Nutrition interventions in women with polycystic ovary syndrome: a systematic review.

Clinical Snapshot

Key Findings

• P Value: Not reported at review level

• Effect Size: Not quantified — narrative synthesis only; most dietary interventions demonstrated beneficial effects on body weight, BMI, waist circumference, insulin sensitivity, reproductive hormone regulation, and menstrual regularity

• Primary Outcome: Effects of dietary interventions on anthropometric, metabolic, hormonal, inflammatory, and oxidative stress parameters in women with PCOS

• Nnt Or Sensitivity: Not calculable from this review — no pooled effect sizes reported; findings for lipid metabolism, inflammatory markers, and oxidative stress were inconsistent across included studies

• Confidence Interval: Not reported — no meta-analytic pooling performed

Clinical Application

Dietary interventions are generally feasible, low-cost, and acceptable as first-line adjunctive management in PCOS. However, the review does not provide sufficient evidence to recommend one specific dietary pattern over another. Calorie restriction, low-GI, Mediterranean, and DASH approaches all show directional benefit and are broadly implementable in primary care and dietetic practice. Ketogenic diets and intermittent fasting require closer clinical supervision given potential risks in reproductive-age women. In Australia, PCOS is the most common endocrine disorder in women of reproductive age, affecting approximately 8–13% of women (Jean Hailes for Women's Health / Monash University PCOS guidelines). The 2023 International Evidence-Based Guideline for the Assessment and Management of PCOS (co-led by Monash University) recommends lifestyle intervention including dietary modification as first-line management. This review supports that recommendation directionally but cannot specify which dietary approach should be preferentially recommended on the PBS or through Medicare-funded dietetic services (CDM/TCA plans). Dietitians Australia and RACGP guidelines support individualised dietary counselling for PCOS. No specific dietary intervention for PCOS is TGA-regulated or PBS-listed; dietary management is delivered through Medicare-subsidised allied health services under chronic disease management plans. The Monash PCOS guideline's emphasis on low-GI diets is broadly consistent with this review's findings. Adult women with PCOS across reproductive age groups, particularly those with metabolic comorbidities (insulin resistance, obesity, dyslipidaemia). Applicability is broadest for women with overweight/obesity-associated PCOS where weight-loss dietary strategies are most studied. Lean PCOS phenotypes are likely underrepresented.

Abstract

PURPOSE: This systematic review aimed to synthesize current evidence on the effects of various dietary interventions on anthropometric, metabolic, hormonal, inflammatory, and oxidative stress parameters in women with polycystic ovary syndrome (PCOS). METHODS: The review followed the PRISMA guidelines and was prospectively registered in PROSPERO (CRD42025641781). Searches were conducted in PubMed, Cochrane Library, EBSCO, Science Direct, Web of Science, National Thesis Center, Google Scholar, and DergiPark Academic for studies published between February 2015 and February 2025. Experimental and observational studies were included if they evaluated the independent effect of dietary interventions in adult women with PCOS. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. RESULTS: A total of 38 studies were included, covering interventions such as calorie-restricted diets, low-glycemic index/load diets, ketogenic diets, intermittent fasting, dietary approaches to stop hypertension, Mediterranean-style, and other diets. Most dietary interventions demonstrated beneficial effects on body weight, body mass index, and waist circumference, as well as improvements in insulin sensitivity, reproductive hormone regulation, and menstrual regularity. However, findings related to lipid metabolism, inflammatory markers, and oxidative stress outcomes were inconsistent. CONCLUSION: Current evidence indicates that dietary interventions are crucial in improving the management of metabolic, anthropometric, hormonal, and clinical outcomes in women with PCOS. Nevertheless, the heterogeneity of dietary approaches, study designs, and outcome measures highlights the need for long-term randomized controlled trials to establish more conclusive recommendations.

References

1. 1.Akbaş, E., Samancı, M., & Öztürk, Y. E. (2026). Nutrition interventions in women with polycystic ovary syndrome: a systematic review. European Journal of Nutrition. https://doi.org/10.1093/humrep/deac267