Affecting 10-15% women of reproductive ages, polycystic ovarian syndrome (PCOS) is an endocrine and metabolic disorder characterized by multiple cysts surrounding the ovaries. These cysts are often benign, with a small chance of becoming malignant. Phenotypes of PCOS may include high levels of androgen, obesity, irregularities in menstrual cycles, and infertility caused by lack of ovulation. PCOS is also known to be associated with insulin resistance, having an increased risk of type 2 diabetes. 

PCOS symptoms & current treatments

Affected women with higher levels of androgen may show distinguished characteristics, such as excessive facial and body hair growth, acne, balding, or increased muscle mass. Irregularities in menstrual cycles may vary from having no periods to having intermittent periods with heavier flows and longer gaps in between cycles. Women with PCOS may be either obese or lean, but excess androgens are thought to promote visceral adiposity, which is strongly correlated with insulin resistance. In turn, obesity is known to exacerbate PCOS phenotypes.

Due to this, primary treatment for obese women with PCOS is weight loss. However, whether obese or lean, all women with PCOS are encouraged to pursue a lifestyle that incorporates a well-balanced nutritional diet and routine physical activity. Other goals of PCOS treatments include facilitating controlled menstruation, hormonal balance, and fertility. Birth control pills are targeted to regulate hormones and to restore menstrual cycles, while metformin can be prescribed to improve insulin resistance.

Benefits of keto for PCOS – overview of studies from 2020 & 2021

Since ketogenic diet is among the favored dietary interventions for weight loss, studies continue to investigate the benefits of ketogenic diet for women with PCOS. A study published in 2020 showed a significant reduction of blood glucose and insulin levels, along with improvements in insulin resistance, in obese women with PCOS who underwent a ketogenic Mediterranean diet for 12 consecutive weeks. These women also showed decreases in BMI and visceral adipose tissue measurements and improvements in different hormonal levels, including, but not limited to testosterone, estradiol, progesterone, and LH/FSH ratio.

Another controlled pilot trial study published in 2021 compared two groups of obese women with PCOS and existing liver dysfunction. One group received ketogenic diet while the control group received conventional pharmacological treatment aimed towards improving liver damage and regulating menstruation. The 8 women who completed the ketogenic diet for 12 weeks showed a significant reduction of weight and blood glucose, improvements in body composition, menstrual cycles, plasma estradiol, and progesterone levels after completion. In addition, they had significant signs of improved liver function and decreased indications of a fatty liver compared to the control group. It should be noted that both studies had small sample sizes of participants.

A low-carb, low-caloric ketogenic diet seems to be a promising therapeutic option that is able to address many concerns of PCOS. It is advised that therapeutic ketogenic diets involve consumption of a wide variety of nutrients and frequent monitoring of blood ketone levels for safety.