A Narrative Review of Dietary Impacts on Glycemic Control and Sex Hormones in Women with Polycystic Ovary Syndrome (PCOS)
Subject Areas :Hadis S. Mansouri 1 , Rozhin Dehghan 2 , Zeinab Taleb 3 , Golshan Ghaffari 4 , Paria Jadidi 5
1 - Department of Nutrition, SR.C., Islamic Azad University, Tehran, Iran
2 - Department of Nutrition, SR.C., Islamic Azad University, Tehran, Iran
3 - Department of Nutrition, SR.C., Islamic Azad University, Tehran, Iran
4 - Department of Nutrition, SR.C., Islamic Azad University, Tehran, Iran
5 - Department of Nutrition, SR.C., Islamic Azad University, Tehran, Iran
Keywords: DASH diet, ketogenic diet, fasting diet, high-protein diet, Polycystic ovary syndrome,
Abstract :
Background and objective: Polycystic ovary syndrome (PCOS) is an endocrine disorder that causes metabolic and reproductive disorders in women of reproductive age. Women with PCOS are at increased risk of type 2 diabetes, obesity, and cardiovascular disease. There is still no definitive agreement on the most effective type of dietary modification for the prevention and treatment of PCOS. The aim of this study was to investigate and compare the effects of different diets on hormonal status and metabolic indices in women with PCOS. Method: A search of references was conducted across four databases up to the year 2025. In total, 20 studies were included in this review. Results: This study showed that calorie-restricted DASH and ketogenic diets can have positive effects on glycemic indices and sex hormones in women with PCOS. Fasting diets are also likely to be useful in the management of this condition. High-protein diets did not show significant differences in terms of blood glucose control parameters and sex hormones compared to the control diet. Conclusions: However, the available number of RCTs is insufficient to draw definitive conclusions about the association between diet and PCOS in women. Therefore, more carefully designed interventional studies are needed to assess the true role of dietary patterns in PCOS.
1.McCartney CR, Marshall JC. Polycystic ovary syndrome. New England Journal of Medicine. 2016;375(1):54–64.
2.ESHRE TR, Group A-SPCW. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and sterility. 2004;81(1):19–25.
3.Hoeger KM, Dokras A, Piltonen T. Update on PCOS: consequences, challenges, and guiding treatment. The Journal of Clinical Endocrinology & Metabolism. 2021;106(3):e1071–e83.
4. Azziz R, Carmina E, Chen Z, Dunaif A, Laven JS, Legro RS, et al. Polycystic ovary syndrome. Nature reviews Disease primers. 2016;2(1):1–18.
5. Teede H, Deeks A, Moran L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC medicine. 2010;8:1–10.
6. Dumesic DA, Oberfield SE, Stener-Victorin E, Marshall JC, Laven JS, Legro RS. Scientific statement on the diagnostic criteria, epidemiology, pathophysiology, and molecular genetics of polycystic ovary syndrome. Endocrine reviews. 2015;36(5):487–525.
7. Reaven GM. The metabolic syndrome: requiescat in pace. Clinical chemistry. 2005;51(6):931–8.
8. Szczuko M, Skowronek M, Zapalowska-Chwyc M, Starczewski A. Quantitative assessment of nutrition in patients with polycystic ovary syndrome (PCOS). Roczniki państwowego zakładu higieny. 2016;67(4).
9. Makki K, Froguel P, Wolowczuk I. Adipose tissue in obesity‐related inflammation and insulin resistance: cells, cytokines, and chemokines. International Scholarly Research Notices. 2013;2013(1):139239.
10.Viollet B, Guigas B, Garcia NS, Leclerc J, Foretz M, Andreelli F. Cellular and molecular mechanisms of metformin: an overview. Clinical science. 2012;122(6):253–70.
11.Sam S, Ehrmann DA. Metformin therapy for the reproductive and metabolic consequences of polycystic ovary syndrome. Diabetologia. 2017;60(9):1656–61.
12.Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human reproduction. 2018;33(9):1602–18.
13.Trost SG, Owen N, Bauman AE, Sallis JF, Brown W. Correlates of adults’ participation in physical activity: review and update. Medicine & science in sports & exercise. 2002;34(12):1996–2001.
14.Kogure GS, Lopes IP, Ribeiro VB, Mendes MC, Kodato S, Furtado CLM, et al. The effects of aerobic physical exercises on body image among women with polycystic ovary syndrome. Journal of affective disorders. 2020;262:350–8.
