Keto for PCOS: Can It Improve Fertility?  

Keto for PCOS has been a center for clinical studies in recent years due to its multiple benefits, specifically in regulating hormones and decreasing insulin resistance. This comprehensive article will discuss how keto helps PCOS and how it helps improve the symptoms.

Key Takeaways:

• PCOS is a hormonal disorder in women that causes infertility.
• Chronic inflammation, genetic factors, hormonal imbalance, and insulin resistance cause it.
• Common symptoms include irregular periods, infertility, obesity, masculine features, and mood changes. 
• Keto helps improve PCOS by regulating hormones, fixing insulin resistance, and promoting overall health. 
• By regulating hormone levels, keto helps resolve obesity, infertility, and masculine features and improves mood among women with PCOS. 

Table of Contents:

• What Is PCOS?
• How Does the Keto Diet Impact PCOS?
• How Does Keto Improve PCOS Symptoms?
• Should You Try the Keto Diet for PCOS?
• Frequently Asked Questions (FAQ)

What Is PCOS?

Polycystic Ovary Syndrome (PCOS)¹ is a hormonal disorder affecting around 8-13% of women throughout their reproductive years. It alters hormone levels and metabolism and is a primary cause of infertility.

Women with PCOS may not ovulate, produce too many male hormones (androgens), and have many small cysts on their ovaries.

Causes of PCOS include chronic inflammation, genetic factors, hormonal imbalances, and insulin resistance, resulting in different PCOS phenotypes:²

• Phenotype A: Hyperandrogenism, ovulatory dysfunction, and polycystic ovaries
• Phenotype B: Hyperandrogenism and ovulatory dysfunction.
• Phenotype C: Hyperandrogenism and polycystic ovaries.
• Phenotype D: Non-hyperandrogenic PCOS but with ovulatory dysfunction and polycystic ovaries.

PCOS manifests differently per individual. Some may experience more symptoms than others. Common symptoms include the following: 

• Irregular periods
• Infertility
• Acne
• Obesity, weight gain, or trouble reducing weight
• Mood changes
• Masculine features
• Excessive body hair or hair loss and balding
• Discoloration or darkening of skin

Although the exact cause and cure are still unclear, PCOS is manageable with a diet like the keto diet and different treatment routes, including fertility treatments and surgical options.

How Does the Keto Diet Impact PCOS?

Hormones

The keto diet regulates hormones in PCOS. The LH/FSH ratio typically ranges between 1 and 2 in healthy women, but in polycystic ovary disease patients, it can reach 2 or 3,³ preventing ovulation. 

This abnormal hormone ratio also increases androgens, resulting in masculine features in women. Studies also confirm that this ratio causes obesity.⁴ 

The keto diet helps reduce the LF/FSH ratio in PCOS, reversing it to normal.

For instance, this 2023 study on a 45-day keto diet⁵ resulted in reduced LH/FSH ratio, serum-free testosterone, and increased serum sex hormone binding globulin. 

Insulin Resistance

The keto diet induces ketosis, a state where the body uses fat as energy,⁶ which ultimately decreases insulin resistance. Insulin is a hormone that regulates your blood sugar levels and plays a role in fat storage.⁷ 

But if you have insulin resistance, your body creates more insulin to cater to the lack of response, leading to increased fat storage, then obesity. 

This is where keto for PCOS helps. By reducing carbohydrate intake, your insulin levels drop, signaling your body to use fat for energy, eventually leading to better insulin sensitivity.

In a 2005 study, 11 women with PCOS started a keto diet,⁸ taking less than 20 grams of carbs per day for 24 weeks, and ended up with a decrease of 12% in body weight, 22% in testosterone, 36% in LH/FSH ratio, and 54% in fasting insulin.

Another 45-day keto study also reports decreased blood glucose and insulin levels and an improved insulin resistance score.⁹ 

Other studies suggest that a very low-carb diet immediately improves insulin resistance,¹⁰ in as early as seven days, making keto a fast and effective way to cure PCOS symptoms. 

Other Effects

Studies have shown that the keto diet can improve weight, hormone levels, liver function, blood lipids, menstrual regularity, and fertility. 

In a 12-week study, participants lost an average of 21 pounds¹¹ and showed improvements in triglyceride and cholesterol levels. 

In a 45-day study, participants lost an average of 21 pounds and reduced their fat mass and waist-hip ratio.⁹ They also experienced a drop in testosterone, triglyceride, total cholesterol, and LDL cholesterol while increasing HDL cholesterol. 

Additionally, 5 of 17 participants in this study experienced a return to menstruation, improved regularity, and pregnancy.

How Does Keto Improve PCOS Symptoms?

Aids Weight Loss

This weight gain is most likely due to insulin resistance, where there is an increase in insulin, encouraging fat storage. Moreover, irregular estrogen levels also result in fat storage and weight gain. 

Keto helps with both insulin resistance and regulating estrogen levels, resulting in weight loss in as early as 4 weeks. Studies suggest that weight loss in PCOS is associated with improved metabolic, endocrine, reproductive, cardiovascular, and psychological features.¹² 

Helps With Infertility

The hormonal imbalance in PCOS interferes with the ovary’s ability to grow and release eggs. If there’s no egg released (no ovulation), a woman cannot get pregnant. 

