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Evidence Based

This article is based on scientific evidence, written by experts and fact checked by experts.

Our team of licensed nutritionists and dietitians strive to be objective, unbiased, honest and to present both sides of the argument.

This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

Improving Your PCOS Symptoms: A User Guide

Written by Michael Ruscio on June 10, 2024

Rebalance Your Hormones With Some Simple Diet and Lifestyle Upgrades

Polycystic ovary syndrome, or PCOS, is a common hormonal condition affecting up to 10% of women worldwide [1]. 

If you’re one of these women, you’ll know the array of symptoms PCOS can cause and how much they can disrupt your life. Some of the symptoms, like acne and hair loss, are usually not of great medical consequence but can still be highly upsetting. Others, like infertility and pre-diabetes, can have serious or life-changing implications.

While I can’t offer a cookie-cutter solution for PCOS, many of my female patients have gotten a lot of relief from a range of self-help options that encompass diet, supplementation, and certain lifestyle changes.

In this article, we’ll look into how to balance hormones, with PCOS as the specific focus. I’ll walk you through what the research says can help the condition. And I’ll share what my clients say are the most useful natural treatments for improving their quality of life.

But first, let’s dive into what PCOS is and what it means when you have it.

What Is PCOS?

PCOS is a condition of imbalanced reproductive hormones. Usually in PCOS, the ovaries produce too much of the androgen (or “male” hormone), testosterone [1]. 

As the name suggests, some women with PCOS develop polycystic ovaries. In other words, their ovaries become enlarged and contain many fluid-filled sacs (follicles) that surround the eggs and interfere with ovulation [1]. But despite the name, not everyone with PCOS has these follicles [1].

In fact, only two of the following three signs and symptoms must be present for a PCOS diagnosis [2]:

  1. Polycystic ovaries, as described above (diagnosed by ultrasound)
  2. Chronic irregular periods, including infrequent periods (oligomenorrhea) or absent periods (amenorrhea)
  3. Elevated testosterone or excessive facial or body hair (aka hirsutism, the most diagnostically valid symptom of too much testosterone)

Among people with PCOS, 80% tend to gain weight and accumulate fat around the belly [3, 4], while the remaining 20% have so-called “lean PCOS” and are a healthy weight [4].

Some other symptoms or health problems that women with PCOS commonly have include:

  • Persistent acne or oily skin [5]
  • Darker or thicker patches of skin on the back of the neck or armpits, or under the breasts [5]
  • Infertility [5] 
  • Metabolic syndrome (including insulin resistance and increased risk for heart disease) [3]
  • Nonalcoholic fatty liver disease [3]
  • Depression and anxiety [3, 6]

Additionally, more than half of women with PCOS develop type-2 diabetes by the time they turn 40 [7]. 

While these statistics appear pretty worrying, a lot can be done to balance hormones and reduce PCOS symptoms [8].  

PCOS Overlaps With Other Conditions

Although we don’t know the precise cause of PCOS, we do know it usually develops under an internal environment of chronic low-grade inflammation [9] typically related to diet, lifestyle, and the gut microbiome.

Below is a simplified flowchart showing the proposed relationships between inflammation, gut microbe imbalances (dysbiosis), insulin resistance, and PCOS [1, 10].

How to balance hormones with PCOS

If this chart appears complex, the key thing to notice is that unhealthy diet and lifestyle are central drivers of PCOS.

We’ll dig a bit more into the underlying role that gut health plays in PCOS later, but first, let’s get straight into what diets may work for the condition.

Diets That Help PCOS

Eating fewer highly processed and non-nutritious calories plays a major part in improving PCOS for most people with the condition [6]. 

In fact, the main evidence-based dietary recommendation is to reduce daily calories, in order to lose weight and improve metabolic and hormonal health [11, 12, 13].

However, losing weight is easier said than done if hormones and metabolism are working against you, as they might be in PCOS. For success, people with PCOS need to find a dietary sweet spot that will help them eat fewer calories while still feeling full and satisfied, and getting balanced nutrition.

Below is a table of some of the diets studies have shown can help with weight loss and PCOS symptoms. These are listed in order of strongest to weakest evidence. But remember, what works in the real world for each person with PCOS might vary.  

DietWhat’s Involved?What the Research Says
Reduced calorie dietThis means cutting down on calorie-dense foods and portion sizes while emphasizing nutritious foods that help you feel full. Most of the lower-calorie diets that show a benefit for PCOS also advocate exercise to increase the calorie deficit [14, 15]Low-calorie diets may be the most effective for weight management in PCOS [16]. Reduced calorie diets can improve body composition [14, 16, 17, 18], reproductive hormone levels [17, 18, 19, 20], insulin resistance [15, , 18], reproductive hormone levels [17, 18, 19, 21], and inflammation [14, 18, 19]. 
DASH (Dietary Approaches to Stop Hypertension) dietThe DASH diet is a whole-food, lower-sodium diet that focuses on a variety of fruits, vegetables, low-fat dairy products, whole grains (like brown rice or quinoa), nuts, seeds, legumes (such as beans and lentils), lean meats, poultry, fish, herbs, spices, and olive oil [22].The DASH diet appears to be best for reducing insulin resistance in PCOS, particularly for those who do not tolerate metformin well [16].