15.Stepto NK, Cassar S, Joham AE, Hutchison SK, Harrison CL, Goldstein RF, et al. Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic–hyperinsulaemic clamp. Human reproduction. 2013;28(3):777–84.
16.Teede HJ, Mlsso ML, Deeks AA, Moran LJ, Stuckey BG, Wong JL, et al. Assessment and management of polycystic ovary syndrome: summary of an evidence-based guideline. Medical Journal of Australia. 2011.
17.Park Y-M, Zhang J, Steck SE, Fung TT, Hazlett LJ, Han K, et al. Obesity mediates the association between Mediterranean diet consumption and insulin resistance and inflammation in US adults. The Journal of nutrition. 2017;147(4):563–71.
18.Mattei J, Sotos-Prieto M, Bigornia SJ, Noel SE, Tucker KL. The Mediterranean diet score is more strongly associated with favorable cardiometabolic risk factors over 2 years than other diet quality indexes in Puerto Rican adults. The Journal of nutrition. 2017;147(4):661–9.
19.Zhang X, Zheng Y, Guo Y, Lai Z. The effect of low carbohydrate diet on polycystic ovary syndrome: A meta‐analysis of randomized controlled trials. International journal of endocrinology. 2019;2019(1):4386401.
20.Lin AW, Dollahite JS, Sobal J, Lujan ME. Health-related knowledge, beliefs and self-efficacy in women with polycystic ovary syndrome. Human Reproduction. 2018;33(1):91–100.
21.Paoli A, Mancin L, Giacona MC, Bianco A, Caprio M. Effects of a ketogenic diet in overweight women with polycystic ovary syndrome. Journal of translational medicine. 2020;18:1–11.
22.Li J, Bai WP, Jiang B, Bai LR, Gu B, Yan SX, et al. Ketogenic diet in women with polycystic ovary syndrome and liver dysfunction who are obese: A randomized, open‐label, parallel‐group, controlled pilot trial. Journal of Obstetrics and Gynaecology Research. 2021;47(3):1145–52.
23.Pandurevic S, Mancini I, Mitselman D, Magagnoli M, Teglia R, Fazzeri R, et al. Efficacy of very low-calorie ketogenic diet with the Pronokal® method in obese women with polycystic ovary syndrome: a 16-week randomized controlled trial. Endocrine Connections. 2023;12(7).
24.Sharifi M, Saber A, Moludi J, Salimi Y, Jahan-Mihan A. The effects of portfolio moderate-carbohydrate and ketogenic diets on anthropometric indices, metabolic status, and hormonal levels in overweight or obese women with polycystic ovary syndrome: a randomized controlled trial. Nutrition Journal. 2024;23(1):152.
25.Mavropoulos JC, Yancy WS, Hepburn J, Westman EC. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. Nutrition & metabolism. 2005;2:1–5.
26.Cincione RI, Losavio F, Ciolli F, Valenzano A, Cibelli G, Messina G, et al. Effects of mixed of a ketogenic diet in overweight and obese women with polycystic ovary syndrome. International Journal of Environmental Research and Public Health. 2021;18(23):12490.
27.Moran LJ, Noakes M, Clifton PM, Norman RJ. The effect of modifying dietary protein and carbohydrate in weight loss on arterial compliance and postprandial lipidemia in overweight women with polycystic ovary syndrome. Fertility and sterility. 2010;94(6):2451–4.
28.Kasim-Karakas SE, Almario RU, Cunningham W. Effects of protein versus simple sugar intake on weight loss in polycystic ovary syndrome (according to the National Institutes of Health criteria). Fertility and sterility. 2009;92(1):262–70.
29.Stamets K, Taylor DS, Kunselman A, Demers LM, Pelkman CL, Legro RS. A randomized trial of the effects of two types of short-term hypocaloric diets on weight loss in women with polycystic ovary syndrome. Fertility and sterility. 2004;81(3):630–7.
30.Moran LJ, Noakes M, Clifton PM, Tomlinson L, Norman RJ. Dietary composition in restoring reproductive and metabolic physiology in overweight women with polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism. 2003;88(2):812–9.
31.Dou P, Zhang T-T, Xu Y, Xue Q, Zhang Y, Shang J, et al. A Randomized Trial of the Efficacy of Three Weight Loss Diet Interventions in Overweight/Obese with Polycystic Ovary Syndrome. Endocrine, Metabolic & Immune Disorders-Drug Targets. 2024;24(14):1686–97.
