Nutrition and lifestyle interventions for PCOS

Polycystic ovary syndrome (PCOS) is a lifelong endocrine condition that affects individuals of reproductive age and often leads to varied symptoms, such as irregular menstruation, weight gain, and excessive hair growth. It is also associated with an increased risk for comorbidities, such as type 2 diabetes and cardiovascular disease.

To be diagnosed with PCOS, an individual must meet two of the following three criteria: oligoovulation or anovulation, hyperandrogenism, or polycystic ovary morphology. While there is no permanent cure for PCOS, nutrition interventions and health-promoting behaviors can help manage symptoms and improve metabolic health.  

Nutrition and lifestyle interventions for PCOS 

While there may not be one specific diet for PCOS, a balanced and nutrient-dense eating pattern, paired with regular movement and other behavioral strategies, can have a powerful impact on metabolic and hormonal health.

Despite weight loss often being emphasized in PCOS management, many improvements, like insulin sensitivity, menstrual regularity, and inflammation, can occur through lifestyle interventions regardless of changes in body weight. Here are some nutrition interventions and lifestyle changes that registered dietitians (RDs) can consider when counseling patients/clients with PCOS: 

Prioritize low-glycemic carbohydrates 

Choosing low-glycemic index and low-glycemic load carbohydrates like vegetables, whole fruits, legumes, and whole grains can support insulin sensitivity and the mitigation of comorbidities.  

Include lean protein at meals and snacks 

Protein plays a role in satiety, blood sugar regulation, and hormone health. Maintaining protein intake is especially important for clients pursuing intentional weight loss to preserve muscle mass. Some sources clients might find helpful include Greek yogurt, eggs, tuna, cottage cheese, and legumes. 

Incorporate anti-inflammatory fats 

Omega-3 fatty acids have been shown to support a healthier lipid profile and improve fasting blood glucose in women with PCOS. RDs should encourage food sources, such as fatty fish, walnuts, flaxseeds, hempseeds, chia seeds, navy beans, and soybeans. If indicated, consider discussing an omega-3 supplement with the interdisciplinary team. 

Support vitamin D status 

Vitamin D deficiency is common in individuals with PCOS and may be associated with insulin resistance. RDs can encourage intake of vitamin D-rich foods, such as fortified dairy products, eggs, and fatty fish. Additionally, it’s important to monitor vitamin D levels and consider supplementation as appropriate. 

Encourage regular movement 

Physical activity not only improves insulin sensitivity but may also support reproductive health and mood. Encourage clients to increase their physical activity level as appropriate and with consideration for individual goals. A recent consensus recommendation for those with PCOS encourages at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity activity per week and two days of resistance or weight-bearing exercise for prevention of weight gain and health maintenance.

Recommendations increase to at least 250 minutes of moderate-intensity or 150 minutes of vigorous-intensity activity per week and two days of resistance or weight-bearing exercise for modest weight loss or prevention of weight regain. In addition to addressing potential barriers to increased physical activity, RDs can also consider referral to other healthcare team members to support this lifestyle intervention.  

Assess sleep patterns 

Sleep disturbances and PCOS often go hand in hand, and the relationship may be bidirectional. Inquiring about sleep habits can be a valuable part of the nutrition assessment, especially since improved sleep quality may positively influence metabolic health. 

Consider a focus on lifestyle 

Many individuals with PCOS experience difficulty losing weight or preventing weight gain. RDs should have an increased awareness that PCOS features can negatively impact body image and that the potential for eating disorders and disordered eating patterns exists regardless of weight status. It is important to note that clients/patients may have previously experienced weight stigma in healthcare. 

A dietitian’s role

Registered dietitians play an essential role in identifying and addressing nutrition concerns in individuals with PCOS. To provide comprehensive care, an interdisciplinary team should be involved in the management of PCOS, including, but not limited to, endocrinologists, gynecologists, and mental health professionals. By utilizing evidence-based nutrition strategies, dietitians can help individuals with PCOS make healthy lifestyle changes to improve insulin sensitivity, support hormone function, and reduce the risk of comorbidities. 

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References

Singh S, Pal N, Shubham S, et al. Polycystic ovary syndrome: etiology, current management, and future therapeutics. J Clin Med. 2023;12(4):1454. 

Lim SS, Hutchison SK, Van Ryswyk E, Norman RJ, Teede HJ, Moran LJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2019;3(3):CD007506.  

Szczuko M, Kikut J, Szczuko U, et al. Nutrition strategy and life style in polycystic ovary syndrome-narrative review. Nutrients. 2021;13(7):2452.  

Manta A, Paschou SA, Isari G, Mavroeidi I, Kalantaridou S, Peppa M. Glycemic index and glycemic load estimates in the dietary approach of polycystic ovary syndrome. Nutrients. 2023;15(15):3483.  

Wang F, Dou P, Wei W, et al. Effects of high-protein diets on the cardiometabolic factors and reproductive hormones of women with polycystic ovary syndrome: a systematic review and meta-analysis. Nutr. Diabetes. 2024;14(6). 

Cochrane KM, Bone JN, Williams BA, Karakochuk CD. Optimizing vitamin D status in polycystic ovary syndrome: a systematic review and dose-response meta-analysis. Nutr Rev. 2024;82(9):1176-1186. 

Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Eur J Endocrinol. 2023;189(2):G43-G64.  

Teede HJ, Misso ML, Costello MF, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2018;110(3):364-379. 

Fernandez RC, Moore VM, Van Ryswyk EM, et al. Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies. Nat Sci Sleep. 2018;10:45-64. 

Lee I, Cooney LG, Saini S, Sammel MD, Allison KC, Dokras A. Increased odds of disordered eating in polycystic ovary syndrome: a systematic review and meta-analysis. Eat Weight Disord. 2019;24(5):787-797. 

Nutrition Care Manual. High Omega-3 Fatty Acids Foods List (2024). https://www.nutritioncaremanual.org/client_ed.cfm?ncm_client_ed_id=448 Accessed May 19, 2025.  

Nutrition Care Manual. Polycystic Ovary Syndrome (PCOS) (2024). https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&lv1=272980&lv2=275481&lv3=275486&ncm_toc_id=275486&ncm_heading=Nutrition%20Care Accessed May 19, 2025.