*Metformin is a drug often prescribed to help PCOS patients manage insulin resistance and diabetes. 
Lower carb/higher proteinLower-carb and  higher-protein diets have fewer or smaller portions of carbs (like bread, potatoes, pasta, rice, and sugary foods). Instead, they focus more on lean protein (such as lean meats, fish, and poultry), plant proteins (like soy products and pea protein powder), and non- starchy veggies (like leafy greens and cauliflower)In people with PCOS, low-carb, higher-protein diets (particularly those that are also lower in fat and total calories) may reduce body weight [23, 24, 25] and improve blood sugar regulation [23], insulin resistance [13, 21, 24], inflammation [19], and hormone balance [13, 24]. In contrast, a high-carb diet may increase androgens (e.g. testosterone) [13]. 
Keto (ketogenic) dietKetogenic diets are extremely low in carbs and high in fat. The idea is that keto dieters stay in a state of ketosis (which is when the body’s main fuel is fat).Some clinical trials have shown that PCOS patients with liver dysfunction and obesity can gain metabolic  benefits (like weight loss and healthy blood sugar and cholesterol) and improve their liver health on a ketogenic diet [26, 27]. Menstrual cycles and hormone levels may also improve [26, 27]. 

Although it’s not been specifically researched for PCOS, the Paleo diet is another diet that my clients with PCOS often find helpful. This diet cuts out refined carbohydrates and focuses on good-quality proteins, nuts, fresh vegetables, and berries, all of which helps reduce blood sugar levels [28, 29] and might help balance hormones [30].

Healthy Fats

Incorporating healthy fats into the diet is important for people with PCOS. That’s because dietary fats are essential for healthy hormone production [31, 32]. 

A good rule of thumb is to include a small portion of healthy fat with every meal. Extra virgin olive oil, avocados or avocado oil, flaxseeds or flaxseed oil, fatty fish, nuts, and chia seeds are all good options for healthy hormone production. 

If you’re not getting enough healthy fat in your diet, a fish oil supplement may also be helpful.

The Microbiome-Hormone Connection

It’s interesting to note that a bunch of microbiome studies have found that PCOS patients have less diverse gut microbes than healthy people [33, 34, 35, 36, 37, 38, 39]. 

A lower diversity of gut bacteria may be linked with insulin resistance and higher testosterone levels, both of which are hormonal imbalances seen in PCOS [40].

The microbiome-based theory of how PCOS develops (which you can see as Gut dysbiosis in the flowchart above) is that it stems from gut dysbiosis, or imbalances in gut microbes. These imbalances cause gut permeability (a leaky gut) and allow harmful substances into the bloodstream, which triggers the immune system and interferes with how insulin works. This may lead to high insulin resistance, more testosterone hormones being made in the ovaries, and the onset of PCOS symptoms [41]. 

Newer research has found that people with PCOS have lower levels of bacteria that break down bile acids (which help us digest fat). Without those bacteria, the levels of certain bile acids that influence fat storage and insulin levels go up, possibly harming gut bacteria and weakening intestinal walls [42].

Fiber Boost?

When good bacteria have plenty of healthy plant fibers to ferment, they can produce more short-chain fatty acids (SCFAs), which may have a positive effect on the metabolic and hormonal aspects of PCOS [42].

You’d imagine that women with PCOS would therefore benefit from eating a lot of fiber, and some randomized clinical research has found that they can [43, 44].

However, it’s important to take any fiber supplementation slowly, especially if you have delicate gut health. For instance, some of my clients have had big improvements in their hormone balance and PCOS symptoms by bumping up their fiber, while for others, too much fiber irritates their gut and makes them feel worse. 

In particular, when people have food intolerances and sensitivities or IBS-type symptoms, increasing fiber—especially quickly—may not be a good idea.

For anyone with gut sensitivities, starting with a gentler way to improve gut health, such as probiotics, could be better. Not only can probiotics help your gut, but I’ll explain how they can also be helpful for dealing with PCOS.

Probiotics Work for PCOS 

Probiotics can offer valuable support for managing PCOS via their microbiome benefits. For this reason, they are usually the next step I recommend to my clients after they’ve made healthy diet changes.

