11/02/2026
Polycystic o***y syndrome (PCOS) is a common endocrine disorder linked to insulin resistance, weight gain, and reproductive hormone imbalance. While dietary modification is a key part of management, the optimal approach to lifestyle interventions remains unclear and no one approach suits everyone. The recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic O***y Syndrome emphasise the role of healthy lifestyle behaviours encompassing healthy eating and/or physical activity for all women with PCOS to optimise general health, quality of life, body composition, and weight management (maintaining weight, preventing weight gain, and/or modest weight loss).
The guidelines recommend that lifestyle management goals and priorities should be co-developed in partnership with women with PCOS and value women's individualised preferences and that there are benefits to a healthy lifestyle even in the absence of weight loss. Healthcare professionals should be aware of weight stigma when discussing lifestyle management with women with PCOS.
When it comes to specific dietary interventions, the guidelines recommend that healthcare professionals and women should consider that there is no evidence to support any 1 type of diet composition over another for anthropometric, metabolic, hormonal, reproductive, or psychological outcomes.
Any diet composition consistent with population guidelines for healthy eating will have health benefits and, within this, healthcare professionals should advise sustainable healthy eating tailored to individual preferences and goals. The guidelines recommend that barriers and facilitators to optimise engagement and adherence to dietary change should be discussed, including psychological factors, physical limitations, socioeconomic and sociocultural factors, and personal motivators for change. The value of broader family engagement should be considered. Referral to suitably trained allied healthcare professionals needs to be considered when women with PCOS need support with optimising their diet.
https://doi.org/10.1210/clinem/dgad463
Here is an interesting study - ‘The effects of ketogenic diet on polycystic o***y syndrome: A systematic review and meta-analysis’ from Elisavet Arsenaki et al. This was a systematic search of five databases (inception-February 2025) identifying studies reporting outcomes in women with PCOS following a ketogenic diet. Meta-analyses compared pre- and post-ketogenic diet outcomes (primary analysis) and ketogenic diet versus other diets (secondary analysis). Fifteen studies were included in the review, of which ten met the criteria for inclusion in the meta-analysis. Most participants in the included studies had a body mass index BMI exceeding 25 kg/m2. In the primary analysis, ketogenic diet led to significant reductions in BMI (MD: -3.38 kg/m2, 95 % CI: 2.53 to 4.23, I2 = 0 %), weight (MD: -10.77 kg, 95 % CI: 8.73 to 12.81, I2 = 0 %), and waist circumference (MD: -8.93 cm, 95 % CI: 5.66 to 12.19; I2 = 44 %). In the secondary analysis, ketogenic diet showed superior effects on BMI (MD: -1.65, 95 % CI: -2.76 to -0.55, I2 = 0 %) and weight loss (MD: -4.98, 95 % CI: -9.05 to -0.91, I2 = 7 %) as well as LH levels (MD 1.68, 95 % CI: -3.18 to -0.19, I2 = 30 %) and insulin resistance (MD: -1.71, 95 % CI: -2.98 to -0.43, I2 = 90 %) compared to other diets, though results for androgen and lipid parameters were inconsistent. Heterogeneity was high for most of the studied outcomes.
The authors concluded that the ketogenic diet appears to be a promising dietary intervention for improving weight, insulin sensitivity, and reproductive hormone profiles in women with PCOS and a BMI exceeding 25. Nonetheless, the considerable heterogeneity among included studies and variations in study quality warrant cautious interpretation of these findings. Further high-quality, long-term randomised controlled trials are needed to more definitively establish the efficacy and safety of the ketogenic diet in women with PCOS.
Well done to Elisavet and team for their continued hard work in researching this important topic.
https://pubmed.ncbi.nlm.nih.gov/41483483/
