Dietary Management of Polycystic Ovary Syndrome (PCOS)

By Neelakshi Singh, RD | Nourish Intelligently
Understanding PCOS and the Role of Nutrition

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting women of reproductive age, characterised by menstrual irregularities, hyperandrogenism and polycystic ovarian morphology. Beyond reproductive issues, PCOS is associated with metabolic and cardiovascular risk factors such as insulin resistance, dyslipidaemia, obesity and increased risk of type 2 diabetes mellitus. Given the metabolic underpinnings of PCOS, diet and lifestyle interventions are considered first‑line strategies to improve insulin sensitivity, restore hormonal balance and reduce long‑term comorbidities.

Overview of PCOS Pathophysiology and Dietary Implications

Insulin resistance (IR) is a hallmark in many women with PCOS, which may occur in lean as well as overweight individuals. Elevated insulin levels reduce sex‑hormone‑binding globulin (SHBG), thereby increasing free androgen levels. High androgens can disrupt ovulation, follicular development and lead to hirsutism, acne and irregular menses. Low‑grade chronic inflammation and altered adipokine profiles further impair insulin sensitivity and endothelial health.

Evidence‑Based Dietary Strategies for PCOS

1. Energy restriction and weight management: Modest weight loss (5‑10 %, if needed) is associated with improved ovulation, insulin sensitivity and hormonal balance.
2. Low glycaemic index diets: Emphasise whole grains, legumes, fibre‑rich vegetables.
3. Mediterranean/anti‑inflammatory pattern: Rich in olive oil, omega‑3 fats, fruits and vegetables.
4. Macronutrient composition: Balanced protein, quality fats, controlled carbohydrate intake.
5. Emerging evidence: Intermittent fasting, ketogenic diet, vitamin D and inositol supplementation may show benefits.

Practical Dietary Recommendations for PCOS

Include: high‑fibre foods, lean proteins, healthy fats, colourful fruits and vegetables.
Limit: refined carbs, sugary foods, saturated and trans fats, processed meats.
Encourage: physical activity, behavioural support, stress and sleep management.

Tailoring Nutrition for Indian Context

Prioritise traditional fibre‑rich staples like millets, legumes and whole wheat; use healthy oils such as olive or rice‑bran; encourage local vegetables and fruits with low GI. Limit deep‑fried and sugary snacks.

Conclusion

Dietary and lifestyle interventions are central to managing PCOS. Healthy eating patterns such as low‑GI and Mediterranean‑style diets improve insulin resistance, hormonal balance and quality of life. The approach should be individualised, culturally appropriate and sustainable.

References
  1. Herbert S, Woolf K. Moving beyond Weight: A Narrative Review of the Dietary and Lifestyle Management for Reducing Cardiometabolic Risk in Polycystic Ovary Syndrome (PCOS). Nutrients. 2023.
  2. Eshaghhosseiny N, et al. The effects of ketogenic diet on metabolic and hormonal parameters in PCOS: a systematic review. J Diabetes Metab Disord. 2024.
  3. International evidence‑based guideline for the assessment and management of PCOS. Fertil Steril. 2023.
  4. Nutritional Management of PCOS: A Review. Biomed Pharmacol J. 2024.
  5. Effect of intermittent fasting on insulin and hormonal markers in PCOS. Front Nutr. 2024.