts as a bridge to deliver glucose to cells and tissues. These cells and tissues use glucose as fuel, like gasoline in a car."

Leftover glucose is stored as glycogen in the liver or muscles or as a lipid in fat tissue.

"If blood sugar levels are consistently high, the pancreas may overproduce insulin," Pham said. "That can cause the cells and tissues to become less sensitive or responsive to insulin, causing sugar to accumulate in the bloodstream rather than fueling the cells and tissues that need it."

Obesity can worsen insulin resistance by causing widespread inflammation that prevents cells and tissues from using insulin effectively, she noted.

Low carb diets and those that involve calorie restriction—such as intermittent fasting—can force the body into ketosis, a metabolic state in which it must burn fat instead of carbohydrates for energy.

"This can improve a person’s insulin sensitivity, or how the muscle, liver and fat cells use fuel with less insulin circulating in the blood," Makhija said.

2. Reduces androgen levels

"Insulin resistance can also increase levels of androgens, such as testosterone," Chuang said. "This can contribute to multiple symptoms, including infertility, excess facial and body hair growth, acne and hair loss from the scalp."

"Insulin encourages the ovaries and adrenal glands to produce more testosterone," Pham said. "Additionally, higher levels of the female hormone LH act on the ovaries to overproduce testosterone."

By reducing insulin levels and normalizing LH production, low-carb diets may help to manage testosterone levels and alleviate related symptoms, Chuang noted.

3. Supports losing weight

"Weight management is important in women with PCOS because the condition is often associated with weight gain and difficulty losing weight," Chuang said.

Eating a balanced diet low in ultra-processed foods, refined carbs and saturated fats can help maintain a healthy body composition, Makhija added.

Besides improving metabolism and insulin sensitivity, shedding excess pounds decreases visceral fat surrounding organs like the liver and pancreas. This type of fat is particularly problematic because it can contribute to conditions women with PCOS have a higher risk of developing, such as:

• Prediabetes
• Type 2 diabetes
• Hypertension
• Fatty liver disease
• Fertility difficulties
• Gestational diabetes

"By maintaining a healthy weight through diet and exercise, individuals with PCOS can help manage their symptoms and improve overall health," Chuang said.

"There’s just one caveat. Not everyone with PCOS has insulin resistance or is overweight, so it’s important to speak with a doctor for personalized guidance," Makhija said. "Women with PCOS who are already at an appropriate body mass index (BMI) and living a healthy lifestyle may not benefit from losing weight."

4. Improves PCOS fertility symptoms

PCOS is one of the leading causes of infertility among women of reproductive age, and about half of women struggling to become pregnant have the condition, indicated a 2015 report.

That’s primarily because of PCOS’ adverse effects on ovulation, Pham said.

Whereas most people who menstruate ovulate once a month, folks with PCOS may ovulate three to four times a year. This makes it more challenging to get pregnant since there are fewer opportunities for sperm to fertilize an egg.

Insulin resistance and resulting hormonal imbalances are usually responsible, and dietary changes may help, she and Chuang said.

A few studies have indicated low-carb diets could help to reverse PCOS fertility issues.

In addition to the 2023 meta-analysis, this includes a 2021 reportt in Frontiers in Endocrinology, which found carbohydrate restriction to be an "effective intervention" for improving fertility in women with PCOS, and a 2022 paper in Nutrients that found a very low-calorie, low-carb diet may improve metabolic and ovulatory function.

The bottom line

Everyone’s experience with PCOS is different, but many people with the condition find lifestyle changes beneficial. While some research supports using low-carb plans like the keto or carnivore diet for PCOS, these aren’t the only means to lose weight and manage symptoms—and they may not be sustainable long-term.

A less restrictive eating plan that emphasizes whole foods and minimizes refined carbs may be equally effective and easier to stick with, indicated a 2020 report.

"A number of studies show improvements in PCOS symptoms, ovulation, weight loss and overall health when patients are placed on diets like low-carb, keto, intermittent fasting, low glycemic index, etcetera. But these findings are mostly seen in the short term while participants are in the study and sticking to the diet," Chuang said.

"While diet can play a crucial role in improving and managing PCOS, it’s important to work with a team of healthcare providers to find a sustainable and practical dietary solution that works for you, which may reflect some of the principles in these studies."