The PCOS diet: How to use food to help manage your PCOS

PCOS is an acronym you may have heard before without really knowing exactly what it means. It stands for polycystic ovary syndrome and is a disorder that affects the hormone levels of people assigned female at birth. It’s believed to be inherited genetically, although the specific inheritance rate is unknown (it’s estimated to be about 70%).

While PCOS can be a really frustrating disorder — causing changes to your menstrual cycle, fertility, weight, and appearance — most people affected by it are able to live normal, healthy lives, thanks to treatment by their health care providers or tweaks to their lifestyles. This includes following a PCOS diet, which can help you to manage some of your symptoms.

What is PCOS, who does it affect, and why?

First things first, let’s break down what PCOS is. Polycystic ovary syndrome is a disorder that can cause problems with our hormones, metabolism, and reproductive system. That’s why it’s scientifically called an endocrine condition — because it hits the endocrine system, aka the body’s hormone regulatory system.  

“Despite the name, you can have PCOS without polycystic ovaries,” says Lauren Talbert, registered dietitian and PCOS expert. This, she explains, is a big misconception around the disorder, because a person doesn’t have to have cysts on their ovaries in order to have PCOS. To be diagnosed with PCOS, you just have to have two of the following:

• Several cysts on your ovaries. These can be identified by your health care provider with an ultrasound.
• An irregular menstrual cycle, such as missing periods or ovulation (specifically, if you have fewer than 9 periods per year or more than 35 days between periods, which is also why it’s a good idea to track your cycle with an app like Flo)
• High levels of the hormones from the androgen group (sometimes known as male hormones). Your health care provider can usually detect this by running some lab work, but sometimes your physical symptoms can help doctors make a diagnosis too.

“The cause of PCOS is still not fully known,” says Talbert. There’s a theory that it’s passed down genetically and triggered by environmental factors. However, scientific research has been increasingly chalking it up to insulin resistance, mainly because many people who have PCOS also have insulin resistance. Insulin is a hormone that helps lower the levels of sugar in your blood; it’s in charge of regulating how glucose travels from the bloodstream into the cells. If you’re experiencing insulin resistance, your body isn’t carrying out this process properly, leaving too much sugar in your bloodstream. 

The most common red flag for PCOS is an irregular menstrual cycle, with some people going for months or even years without a period, according to Talbert. Other symptoms of PCOS can include:

• Acne
• Irregular, dark hair growth on the body including the chin, chest, neck, belly, and back
• Losing head hair around the temples and/or crown of the head
• Unintentional weight gain around the belly (or difficulty losing weight)
• Skin discoloration (either around the neck, armpits, and groin, or seen after acne)
• Skin tags (flaps of extra skin often found in the armpits or neck)

PCOS is also the leading cause of female infertility, and unfortunately research seems to show that between 70% and 80% of women with PCOS struggle to conceive. But this doesn’t rule out your ability to have children if you want to. Studies have found that most women with PCOS will eventually be able to get pregnant if they manage the condition with treatment, so just make sure you’re speaking to your health care provider if you want to conceive. 

You might also want to seek out help from a psychological expert if you’re struggling with this hormonal condition. PCOS can have an effect on people’s mental health, and conditions such as depression, anxiety, bipolar disorder, and binge eating are more common in those with the condition, according to research. 

Remember, you’re not alone. PCOS affects around one in ten women of reproductive age. But it’s true that not much is known about its cause or a cure, although scientists are working on it. That means PCOS is often misdiagnosed or left undiagnosed for a long time. If you’ve experienced this and have found it difficult, consider reaching out to organizations like PCOS Awareness Association and Verity for help and support.

PCOS diet: How can you use your diet and lifestyle to manage PCOS?

“Diet and lifestyle are the primary approach to management of PCOS,” says Talbert. That’s because diet is often linked with metabolism and reproductive health. “Remember that insulin resistance is a key component to this condition, so following a lifestyle to combat this is most beneficial.”

At this point though, it’s important to make a distinction. “Another misconception is that all women with PCOS are obese or overweight,” says Talbert. Research estimates that 40% to 80% of people with PCOS are overweight or obese, but all people with PCOS are at metabolic risk. This means that no matter your weight, your body’s ability to convert what you eat and drink into energy could still be a little off. For example, people with PCOS tend to have increased fat in their organs and higher cholesterol compared to those without PCOS.

So, weight loss can be helpful for improving insulin sensitivity and regulating your menstrual cycle. In fact, this Australian study showed that losing as little as 5% to 10% of initial body weight helped with symptoms of PCOS — but everybody with PCOS can likely benefit from making a couple of tweaks to their diet and lifestyle.

Talbert says that most of the research to date has supported three main diets to improve symptoms of PCOS: the Mediterranean diet, the DASH (dietary approach to stop hypertension) diet, and a low-glycemic-index diet. Research has shown that all three of these approaches can help those with PCOS to lose weight and decrease inflammation.

“All of these diets are rich in fiber, which has been shown to improve insulin resistance,” says Talbert. They are also all generally rich in plant-based foods, such as whole grains, legumes, nuts, and seeds, Talbert notes, with a wide variety of healthy unsaturated fats, like olive oil, nuts, seeds, and fatty fish (e.g., salmon). 

Easy ways to follow a PCOS diet plan

Learning more about these diets is a great starting point, but it doesn’t mean you have to stick to them strictly. You can easily start by making some small tweaks to your everyday eating. That could mean finding ways to include more fruit, vegetables, whole grains, nuts, seeds, legumes, and lean protein such as fish and chicken, as well as olive oil, in your cooking. 

Our dietitian suggests starting simple: 

• Switch from processed to whole grains.
• Add a serving or two of fruit or vegetables at meals.
• Snack on nuts.
• Replace red meat with fish.
• Stay away from foods high in saturated fat and/or sugar, such as red meat, fried foods, and creamy sauces, as well as desserts and sugary beverages. 

You can also start by replacing red meat with plant protein in your diet — think lentil soup instead of beef chili or a black bean burger instead of a beef burger. You could also try to find fun ways to eat more veggies and fruits. Perhaps spiralizing vegetables in place of pasta or switching to cauliflower rice could be good options for you. Other easy swaps are to snack on vegetables and dip instead of chips and shift from processed grains to whole grains, such as whole wheat bread, oats, and quinoa.

Supplements can also help, as they can add in some of the elements you may have been missing in your diet before. Talbert suggests looking into taking omega-3, vitamin D, and magnesium. Just make sure you consult a health care professional first. They’ll be able to help you tailor what you take to your needs.  

Diet comes in handy for boosting your chances of having children if you have PCOS too, says Talbert. For example, this 2021 study from China found that women who ate a healthy diet rich in fruits, vegetables, fish, and whole grains were three times more likely than study participants who ate a less healthy diet to be able to conceive even if they had PCOS. The same research also suggested that pregnancy rates increased with Mediterranean and low-carbohydrate diets.

It’s probably no surprise that a lot of research has shown it’s important to exercise regularly. “Exercise decreases insulin resistance and improves insulin sensitivity as well as improving mood,” says Talbert. Both, as we’ve learned, can be key to managing the symptoms of PCOS.

PCOS diet: The takeaway

Like with many other conditions, every PCOS case is personal and different. There are small lifestyle changes you can make yourself, such as adapting to a PCOS-friendly diet, that might help soothe your symptoms. But it’s also important to make sure you’re speaking to a trusted health care provider about what symptoms you are experiencing. They’ll always be able to offer more tailored advice.