32.Li C, Xing C, Zhang J, Zhao H, Shi W, He B. Eight-hour time-restricted feeding improves endocrine and metabolic profiles in women with anovulatory polycystic ovary syndrome. Journal of translational medicine. 2021;19:1–9.
33.Feyzioglu BS, Güven CM, Avul Z. Eight-hour time-restricted feeding: a strong candidate diet protocol for first-line therapy in polycystic ovary syndrome. Nutrients. 2023;15(10):2260.
34.Jiang X, Wang Y, Tang H, Ma J, Li H. Effect of light fasting diet therapy on lipid metabolism and sex hormone levels in patients with polycystic ovary syndrome combined with infertility. Gynecological Endocrinology. 2025;41(1):2458084.
35.Asemi Z, Samimi M, Taghizadeh M, Esmaillzadeh A. Effects of Ramadan fasting on glucose homeostasis, lipid profiles, inflammation and oxidative stress in women with polycystic ovary syndrome in Kashan, Iran. Archives of Iranian medicine. 2015;18(12):0–.
36.Asemi Z, Esmaillzadeh A. DASH diet, insulin resistance, and serum hs-CRP in polycystic ovary syndrome: a randomized controlled clinical trial. Hormone and metabolic research. 2015;47(03):232–8.
37.Azadi‐Yazdi M, Karimi‐Zarchi M, Salehi‐Abargouei A, Fallahzadeh H, Nadjarzadeh A. Effects of Dietary Approach to Stop Hypertension diet on androgens, antioxidant status and body composition in overweight and obese women with polycystic ovary syndrome: a randomised controlled trial. Journal of human nutrition and dietetics. 2017;30(3):275–83.
38.Foroozanfard F, Rafiei H, Samimi M, Gilasi HR, Gorjizadeh R, Heidar Z, et al. The effects of dietary approaches to stop hypertension diet on weight loss, anti‐Müllerian hormone and metabolic profiles in women with polycystic ovary syndrome: a randomized clinical trial. Clinical endocrinology. 2017;87(1):51–8.
39.Joshi S, Ostfeld RJ, McMacken M. The ketogenic diet for obesity and diabetes—enthusiasm outpaces evidence. JAMA internal medicine. 2019;179(9):1163–4.
40.Sumithran P, Proietto J. Ketogenic diets for weight loss: a review of their principles, safety and efficacy. Obesity Research & Clinical Practice. 2008;2(1):1–13.
41.Luo W, Zhang J, Xu D, Zhou Y, Qu Z, Yang Q, et al. Low carbohydrate ketogenic diets reduce cardiovascular risk factor levels in obese or overweight patients with T2DM: A meta-analysis of randomized controlled trials. Frontiers in Nutrition. 2022;9:1092031.
42.Makievskaya CI, Popkov VA, Andrianova NV, Liao X, Zorov DB, Plotnikov EY. Ketogenic diet and ketone bodies against ischemic injury: targets, mechanisms, and therapeutic potential. International journal of molecular sciences. 2023;24(3):2576.
43.Charlot A, Bringolf A, Mallard J, Charles A-L, Niederhoffer N, Duteil D, et al. Hypercaloric low-carbohydrate high-fat diet protects against the development of nonalcoholic fatty liver disease in obese mice in contrast to isocaloric Western diet. Frontiers in Nutrition. 2024;11:1366883.
44.Nasser S, Solé T, Vega N, Thomas T, Balcerczyk A, Strigini M, et al. Ketogenic diet administration to mice after a high-fat-diet regimen promotes weight loss, glycemic normalization and induces adaptations of ketogenic pathways in liver and kidney. Molecular metabolism. 2022;65:101578.
45.Anderson JC, Mattar SG, Greenway FL, Lindquist RJ. Measuring ketone bodies for the monitoring of pathologic and therapeutic ketosis. Obesity science & practice. 2021;7(5):646–56.
46.Kennedy AR, Pissios P, Otu H, Xue B, Asakura K, Furukawa N, et al. A high-fat, ketogenic diet induces a unique metabolic state in mice. American Journal of Physiology-Endocrinology and Metabolism. 2007.