In this study of 17 participants with PCOS doing a 45-day keto diet,⁹ 5 experienced a menstrual cycle after not having one for years, 12 reported more regular cycles, and 5 became pregnant after prior unsuccessful attempts. 

Prevents Masculine Features

Masculine features, acne, and excessive hair loss in PCOS women are due to high levels of testosterone.¹³ Studies show that keto decreases serum levels of free testosterone,⁵ which will help resolve these symptoms. 

Improves Mood

Due to hormonal imbalance, women with PCOS are prone to having mood swings, depression, or anxiety. These emotions are mainly effects of obesity, hirsutism, and infertility, leading to low self-esteem.¹⁴

Keto’s ability to regulate hormones, promote weight loss, and help resolve infertility ultimately leads to better self-esteem. 

Should You Try the Keto Diet for PCOS?

The keto diet is a natural yet effective way to help resolve PCOS. It has been proven effective through thorough scientific studies, with lesser risks than medicinal routes. While it can be restrictive, keto’s promise to improve PCOS outweighs this challenge. 

Frequently Asked Questions (FAQ)

References

¹Rasquin LI, Anastasopoulou C, Mayrin JV. Polycystic Ovarian Disease. [Updated 2022 Nov 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459251/

²Sachdeva, G., Gainder, S., Suri, V., Sachdeva, N., & Chopra, S. (2019). Comparison of the Different PCOS Phenotypes Based on Clinical Metabolic, and Hormonal Profile, and their Response to Clomiphene. Indian Journal of Endocrinology and Metabolism, 23(3), 326-331. https://doi.org/10.4103/ijem.IJEM_30_19

³Saadia, Z. (2020). Follicle Stimulating Hormone (LH: FSH) Ratio in Polycystic Ovary Syndrome (PCOS) – Obese vs. Non- Obese Women. Medical Archives, 74(4), 289-293. https://doi.org/10.5455/medarh.2020.74.289-293

⁴Esmaeilzadeh, S., Andarieh, M. G., Ghadimi, R., & Delavar, M. A. (2014). Body mass index and gonadotropin hormones (LH & FSH) associate with clinical symptoms among women with polycystic ovary syndrome. Global journal of health science, 7(2), 101–106. https://doi.org/10.5539/gjhs.v7n2p101

⁵Khalid, K., Apparow, S., Mushaddik, I. L., Anuar, A., A Rizvi, S. A., & Habib, A. (2023). Effects of Ketogenic Diet on Reproductive Hormones in Women With Polycystic Ovary Syndrome. Journal of the Endocrine Society, 7(10). https://doi.org/10.1210/jendso/bvad112

⁶Dhillon KK, Gupta S. Biochemistry, Ketogenesis. [Updated 2023 Feb 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493179/

⁷Vargas E, Joy NV, Carrillo Sepulveda MA. Biochemistry, Insulin Metabolic Effects. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525983/

⁸Mavropoulos, J. C., Yancy, W. S., Hepburn, J., & Westman, E. C. (2005). The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: A pilot study. Nutrition & Metabolism, 2, 35. https://doi.org/10.1186/1743-7075-2-35

⁹Cincione, R. I., Losavio, F., Ciolli, F., Valenzano, A., Cibelli, G., Messina, G., & Polito, R. (2021). Effects of Mixed of a Ketogenic Diet in Overweight and Obese Women with Polycystic Ovary Syndrome. International Journal of Environmental Research and Public Health, 18(23). https://doi.org/10.3390/ijerph182312490

¹⁰Markovic, T. P., Jenkins, A. B., Campbell, L. V., Furler, S. M., Kraegen, E. W., & Chisholm, D. J. (1998). The determinants of glycemic responses to diet restriction and weight loss in obesity and NIDDM. Diabetes care, 21(5), 687–694. https://doi.org/10.2337/diacare.21.5.687

¹¹Paoli, A., Mancin, L., Giacona, M. C., Bianco, A., & Caprio, M. (2020). Effects of a ketogenic diet in overweight women with polycystic ovary syndrome. Journal of translational medicine, 18(1), 104. https://doi.org/10.1186/s12967-020-02277-0

¹²Ozgen Saydam, B., & Yildiz, B. O. (2021). Weight management strategies for patients with PCOS: current perspectives. Expert review of endocrinology & metabolism, 16(2), 49–62. https://doi.org/10.1080/17446651.2021.1896966

¹³Grymowicz, M., Rudnicka, E., Podfigurna, A., Napierala, P., Smolarczyk, R., Smolarczyk, K., & Meczekalski, B. (2020). Hormonal Effects on Hair Follicles. International Journal of Molecular Sciences, 21(15). https://doi.org/10.3390/ijms21155342

¹⁴BALIKCI, A., ERDEM, M., KESKIN, U., ZINCIR, S. B., GÜLSÜN, M., ÖZÇELIK, F., AKGÜL, E. Ö., AKARSU, S., ÖZTOSUN, M., & ERGÜN, A. (2014). Depression, Anxiety, and Anger in Patients with Polycystic Ovary Syndrome. Nöro Psikiyatri Arşivi, 51(4), 328-333. https://doi.org/10.5152/npa.2014.6898