How to treat polycystic ovary syndrome (PCOS)

How insulin resistance affects PCOS:

• In insulin resistance, cells respond poorly to insulin, and the pancreas compensatorily increases its production.
• High insulin levels stimulate the ovaries to produce excess androgens (testosterone, androstenedione).
• Excess androgens disrupt follicle maturation and lead to anovulation, resulting in the formation of multiple immature follicles (visually - “polycystic” ovaries).
• Insulin also lowers the level of sex hormone-binding globulin (SHBG), which further increases the free fraction of androgens.

Why the ketogenic diet may help:

• Reduction of carbohydrate load → blood glucose levels stabilize, and insulin secretion decreases.
• Increased insulin sensitivity due to the shift to using fats and ketones as the primary energy source.
• Reduction of hyperandrogenism: with normalization of insulin, the ovaries start to produce less androgens.
• Restoration of ovulation: many women with PCOS experience improved cycles, ovulatory cycles, and the possibility of conception on a ketogenic diet.
• Reduction of chronic inflammation (ketones have anti-inflammatory effects, reducing systemic levels of pro-inflammatory cytokines).

The ketogenic diet in the case of PCOS works not as a “magic pill,” but as a tool to eliminate the key pathogenic factor - hyperinsulinemia. However, its effectiveness is maximized when combined with other measures: adequate protein intake, physical activity (especially strength training that increases insulin sensitivity), normalization of sleep, and stress management.