PCOS and Keto

Reviewed by Karla Vanessa T. Santos, BSN, RN, Maternity and Pediatrics OR Nurse

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that affects women of child-bearing age. There’s no definitive answer yet as to how women develop PCOS in the first place, but research has shown that many factors including diet, stress, and genetics may play a role.

“Although the pathogenesis of PCOS remains unclear, the syndrome appears to involve environmental and genetic components. Starting from early life and extending throughout the lifecycle, environmental insults may affect susceptible women who finally demonstrate the clinical phenotype of PCOS. Diet emerges as the major environmental determinant of PCOS. Overnutrition leading to obesity is widely recognized to have an aggravating impact, while another detrimental dietary factor may be the high content of food in advanced glycated end products (AGEs).”

Diamanti-Kandarakis E (2012)

What we do know is that women with PCOS have insulin resistance and high levels of androgen. Insulin is the hormone responsible for how our body converts food to energy. Insulin-resistance means the body does not convert food to energy efficiently, which often results in weight gain.

Androgens are hormones responsible for male-traits, although women normally produce them in small quantities. When our bodies are always stressed and in “fight” mode, it produces white blood cells to fight off infection. This low-grade inflammation can also cause the ovaries to produce excess Androgens. This hormonal imbalance can disrupt the menstrual cycle by stunting the development of egg-producing follicles.

How Do You Know If You Have PCOS?

The best way to confirm if you have a PCOS is through a Transvaginal Ultrasound. If you do have PCOS, the scan will show these black “cysts” around your ovary. They’re not really cysts, but fluid-filled follicles. They vary in sizes and number but ultimately, they do not fully develop to successfully release an egg. So no egg, no fertilization.

Common Symptoms

Women with PCOS may exhibit the following symptoms:

  • Acne: this is the most visible sign of PCOS, usually they manifest as painful cystic acne on the face, back and chest area.
  • Skin Abnormalities: PCOS sufferers will notice skin tags, milia, skin darkening under their breasts, on their neck and on their groin.
  • Weight Gain: It is difficult to lose weight even on a caloric deficit.
  • Hirsutism: Women with PCOS will notice abnormal hair growth on their chin, cheeks and upper lip.
  • Male-Pattern Baldness: Hair thins out or falls off around the scalp. Women will notice a lot of hair fall after showering or brushing their hair.
  • Irregular Periods: Their periods may come too often or more commonly delayed. Some women will not have periods for 100+ days.
  • Infertility: Most women with PCOS will have trouble ovulating or tracking their ovulation, which could result in difficulties conceiving.

Conventional Treatments

There’s no cure yet, but depending on what you want to accomplish, there are different ways to treat the symptoms of Polycystic Ovary Syndrome. For starters, your doctor will advise you to make lifestyle and diet changes. The most common advice is to go on a Low Carb diet to control your blood sugar.

If you want to control the symptoms but do not want to get pregnant, your OB-Gyn will most likely prescribe Metformin to control your blood sugar, and Contraceptive Pills to regulate your period. Not all pills are compatible with PCOS patients, so make sure to buy only what your doctor prescribes. If you experience any problems, talk to your doctor right away so that your medications can be adjusted. If Metformin makes you nauseous, ask for slow-release Metformin.

If you want to get pregnant, your OB-Gyn will ask you to undergo a series of tests to check for other fertility issues (like the condition of your Fallopian tubes or your partner’s sperm count and quality). Depending on the results, your doctor may prescribe Metformin and Duphaston first, to regulate your hormones.

If you don’t get results within 3 months, then your doctor may place you on a program that involves more medicine (e.g. Clomid, Puregon and Pregnyl) to stimulate your ovaries to release an egg. You will also have to track your ovulation through urine testing kits, vaginal thermometers, and even ultrasound to successfully time your intercourse. This program could take up to six months depending on your OB-Gyn’s assessment of your condition.

How Keto Can Help PCOS Patients

There is a relationship between what we eat, the way our body metabolizes food and hormonal balance. Research shows that excess sugar in our diet can drastically impact the hormonal balance in our bodies:

“Eating too much fructose and glucose can turn off the gene that regulates the levels of active testosterone and estrogen in the body, shows a new study in mice and human cell cultures published in the Journal of Clinical Investigation.”

Child & Family Research Institute (2007)

The Standard Ketogenic Diet promotes a healthy diet rich in naturally-sourced fat, moderate protein, and very low carbohydrates. We avoid sugar and sugar-substitutes that spike insulin levels. We also avoid inflammatory ingredients such as soy derivatives and high trans-fat oils like vegetable oil and canola oil. The less processed our food is, the easier for our bodies to break them down for nutrients. The more nutrient-dense our food, the better our bodies can function.

There are research studies being conducted on the effects of a Keto diet on women with PCOS, which are gleaning positive results.

“In this pilot study, a LCKD (Low Carb Ketogenic Diet) led to significant improvement in weight, percent free testosterone, LH/FSH ratio, and fasting insulin in women with obesity and PCOS over a 24 week period.”

Mavropoulos (2005)

Another study found:

“that reducing carbohydrate load can reduce circulating insulin levels, improve hormonal imbalance and resume ovulation to improve pregnancy rates compared to usual diet.”

McGrice (2017)

There are also numerous anecdotes from online forums where many PCOS sufferers report that their cycles improved when they started Keto, citing shorter cycles and menstrual periods. Some were able to conceive while doing Keto. If you plan on doing Keto, please consult your doctor to rule out any other illnesses that may require medication adjustments while doing a low carb diet.

What to Eat on Keto When You PCOS

You’ll need to make a few minor tweaks to your diet. Aside from strict Keto, you should focus on white meat like chicken and fish, instead of red meat. Use creams in moderation, and avoid inflammatory ingredients such a soy sauce, tofu, and other soy-based products. Avoid hydrogenated oils like Canola, Sunflower and Vegetable Oils.

Seeking Support

The information In this article is a simplified explanation of PCOS. If you would like to read more about this condition, please check the sources cited at the end of this article.

You can also join communities such as the subreddit: r/pcos and r/xxketo to talk to other women who are going through PCOS. If you’re looking for a Filipino community online, you may want to visit the Facebook group: “Keto and Intermittent Fasting International (K.I.F.I.)“.


Child & Family Research Institute. “Too Much Sugar Turns Off Gene That Controls Effects Of Sex Steroids.” ScienceDaily. ScienceDaily, 21 November 2007. <www.sciencedaily.com/releases/2007/11/071109171610.htm>.

Diamanti-Kandarakis, E, et al. “Phenotypes and Environmental Factors: Their Influence in PCOS.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, 2012, www.ncbi.nlm.nih.gov/pubmed/22229564.

Mavropoulos, John C et al. “The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study” Nutrition & metabolism vol. 2 35. 16 Dec. 2005, doi:10.1186/1743-7075-2-35

McGrice M, Porter J. The Effect of Low Carbohydrate Diets on Fertility Hormones and Outcomes in Overweight and Obese Women: A Systematic Review. Nutrients. 2017;9(3):204. Published 2017 Feb 27. doi:10.3390/nu9030204