The Impact of Diet on Polycystic Ovary Syndrome: A Comprehensive Review of Therapeutic Mechanisms and Clinical Applications

Polycystic ovary syndrome (PCOS) affects 4-20% of women globally and represents a complex endocrine disorder characterized by insulin resistance, hyperandrogenism, and metabolic dysfunction. Dietary approaches have emerged as fundamental therapeutic modalities with potential to address PCOS pathophysiology through various biological mechanisms. This comprehensive narrative review examines the impact of dietary interventions on PCOS management, synthesizing current evidence on mechanisms of action, clinical efficacy, and implementation considerations. A literature search was conducted across PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, and Google Scholar from 1990-2025. Studies involving women with PCOS and dietary interventions were included, including randomized controlled trials, observational studies, systematic reviews, and mechanistic research. Data synthesis used a thematic approach organizing evidence around mechanistic pathways, dietary approaches, and clinical outcomes. Evidence shows that dietary interventions significantly improve PCOS outcomes through gut microbiota modulation, insulin-glucose regulation, antiinflammatory effects, and hormonal optimization. Low-glycemic index diets show 15-25% improvements in insulin sensitivity and 20-30% testosterone reductions. Mediterranean diet patterns provide anti-inflammatory benefits and cardiovascular protection. Ketogenic interventions show rapid metabolic improvements with 87% reduced PCOS risk with high-quality dietary patterns. Omega-3 fatty acids, polyphenols, fiber, and micronutrients address distinct pathophysiological mechanisms. Implementation challenges include poor adherence, cultural barriers, and limited provider education. Dietary interventions represent evidence-based therapeutic modalities for PCOS management with demonstrable metabolic, reproductive, and psychological benefits. Integrating precise nutrition approaches considering individual biological profiles represents the future of PCOS care. Healthcare providers should prioritize nutritional counseling as first-line therapy, while future research should focus on personalized strategies and digital health integration to optimize outcomes globally