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Polycystic ovarian syndrome (PCOS) is a common hormonal condition that occurs in females.

The condition can cause infertility, acne, insulin resistance, and other health issues.

Fortunately, diet and other lifestyle factors play a significant role in managing PCOS and its associated health issues.

This article explains what to eat and avoid with PCOS, provides a 3-day sample PCOS diet menu, and discusses supplements and exercise for the condition.

PCOS diet

What is PCOS?

PCOS is the most common hormonal condition in females, affecting 5% to 15% of females worldwide (1).

It’s diagnosed based on the presence of at least two of the following criteria (1):

  • Anovulation. This occurs when an egg does not release, or ovulate, from the ovaries.
  • Hyperandrogenism. Excessive circulating male sex hormones, like testosterone.
  • Polycystic ovaries. The presence of multiple follicles, or fluid-filled sacs, on the ovaries.

Several factors related to genetics and the environment are believed to cause PCOS, similar to endometriosis, a different but common condition that affects fertility in women.

PCOS is associated with many conditions including (1):

There is no cure for PCOS but making certain dietary changes can help you manage many of the conditions associated with PCOS, especially infertility and insulin resistance (2).

Insulin resistance occurs when the body’s cells don’t respond well to insulin and can’t efficiently absorb glucose — or blood sugar — from your blood.

This causes the pancreas — which produces insulin — to compensate and produce more insulin to lower blood sugar and maintain normal levels.

Insulin resistance worsens hyperandrogenemia and contributes to many of the conditions associated with PCOS like infertility, obesity, and fatty liver.

Insulin resistance is more common in women with PCOS who are overweight or obese but it’s also common in those at a healthy weight.

PCOS diet

Multiple diets have been shown to restore insulin sensitivity and balance hormones to support a healthy weight and improve fertility when followed for at least three months (2, 3).

These diets include:

  • low-carb
  • low-fat
  • the Mediterranean diet
  • the Dietary Approaches to Stop Hypertension (DASH) diet

Although these diets may differ in their macronutrient composition — or their ratio of carbs, fats, and proteins — most of them reduced calories.

However, this doesn’t mean that you need to meticulously track your calories or portion out all the foods you eat.

Instead, most people can reduce their calories by incorporating more nutrient-dense foods like fruits, vegetables, whole grains, and lean proteins in their diets and limiting sugary beverages, fried foods, and refined grains.

Doing so also helps decrease inflammation and reduce oxidative stress, which helps restore insulin sensitivity.

Decreasing calories will likely result in some weight loss, but weight loss isn’t always needed to restore insulin sensitivity or enhance fertility.

Foods to eat

Here are foods to eat with PCOS to decrease insulin resistance and increase fertility:

  • Fruits: apples, avocados, bananas, berries, cherries, grapes, mangos, melons, oranges, peaches, pears, etc.
  • Vegetables: arugula, asparagus, beets, broccoli, carrots, cucumbers, lettuce, mushrooms, onions, peppers, potatoes, radishes, spinach, squash, tomatoes, etc.
  • Whole grains: amaranth, barley, buckwheat, oats, quinoa, brown rice, and whole-grain breads or pastas
  • Low-fat dairy: cottage cheese, Greek yogurt, milk
  • Lean proteins: eggs, pork loin, seafood, skinless white meat poultry, round steak or top sirloin
  • Nuts and seeds: almonds, Brazil nuts, chia seeds, flaxseeds, pine nuts, pistachios, sunflower seeds, walnuts, etc.
  • Legumes: black beans, black-eyed peas, chickpeas, green peas, kidney beans, lentils, pinto beans, soybeans, etc.
  • Beverages: black coffee, green tea, water

Replacing some carbohydrates like potatoes and grains with lean proteins may be particularly beneficial for improving insulin resistance, but calorie reduction is still the most important factor (4, 5).

Foods to limit or avoid

Here are foods to limit or avoid with PCOS as they can worsen insulin resistance when consumed in large amounts:

  • Refined grains: breakfast cereals, cakes, crackers, cookies, desserts, pancakes, pastries, waffles, white bread, white rice
  • Added sugars: barbeque sauce, candy, French dressing, ice cream, and sugar-sweetened beverages like coffee, energy drinks, flavored milk, tea, and sports drinks
  • Processed meats: bacon, canned meats, deli meats, hot dogs, salami, smoked meats
  • Fried foods: cheese curds, chicken strips, fried fish, french fries, onion rings, etc.
  • Alcohol: beer, spirits, wine

You can still enjoy these foods in moderation but save them for special occasions.

3-day sample PCOS diet

Here’s a 3-day sample PCOS diet for fertility with a vegan option:

Day 1

  • Breakfast: cottage cheese with cucumber and tomato slices on whole-grain toast
  • Lunch: strawberry spinach salad with grilled chicken
  • Snack: Greek yogurt, almonds, and apple slices
  • Dinner: baked salmon and roasted brussels sprouts

Day 2 (vegan option)

  • Breakfast: oatmeal cooked with soymilk and topped with berries
  • Lunch: Mediterranean chickpea salad
  • Snack: hummus with veggies for dipping
  • Dinner: black beans with brown rice with chopped peppers, onions, and tomatoes

Day 3

  • Breakfast: baby spinach omelet with whole-grain toast
  • Lunch: chicken avocado roll-ups made with whole-wheat tortilla
  • Snack: hummus with veggies for dipping
  • Dinner: pan-seared sea bass with brown rice and sauteed green beans

PCOS supplements

Along with diet, certain supplements have been shown to improve measures of insulin resistance, cholesterol, and certain hormones related to PCOS, among other health markers.