47.Valinejad A, Khodaei K. Does exercise during a ketogenic diet effectively alter appetite sensation, appetite-regulating hormones, and body composition? Experimental Biology and Medicine. 2022;247(21):1898–906.
48.Roekenes J, Martins C. Ketogenic diets and appetite regulation. Current Opinion in Clinical Nutrition & Metabolic Care. 2021;24(4):359–63.
49.Draznin B, Wang C, Adochio R, Leitner J, Cornier M-A. Effect of dietary macronutrient composition on AMPK and SIRT1 expression and activity in human skeletal muscle. Hormone and Metabolic Research. 2012;44(09):650–5.
50.Moon J, Koh G. Clinical evidence and mechanisms of high-protein diet-induced weight loss. Journal of obesity & metabolic syndrome. 2020;29(3):166.
51.Marckmann P, Osther P, Pedersen AN, Jespersen B. High-protein diets and renal health. Journal of Renal Nutrition. 2015;25(1):1–5.
52.Wang F, Dou P, Wei W, Liu PJ. Effects of high-protein diets on the cardiometabolic factors and reproductive hormones of women with polycystic ovary syndrome: a systematic review and meta-analysis. Nutrition & Diabetes. 2024;14(1):6.
53.Nesti L, Mengozzi A, Tricò D. Impact of nutrient type and sequence on glucose tolerance: physiological insights and therapeutic implications. Frontiers in Endocrinology. 2019;10:144.
54.Tricò D, Frascerra S, Baldi S, Mengozzi A, Nesti L, Mari A, et al. The insulinotropic effect of a high-protein nutrient preload is mediated by the increase of plasma amino acids in type 2 diabetes. European Journal of Nutrition. 2019;58:2253–61.
55.Brinkworth G, Noakes M, Keogh J, Luscombe N, Wittert G, Clifton P. Long-term effects of a high-protein, low-carbohydrate diet on weight control and cardiovascular risk markers in obese hyperinsulinemic subjects. International Journal of Obesity. 2004;28(5):661–70.
56.Moon S, Kang J, Kim SH, Chung HS, Kim YJ, Yu JM, et al. Beneficial effects of time-restricted eating on metabolic diseases: a systemic review and meta-analysis. Nutrients. 2020;12(5):1267.
57.Cho Y, Hong N, Kim K-w, Cho Sj, Lee M, Lee Y-h, et al. The effectiveness of intermittent fasting to reduce body mass index and glucose metabolism: a systematic review and meta-analysis. Journal of clinical medicine. 2019;8(10):1645.
58.Harvie MN, Pegington M, Mattson MP, Frystyk J, Dillon B, Evans G, et al. The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomized trial in young overweight women. International journal of obesity. 2011;35(5):714–27.
59.Gnanou JV, Caszo BA, Khalil KM, Abdullah SL, Knight VF, Bidin MZ. Effects of Ramadan fasting on glucose homeostasis and adiponectin levels in healthy adult males. Journal of Diabetes & Metabolic Disorders. 2015;14:1–6.
60.Kiyani MM, Memon AR, Amjad MI, Ameer MR, Sadiq M, Mahmood T. Study of human biochemical parameters during and after Ramadan. Journal of religion and health. 2017;56:55–62.
61.Cienfuegos S, Corapi S, Gabel K, Ezpeleta M, Kalam F, Lin S, et al. Effect of intermittent fasting on reproductive hormone levels in females and males: a review of human trials. Nutrients. 2022;14(11):2343.
62.Varady KA. Impact of intermittent fasting on glucose homeostasis. Current Opinion in Clinical Nutrition & Metabolic Care. 2016;19(4):300–2.
63.Mattson MP. Energy intake and exercise as determinants of brain health and vulnerability to injury and disease. Cell metabolism. 2012;16(6):706–22.
64.Chiofalo B, Laganà AS, Palmara V, Granese R, Corrado G, Mancini E, et al. Fasting as possible complementary approach for polycystic ovary syndrome: Hope or hype? Medical hypotheses. 2017;105:1–3.
65.Thankamony A, Capalbo D, Marcovecchio ML, Sleigh A, Jørgensen SW, Hill NR, et al. Low circulating levels of IGF-1 in healthy adults are associated with reduced β-cell function, increased intramyocellular lipid, and enhanced fat utilization during fasting. The Journal of Clinical Endocrinology & Metabolism. 2014;99(6):2198–207.