Numerous meta-analyses show that probiotics can significantly improve various aspects of PCOS, including [45, 46, 47]: 

  • Insulin sensitivity
  • Triglyceride levels
  • Inflammation 
  • Hirsutism (excessive hair growth in unwanted places)
  • Testosterone levels 

That said, some research has found probiotics might be less useful for helping with hormonal balance, body composition, and blood sugar control [45, 48, 49] . However, there are no known downsides to taking probiotics, so it usually makes good sense to try them.

Triple Therapy

While any well-formulated probiotic is likely better than none, we’ve found at the clinic that our clients achieve the best results by using probiotics from these three main categories:

  1. A Lactobacillus and Bifidobacterium blend (for example, L. acidophilus, L. plantarum, B. infantis, and B. lactis).
  2. Saccharomyces boulardii (a beneficial yeast).
  3. Soil-based probiotics, typically Bacillus species.

Some clients find that a Lactobacillus and Bifidobacterium blend alone is sufficient, while others benefit more by adding Saccharomyces boulardii and soil-based probiotics. 

For those who respond well to this triple-therapy approach, this convenient combination product is stable at room temperature and easy to travel with.

Lifestyle Support for PCOS: Exercise, Sleep, and More

Diet and lifestyle modifications—especially exercise—remain a cornerstone of PCOS management. Other lifestyle changes that reduce stress and insomnia can have a big impact, too. I’ll describe my favorite ways to help people change their lifestyle and form habits that will support hormone health.

Exercise You Can Stick To

Many types of exercise show promise for improving the symptoms of polycystic ovary syndrome. Benefits include improved body composition (more lean muscle, less fat) [50, 51], lowered androgen levels [11, 12], improved cardiovascular health [14], and improved measures of metabolic health [11, 50, 52]. 

However, because PCOS can negatively affect both body image and mood, people with the condition must find physical activities they enjoy and that boost their self-esteem. 

Common options include walking, hiking, jogging, or bicycling. Other great options include dance classes, kettlebell training, high-intensity interval training (HIIT), weight lifting, pilates, rowing, rebounding (minitrampoline), body-weight exercises, fencing, or rock climbing. 

HIIT is probably one of the best things women with PCOS can do to improve insulin resistance and body mass index [53].

But even more meditative types of exercise can be beneficial, too. For example, one randomized controlled trial found that yoga improved female hormone levels, testosterone levels, male-pattern hair growth, and menstrual cycle frequency in women with PCOS [54]. Another one found that tai chi helped reduce BMI, testosterone, and cholesterol in a group of young women with PCOS [55].

And don’t discount everyday movements like pushing or pulling heavy loads (say, in a wheelbarrow), lifting and moving things around the house or office, watering plants, carrying groceries and kids, doing yard work, vacuuming, and other bits of labor that get the muscles moving. These can add up and help regulate your hormones.

In a nutshell, exercising regularly (which most of us will only do if we find movements that we enjoy) is more important for health, with or without PCOS, than the type of exercise performed. 

Sleep Solutions

Sleep disturbances are very common in people with PCOS [56], so any habits that improve sleep are worthwhile. Science-backed steps that have worked for my clients include [57]:

  • Maximizing outdoor light exposure in the morning and limiting light exposure in the evening
  • Maintaining consistent sleep/wake times
  • Maintaining consistent meal times each day, including eating breakfast shortly after waking and eating dinner by 7pm 
  • Not napping after 4pm 
  • Not drinking coffee or other caffeine sources in the afternoon [58]
  • Exercising regularly (see above) [59], but not close to bedtime
  • Wearing blue light-blocking glasses before bed [60, 61, 62]
  • CBTi (a special sort of cognitive behavioral therapy for insomnia) [63]
  • Acupuncture [64]

Mental Health Support

Unfortunately, PCOS often introduces depression, anxiety, and a lower quality of life. But the good news is that a couple of interventions can support mental health in people with PCOS. These are: 

  • Cognitive behavioral therapy (CBT), which can greatly reduce depression in women with PCOS [65]; and
  • Mindfulness-based stress reduction (MBSR), which, in one randomized controlled trial, cut the worries of PCOS patients to half the worries of those who didn’t do MBSR [66].

Other Potentially Useful Supplements

A gut-healthy diet with probiotics and healthy lifestyle changes are central to how we balance hormones with PCOS clients at the clinic. However, for clients who need extra help to get their hormonal balance back on track, the following supplements are also worth considering.

Inositol

Sometimes inaccurately classified as a B vitamin (it’s actually a type of natural sugar), inositol can greatly improve the chances of PCOS patients having regular periods again [67]. Inositol is also as good as the diabetes medication metformin at improving body mass index, hormone levels, blood sugar, and insulin in people with PCOS [67, 68]. 

DOSE: Studies used a range of 600–4,000 mg/day for 7–24 weeks, but always work with your doctor to get the right dose for you. Myo-inositol (or just “inositol”) is the type used in studies and what to look for in supplements.

