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Polycystic Ovary Syndrome (PCOS) Diet

How Does It Help, What Foods are Included, and More

Author:Nikol Natalia Armata, MD

Editors:Alyssa Haag,Ian Mannarino, MD, MBA,Kelsey LaFayette, DNP, RN, FNP-C

Illustrator:Jessica Reynolds, MS

Copyeditor:Sadia Zaman, MBBS, BSc


What is polycystic ovary syndrome (PCOS)?

Polycystic ovary syndrome (PCOS) is one of the most common endocrine and metabolic disorders of reproductive-aged individuals assigned female at birth. Heterogeneous by nature, PCOS is described through a combination of signs and symptoms of androgen excess and ovarian dysfunction, in the absence of other specific diagnoses.

Three main features are identified in individuals with PCOS, including irregular menstruation (i.e., ovulation does not follow a regular pattern); elevated androgen levels that may increase the appearance of facial or body hair; and polycystic ovaries (i.e., ovaries become enlarged and contain many fluid-filled sacs, also known as follicles, that surround the eggs). At least two of the above conditions are required in order to diagnose PCOS. 

Individuals with PCOS have an increased risk for elevated blood sugar levels,  type 2 diabetes mellitus, and obesity. Hepatic steatosis (i.e., excessive fat build up in the liver); metabolic syndrome (i.e., a combination of diabetes, hypertension, dyslipidemia, and/or obesity); vascular thrombosis; cerebrovascular accidents; and cardiovascular events are among pathologies that individuals with PCOS are at greatest risk of acquiring. Subfertility; obstetric complications (e.g., gestational diabetes, pregnancy-induced hypertension, and preeclampsia); endometrial atypia or carcinoma; and ovarian malignancies are also associated with PCOS. Additionally, mood and psychosexual disorders have been associated with PCOS.

Ovary with multiple cysts.

What is a polycystic ovary syndrome (PCOS) diet?

According to multiple medically reviewed studies, diet appears to play an important role in regulating the clinical presentation and laboratory findings of individuals with PCOS. The suggested diet contains non-starchy fruits and vegetables with a low glycemic index, as well as low-fat dairy products in small quantities. Fish rich in omega-3 fatty acids (e.g., mackerel), lean red meat, poultry, fatty acids, legumes, whole grain products, and alcohol, may also be included in moderation.

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How does a PCOS diet help PCOS?

Research has shown that the PCOS diet can induce positive improvements to the clinical appearance of the syndrome. More specifically, weight loss and reduction of other body measurements were observed and a decrease in insulin levels, free testosterone, and glucose levels was noted. Moreover, most of the population tested exhibited a decrease in hyperandrogenism, cholesterol, triglycerides, low-density lipoprotein (LDL), luteinizing hormone (LH) and follicle stimulating hormone (FSH), hair loss, acne, and menstrual irregularities. In general, there was an improvement in the composition of inflammatory mediators (e.g., prostaglandins and leukotrienes) and better imaging of the ovaries, with fewer follicles and smaller ovary size. 

It is well established that dietary changes can rapidly change the relative abundance of microorganisms that create intestinal flora. Therefore, understanding the role of intestinal microbiota in PCOS pathogenesis is essential, as the diet may act as a mediator between the individual’s microbiota and their PCOS clinical and laboratory appearance. For example, high-sugar foods may induce PCOS by causing intestinal flora imbalance and triggering chronic inflammation, insulin resistance, and production of androgen. Gut microbiota dysbiosis can also cause insulin resistance, which is closely linked to the occurrence of PCOS.

What foods are best on a PCOS diet?

The PCOS diet contains fruits (e.g., berries, oranges, grapefruit, lemons, peaches, tomatoes, and cherries) and non-starchy vegetables that have a low in glycemic index, such as artichokes, asparagus, broccoli, celery, cucumber, cabbage, and mushrooms. It is recommended to avoid saturated fats, supplementing with unsaturated fatty acids, such as olive oil, vegetable oils, and fish oils. Low-fat dairy products in small quantities are included in the diet. The proteins recommended include leaner meats, fish rich in omega-3 fatty acids (e.g., mackerel, salmon, herring); lean red meat; and poultry (e.g., chicken, turkey) in small quantities. Almonds, pumpkin seeds, sunflower seeds, sesame seeds, legumes, whole grain products (e.g., brown rice, oatmeal), and alcohol in moderate amounts (e.g., 150 mL of red wine per day) are other components of the PCOS diet.

The Med (i.e., Mediterranean diet) and DASH (i.e., Dietary Approaches to Stop Hypertension) diets are also associated with improving PCOS symptoms and the imaging of the ovaries. For instance, the DASH diet, a popular eating plan for reducing heart disease risk, reduces salt intake and focuses on heart-healthy foods. Studies found that individuals with high body mass index (BMI) and PCOS who follow the DASH diet lost more abdominal fat and showed significant improvements in insulin resistance and inflammatory markers compared to patients following a standard diet. Similarly, the Med diet recommends low quantities of processed, refined fats and high quantities of healthy fats, like olive oil, nuts, and seeds, to reduce inflammation.

Hydration and physical activity are also necessary components to the PCOS diet. Appropriate diet and lifestyle changes can strengthen the weight loss effort, which can be quite difficult for women with PCOS.

What foods should be avoided on a PCOS diet?

Individuals with PCOS are suggested to limit sugar and saturated or trans fats. Diets high in sodium can lead to hypertension (i.e., high blood pressure), which increases the risk for cardiovascular disease. Additionally, the sugar content in processed snacks, baked goods, and soft drinks can worsen insulin resistance. Therefore, fried foods, processed meats (e.g., sausages, hamburgers, and hot dogs), refined carbohydrates (e.g., white bread, pasta, and pastries), and processed snacks (e.g., cakes, candy, sweetened yogurt, ice creams with excess sugar, sugary drinks) are foods to avoid when following the PCOS diet.

What are the most important facts to know about a polycystic ovary syndrome (PCOS) diet?

Polycystic ovary syndrome (PCOS) is a medical condition of reproductive age, typically in those assigned female at birth, characterized by a hormonal and metabolic imbalance that may ultimately affect the overall health and appearance of affected individuals. Diet has been proven to improve the symptoms of PCOS. The PCOS diet involves eating non-starchy fruits and vegetables with a low glucose index; low-fat dairy products in small quantities; fish rich in omega-3 fatty acids; lean red meat; poultry; legumes; and whole grain products. It can also help individuals lose weight while simultaneously improving their clinical and laboratory symptoms.  

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Related links

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Resources for research and reference

Azziz, R. (2018). Polycystic Ovary Syndrome. Obstetrics and gynecology, 132(2): 321–336. DOI: 10.1097/AOG.0000000000002698 

Escobar-Morreale H. F. (2018). Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nature Reviews Endocrinology, 14(5): 270–284. DOI: 10.1038/nrendo.2018.24

Ndefo, U. A., Eaton, A., & Green, M. R. (2013). Polycystic ovary syndrome: a review of treatment options with a focus on pharmacological approaches. P & T: a peer-reviewed journal for formulary management, 38(6): 336–355.