PCOS

What is PCOS?

Polycystic ovary syndrome (PCOS) is a common hormonal disorder. Symptoms can include: irregular cycle, acne, excess hair growth, hair loss, weight gain around the abdomen, difficulty losing weight, or a desire to conceive that doesn’t happen quickly.

Why PCOS often coincides with insulin resistance

In many women with PCOS, insulin resistance is an important driver. The body then produces more insulin to keep blood sugar normal (hyperinsulinemia). A higher insulin level stimulates androgen production and often lowers sex hormone-binding globulin. This can increase symptoms.

Why take the metabolic part seriously?

PCOS can be associated with a higher risk of prediabetes or type 2 diabetes, fatty liver, high triglycerides, low HDL cholesterol (the good cholesterol) and high blood pressure. These risks are often well influenced by lifestyle.

Action plan

The core is lowering insulin burden. This can be done step by step with therapeutic carbohydrate restriction and, if needed, with ketogenic metabolic therapy.

Step 1: Therapeutic carbohydrate restriction

Therapeutic carbohydrate restriction means: fewer (fast) carbohydrates and more whole foods. This lowers insulin, often improves the lipid profile and can support the cycle.

Guideline: 50-100 grams carbohydrates per day (personal, depending on goals and tolerance)
Eliminate added sugars, soft drinks and fruit juice, white flour and ultra-processed snacks
Choose as basis: protein (fish, meat, eggs, dairy or tofu/tempeh), vegetables and quality fats
Eat 2-3 whole meals per day and limit snacks if possible

Practical start

Protein per meal: eggs, fish, meat or chicken, full-fat quark or Greek yogurt, cheese, tofu or tempeh
Plenty of vegetables (especially leafy greens and cabbages) and fats such as olive oil, butter or avocado
Drinks: water, tea, coffee; avoid sugary drinks and juices
Exercise: 10-15 minutes walking after meals often helps against glucose spikes

Step 2: Ketogenic metabolic therapy

Ketogenic metabolic therapy is a stricter form of carbohydrate restriction aimed at stable low insulin and (mild) nutritional ketosis. It can be useful with clear hyperinsulinemia, high triglycerides, fatty liver, or if therapeutic carbohydrate restriction gives insufficient effect.

Guideline: usually less than 30 grams carbohydrates per day, with sufficient protein and fats from real food
Practical: non-starchy vegetables, a protein source, and fats such as olive oil, avocado and fatty fish
Start preferably with guidance. Discuss with pregnancy (desire), medication, kidney disease or eating disorders
In the first 1-2 weeks, temporary complaints may occur; extra salt, water and magnesium often help

Additional lifestyle pillars

Strength training 2-3x per week and daily movement
Sleep 7-9 hours and build in stress reduction (insulin resistance can otherwise worsen)
Limit alcohol, especially with (suspected) fatty liver

Supplements (optional)

Sometimes supportive, but no replacement for food and lifestyle. Preferably discuss use.

Myo-inositol (sometimes combined with D-chiro-inositol in a 40:1 ratio)
Vitamin D if blood level is low (target value often 75 nmol/l or higher)
Omega-3 fatty acids (for example from fatty fish or fish oil) with high triglycerides; magnesium can help with cramps or fatigue

What can you track?

Cycle and symptoms (acne, hair, mood), plus weight and especially waist circumference
Blood: glucose, HbA1c (long-term sugar), triglycerides and HDL cholesterol; possibly insulin, C-peptide and sex hormone-binding globulin in consultation
Avoid large post-meal spikes (possibly with finger prick or glucose sensor)

When to contact?

With pregnancy (desire) or strong desire to conceive: discuss timing and approach in time
With medication use (for example for diabetes or blood pressure): dosage may need adjustment
If periods are absent or with abnormal blood loss; or with alarm symptoms such as fainting

Veelgestelde vragen

What is PCOS?

Polycystic ovary syndrome (PCOS) is a common hormonal disorder with symptoms such as irregular cycle, acne, excess hair growth, hair loss, weight gain around the abdomen, difficulty losing weight, or fertility problems.

What is the relationship between PCOS and insulin resistance?

In many women with PCOS, insulin resistance is an important driver. The body produces more insulin (hyperinsulinemia), which stimulates androgen production and lowers sex hormone-binding globulin, causing symptoms to increase.

How many carbohydrates per day with PCOS?

With therapeutic carbohydrate restriction (TCR), the guideline is 50-100 grams of carbohydrates per day. With ketogenic metabolic therapy (KMT), this is usually less than 30 grams per day.

Which supplements can help with PCOS?

Optional and supportive: myo-inositol (sometimes combined with D-chiro-inositol in 40:1 ratio), vitamin D when blood level is low (target 75 nmol/l), and omega-3 fatty acids with high triglycerides. Discuss use with your healthcare provider.

Medische Disclaimer: De informatie van Stichting Je Leefstijl Als Medicijn over leefstijl, ziektes en stoornissen mag niet worden opgevat als medisch advies. In geen geval adviseren wij mensen om hun bestaande behandeling te veranderen. We raden mensen met chronische aandoeningen aan om zich over hun behandeling goed door bevoegde medische professionals te laten adviseren.

Medical Disclaimer: The information provided by Stichting Je Leefstijl Als Medicijn regarding lifestyle, diseases, and disorders should not be construed as medical advice. Under no circumstances do we advise people to alter their existing treatment. We recommend that people with chronic conditions seek advice regarding their treatment from qualified medical professionals.