Probiotics

Probiotics are living organisms that support a healthy gut microbiota.

Insulin resistance — like in PCOS — negatively alters the diversity of bacteria that compose the gut microbiota.

By promoting healthy gut bacteria diversity, probiotics are thought to improve insulin resistance in those with PCOS.

Indeed, several reviews of randomized control trials have shown that supplementation with probiotics significantly restores insulin sensitivity and balances hormones (6, 7, 8).

As a result of these benefits, probiotic supplementation may increase fertility, but studies are necessary to confirm this.

The main probiotic strains used in studies are Lactobacillus, Bifidobacterium, and Bacillus.

Fish oil

Insulin resistance is caused and worsened by increased inflammation and oxidative stress.

Fish oil is rich in omega-3 fatty acids — namely eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) — which have powerful anti-inflammatory effects.

As such, supplementing with fish oil may improve insulin sensitivity by decreasing the inflammation and oxidative stress that worsens it.

While not all studies have shown improvements in insulin sensitivity with omega-3 supplementation, several reviews of randomized controlled trials have reported significant decreases in markers of inflammation like high-sensitivity C-reactive protein (hsCRP) and increases in levels of adiponectin, a hormone that increases insulin sensitivity (9, 10, 11).

Omega-3 fatty acid supplementation has also been shown to improve cholesterol and triglycerides, which may help reduce the risk of heart disease (12).

The dose of omega-3 fatty acids used in these studies ranges from 1,000 to 3,500 mg daily for 6–12 weeks in the form of fish oil.

Wiley’s Finest and Nordic Naturals are two reputable fish oil brands.

Vitamin D

Vitamin D is a hormone-like vitamin that has been shown to improve insulin sensitivity and support healthy blood sugar levels.

In a review of 10 studies involving 520 women with PCOS, daily supplementation with less than 4,000 IU (100 mcg) of vitamin D led to significant reductions in fasting blood sugar levels (13).

A different review found that this same dose also improved insulin sensitivity (14).

Vitamin D hasn’t been shown to improve insulin sensitivity or decrease blood sugar in everyone with PCOS, but it’s likely most effective for those who are deficient (15).

Still, vitamin D is a relatively inexpensive way to maintain optimal levels since few foods are naturally good sources and relying on your body’s ability to produce it from the sun isn’t always possible.

Find vitamin D online.

Cinnamon

In addition to its culinary uses, cinnamon has strong blood-sugar-lowering properties owing to its concentrations of a compound called cinnamaldehyde (16).

Two reviews found that women with PCOS who supplemented with 0.5–1.5 grams of cinnamon daily for at least eight weeks experienced significant reductions in insulin resistance and fasting blood sugar levels, despite no significant changes in body weight (17, 18).

There are currently no studies to determine whether the improvements in insulin sensitivity from cinnamon supplementation would translate to improved fertility in women with PCOS.

Of the four main types of cinnamon, Ceylon is a good choice since its commonly used in studies.

Find Ceylon cinnamon online.

Myo-inositol

Myo-inositol is a sugar alcohol that regulates several hormones related to reproduction, including thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH), and insulin.

As such, supplementing with myo-inositol has been suggested to enhance fertility.

One review demonstrated that daily supplementation with 1.1–4 grams of myo-inositol for 12 to 24 weeks led to significant improvements in insulin sensitivity with a slight reduction in testosterone in women with PCOS (19).

However, it’s unknown whether supplementing with myo-inositol increases the chance of becoming pregnant or having a baby among women with PCOS (20).

You can find myo-inositol as a supplement alone or alongside another form of inositol called D-chiro inositol.

Find myo-insoitol supplements online.

PCOS and exercise

Next to diet, exercise is one of the most beneficial things you can do to manage PCOS and improve fertility (21).

Exercise not only increases insulin sensitivity but it also helps balance hormones and decreases the risk of conditions for which those with PCOS are at risk of developing, like heart disease and fatty liver (22).

Beyond these benefits, exercise has also been shown to improve symptoms of depression and anxiety in women with PCOS (23).

Research suggests that a minimum of 120 minutes of vigorous exercise per week is necessary to provide meaningful results but really any exercise that you can fit in your week is likely to offer health benefits (x).

Here are some examples of vigorous exercise:

  • hiking
  • jogging
  • weight lifting
  • biking
  • climbing stairs
  • playing soccer, basketball, or tennis

The bottom line

PCOS is a common hormonal condition that affects women.

It can decrease fertility, increase insulin resistance, and cause other health problems.

Fortunately, you can better manage PCOS and improve fertility by emphasizing fruits, vegetables, whole grains, legumes, lean proteins, and healthy fats while limiting refined grains, added sugars, processed meats, fried foods, and alcohol.

Taking certain supplements like probiotics, fish oil, vitamin D, cinnamon, and myo-inositol may also help but their effects on increasing fertility are less studied.

Finally, regular exercise — especially vigorous exercise — may enhance fertility and help you better manage conditions associated with PCOS like depression, heart disease, and fatty liver.


Gavin Van De Walle, MS, RD, LN
Gavin Van De Walle, MS, RD, LN

Gavin Van De Walle holds a master's degree in human nutrition and bioenergetics. He is a registered dietitian who aims to arm the public with evidence-based nutrition recommendations so they can make their own educated and informed health decisions.