Vitamin D 

Of all the true vitamins that have been researched for PCOS, vitamin D has the most promising effects on menstrual cycle regularity. High doses of vitamin D for more than 8 weeks improved menstrual cycle regularity by 35% [69]. 

DOSE: When working with clients who might benefit from vitamin D supplementation, I recommend they start by testing their current vitamin D levels. Depending on their starting point, they’ll typically need to take between 400 and 2,000 IU vitamin D per day to achieve the 100–125 nmol/L (40–50 ng/mL) vitamin D level I think is optimal [70, 71, 72]. It’s always ideal to work with a trusted clinician to get your levels right.

For better absorption and utilization, choose vitamin D3 rather than D2 [73]. Combining D3 with vitamin K can support bone mineral density, too [74].

Omega-3 Fatty Acids

A meta-analysis showed that omega 3s can help reduce waist size, blood sugar, insulin resistance, triglycerides, and LDL cholesterol in PCOS patients [75].

DOSE: The study found that any amount of omega 3s from fish oil or flaxseed oil was  helpful. Work with your doctor to find the form and dosage best for you. 

Vitamin E

A meta-analysis found that vitamin E helped reduce triglycerides, LDL, and total cholesterol, C-reactive protein, and unwanted hair growth in women with PCOS. Vitamin E also increased nitric oxide (an important chemical messenger that helps blood flow) [76].

DOSE: Most studies used 400 mg/day for 8–12 weeks, but ask your doctor what’s right for you.

Coenzyme Q10 (aka CoQ10 or Ubiquinol)

CoQ10 is a vitamin-like substance in the mitochondria of cells. It acts as an antioxidant and plays an important role in energy release. 

Research suggests that CoQ10 supplements can also improve insulin resistance, blood sugar, sex hormone levels, testosterone, triglycerides, and cholesterol in women with PCOS [77].

DOSE: Doses of between 50 mg and 300 mg are typical. Ask your doctor what is likely to work best for you.

Chromium 

This trace mineral plays a role in how insulin helps the body regulate blood sugar levels. A meta-analysis of randomized controlled trials found that chromium (as chromium picolinate) can help reduce BMI, free testosterone, and insulin levels in PCOS patients [78].

DOSE: Studies used 200–1,000 micrograms/day for 8–24 weeks, but please ask your doctor what dose is right for you.

Resveratrol

Resveratrol is a polyphenol (type of plant chemical) found naturally in grapes and other fruits and vegetables. It has antioxidant and anti-inflammatory effects and can help to reduce cholesterol and improve acne severity in women with PCOS. It also lowers excess prolactin [79].

DOSE: Studies found benefits when patients used 800–1,500 mg/day resveratrol, for 40–90 days, but check with your doctor. 

Herbal Blends 

Several herbs may help to balance hormones in general and for people with PCOS. When I’m using herbals in clients with PCOS, I’ll usually recommend a proprietary blend (Progest-Harmony or Estro-Harmony), depending on symptoms and whether they’re pre- or postmenopausal. Which herbs may be best for you is something to figure out with your healthcare provider and may take some trial and error.

Here are some potentially useful herbs to look out for:

  • Berberine can improve insulin resistance in PCOS patients [80].
  • Chasteberry (aka Vitex) may lower prolactin and improve menstrual regularity in PCOS, and it might help with infertility issues [81].
  • Black cohosh may improve pregnancy rates when used alongside clomiphene citrate (a medication that can stimulate the ovaries to produce eggs) in women with PCOS [81].
  • Licorice may reduce testosterone levels in women with PCOS [81].
  • White peony (also known as Chinese peony): When combined with licorice, it may help reduce testosterone, and when combined with cinnamon, it may help improve ovulation in PCOS patients [81].

PCOS: Tricky but Solvable

Though managing PCOS is challenging, understanding the condition and making targeted diet and lifestyle changes can significantly improve your quality of life. 

Research shows that inflammation and poor gut health often play a significant role in the insulin resistance and higher testosterone levels that occur in PCOS. Addressing these by eating a balanced diet with probiotics, making positive lifestyle changes, and possibly adding other targeted supplements can improve symptoms, fertility, and life in general.

However, if you are finding PCOS or other hormonal issues too tricky to resolve alone (or if you can’t find a practitioner to fit your needs and help you), we’d be delighted to help—just reach out to one of our experienced health practitioners. If digging deeper into gut-healing therapies interests you, you may also benefit from reading my book, Healthy Gut, Healthy You.

The Ruscio Institute has developed a range of high-quality formulations to help our clients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you. The information on DrRuscio.com is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.

Dr. Michael Ruscio is a DC, Naturopathic Practitioner, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.

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