66.Siervo M, Lara J, Chowdhury S, Ashor A, Oggioni C, Mathers JC. Effects of the Dietary Approach to Stop Hypertension (DASH) diet on cardiovascular risk factors: a systematic review and meta-analysis. British Journal of Nutrition. 2015;113(1):1–15.
67.Craddick SR, Elmer PJ, Obarzanek E, Vollmer WM, Svetkey LP, Swain MC. The DASH diet and blood pressure. Current atherosclerosis reports. 2003;5:484–91.
68.Pirouzeh R, Heidarzadeh-Esfahani N, Morvaridzadeh M, Izadi A, Yosaee S, Potter E, et al. Effect of DASH diet on oxidative stress parameters: A systematic review and meta-analysis of randomized clinical trials. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2020;14(6):2131–8.
69.Joyce BT, Wu D, Hou L, Dai Q, Castaneda SF, Gallo LC, et al. DASH diet and prevalent metabolic syndrome in the Hispanic Community Health Study/Study of Latinos. Preventive medicine reports. 2019;15:100950.
70.Asemi Z, Samimi M, Tabassi Z, Sabihi S-s, Esmaillzadeh A. A randomized controlled clinical trial investigating the effect of DASH diet on insulin resistance, inflammation, and oxidative stress in gestational diabetes. Nutrition. 2013;29(4):619–24.
71.Moslehi N, Zeraattalab-Motlagh S, Rahimi Sakak F, Shab-Bidar S, Tehrani FR, Mirmiran P. Effects of nutrition on metabolic and endocrine outcomes in women with polycystic ovary syndrome: an umbrella review of meta-analyses of randomized controlled trials. Nutrition reviews. 2023;81(5):555–77.
72.Soltani S, Shirani F, Chitsazi MJ, Salehi‐Abargouei A. The effect of dietary approaches to stop hypertension (DASH) diet on weight and body composition in adults: a systematic review and meta‐analysis of randomized controlled clinical trials. Obesity reviews. 2016;17(5):442–54.
73.Pasquali R, ANTENUCCI D, CASIMIRRI F, VENTUROLI S, PARADISI R, FABBRI R, et al. Clinical and hormonal characteristics of obese amenorrheic hyperandrogenic women before and after weight loss. The Journal of Clinical Endocrinology & Metabolism. 1989;68(1):173–9.
74.DJ J. 17a-Hydroxyprogesterone responses to leuprolide and serum androgens in obese women with and without polycystic ovary syndrome after dietary weight loss. J Clin Endocrinol Metab. 1997;82:556–60.
75.Pittas AG, Roberts SB. Dietary composition and weight loss: can we individualize dietary prescriptions according to insulin sensitivity or secretion status? Nutrition reviews. 2006;64(10):435–48.
76.Chen X, Touyz RM, Park JB, Schiffrin EL. Antioxidant effects of vitamins C and E are associated with altered activation of vascular NADPH oxidase and superoxide dismutase in stroke-prone SHR. Hypertension. 2001;38(3):606–11.
77.Thys-Jacobs S, Donovan D, Papadopoulos A, Sarrel P, Bilezikian JP. Vitamin D and calcium dysregulation in the polycystic ovarian syndrome. Steroids. 1999;64(6):430–5.
78.dehghani Firouzabadi R, Aflatoonian A, Modarresi S, Sekhavat L, MohammadTaheri S. Therapeutic effects of calcium & vitamin D supplementation in women with PCOS. Complementary therapies in clinical practice. 2012;18(2):85–8.
79.Yildizhan R, Kurdoglu M, Adali E, Kolusari A, Yildizhan B, Sahin HG, et al. Serum 25-hydroxyvitamin D concentrations in obese and non-obese women with polycystic ovary syndrome. Archives of gynecology and obstetrics. 2009;280:559–63.
80.Hahn S, Haselhorst U, Tan S, Quadbeck B, Schmidt M, Roesler S, et al. Low serum 25-hydroxyvitamin D concentrations are associated with insulin resistance and obesity in women with polycystic ovary syndrome. Experimental and clinical endocrinology & diabetes. 2006;114(10):577–83.
81.Lou Y-R, Murtola T, Tuohimaa P. Regulation of aromatase and 5α-reductase by 25-hydroxyvitamin D3, 1α, 25-dihydroxyvitamin D3, dexamethasone and progesterone in prostate cancer cells. The Journal of steroid biochemistry and molecular biology. 2005;94(1-3):151–7.