The Impact of Plant-Based Diet on Menstrual Cycle Irregularities in Women with Polycystic Ovary Syndrome (PCOS) at Wasit City
Abstract
Polycystic Ovary Syndrome (PCOS) is a common endocrine-metabolic disorder characterized by hormonal imbalances, ovulatory dysfunction, and menstrual irregularities. While pharmacological treatments exist, dietary strategies offer a non-invasive alternative for managing PCOS symptoms. This randomized controlled trial evaluated the impact of a plant-based diet on menstrual cycle frequency, hormonal parameters, and ovulatory function in women with PCOS in Wasit city. Fifty women with irregular menstrual cycles were randomly assigned to a plant-based diet group (n=25) or a control group (n=25) for a three-month intervention period. The plant-based group received structured dietary counseling emphasizing whole, minimally processed plant foods, while the control group maintained their habitual diet.
Primary and secondary outcomes included menstrual cycle frequency, serum hormone levels (testosterone, LH/FSH ratio), fasting insulin, and mid-luteal progesterone. Post-intervention comparisons revealed significantly improved outcomes in the plant-based group. Menstrual cycle frequency was higher (0.98 vs. 0.61 cycles/month, p<0.001), LH/FSH ratio was lower (1.52 vs. 2.25, p<0.001), and fasting insulin levels were reduced (13.8 vs. 16.2 μIU/mL, p=0.03). Mid-luteal progesterone levels, indicating ovulation, were markedly elevated (7.17 vs. 3.15 ng/mL, p<0.001). Multiple linear regression confirmed that diet group, mid-luteal progesterone, and LH/FSH ratio significantly predicted menstrual frequency (R²=0.64, p<0.001). Logistic regression identified plant-based diet as the sole significant predictor of ovulation (OR ≈ 293.3, p=0.001), independent of other hormonal or metabolic parameters.
These findings suggest that a fully plant-based diet may significantly improve reproductive outcomes in PCOS by restoring menstrual regularity and enhancing ovulation, potentially through pathways beyond traditional endocrine markers. This study fills a critical gap by evaluating a holistic plant-based approach and highlights its potential as a lifestyle-based intervention in PCOS management.
References
Alhassan, Samia & Elmugadam, Abdelgadir & Abubaker, Nuha & Elfadil, Ghada. (2022). Testosterone level correlates significantly with luteinizing hormone to follicle-stimulating hormone ratio among women with polycystic ovary syndrome: A cross sectional study. F1000Research. 11. 152. 10.12688/f1000research.76220.1.
Attia GM, Almouteri MM, Alnakhli FT. Role of Metformin in Polycystic Ovary Syndrome (PCOS)-Related Infertility. Cureus. 2023 Aug 31;15(8):e44493. doi: 10.7759/cureus.44493.
Avolio, E., Ferraro, S., Mocciaro, R., De Pergola, G., Buzzanca, F., Venturella, R., Pecorella, C., Palma, G., Romano, L., Mahata, S., Lorenzo, A., & Marchetti, M. (2020). The effect of ketogenic and low carb diet (Cyclic Alternation) on the ovarian morphology and insulin metabolism in polycystic ovary syndrome patients. Volume 6: 1-6
Brandner MME, Fyfe CL, Horgan GW, Johnstone AM. Self-Reported Purchasing Behaviour, Sociodemographic Predictors of Plant-Based Protein Purchasing and Knowledge about Protein in Scotland and England. Nutrients. 2022 Nov 7;14(21):4706.
Chavez GN, Jaworsky K, Basu A. The Effects of Plant-Derived Phytochemical Compounds and Phytochemical-Rich Diets on Females with Polycystic Ovarian Syndrome: A Scoping Review of Clinical Trials. Int J Environ Res Public Health. 2023 Aug 6;20(15):6534.
Chang, Hui & Wu, Qi & Ge, Hang & Li, Jian & Zhu, Meng-Yi & Luo, Xi & Han, Yan-Hua & Wu, Xiao-Ke. (2021). High Baseline SHBG, as an Independent Predictor, Was Associated With High Ovulation: a Secondary Analysis of PCOSAct. 10.21203/rs.3.rs-146920/v1.
Coyle, C., Ruddenklau, A., Prescott, M., Walters, K., & Campbell, R. (2021). Chronic excess of non-aromatizable androgens from puberty does not drive a neuroendocrine phenotype observed in other preclinical rodent models of PCOS. Journal of the Endocrine Society, 5, A533–A534.
Ge H, Chang H, Wang Y, Cong J, Liu Y, Zhang B, Wu X. Establishment and validation of a nomogram model for predicting ovulation in the PCOS women. Medicine (Baltimore). 2024 Apr 5;103(14):e37733.
Grzesik, Karina & Pilarczyk, Katarzyna & Rabęda, Aleksandra & Klepacz, Natalia & Cudziło, Zuzanna & Sawczuk, Hubert & Nowak, Weronika & Kaus, Marta & Adamska, Hanna & Malicka, Marta. (2024). The impact of a plant-based diet on the menstrual cycle and female fertility. Journal of Education, Health and Sport. 76. 56507. 10.
Gautam R, Maan P, Jyoti A, Kumar A, Malhotra N, Arora T. The Role of Lifestyle Interventions in PCOS Management: A Systematic Review. Nutrients. 2025 Jan 16;17(2):310.
Illescas, O., Ferrero, G., Belfiore, A., Pardini, B., Tarallo, S., Ciniselli, C., Noci, S., Daveri, E., Signoroni, S., Cattaneo, L., Mancini, A., Morelli, D., Milione, M., Cordero, F., Rivoltini, L., Verderio, P., Pasanisi, P., Vitellaro, M., Naccarati, A., & Gariboldi, M. (2024). Modulation of faecal miRNAs highlights the preventive effects of a Mediterranean low-inflammatory dietary intervention. Clinical Nutrition, 43(4), 951–959.
Irmak E, Tunca Sanlier N, Sanlier N. Could polyphenols be an effective treatment in the management of polycystic ovary syndrome? Int J Vitam Nutr Res. 2024 Jun;94(5-6):422-433.
Johra, T., Akther, N., Rabeya, S., Khan, M. A. H. K., & Amanullah, M. (2023). Observing the use of insulin sensitizers for ovulation induction among PCOS women. Sch J App Med Sci, 2023 Jan 11(1): 236-241.
Li C, Xing C, Zhang J, Zhao H, Shi W, He B. Eight-hour time-restricted feeding improves endocrine and metabolic profiles in women with anovulatory polycystic ovary syndrome. J Transl Med. 2021 Apr 13;19(1):148.
Masood, I., Noreen, S., Raza, K., Khalid, W., Rahim, M. A., & Mohamedahmed, K. A. (2023). Effect of ketogenic diet and hypocaloric Mediterranean diet on metabolic and endocrine parameters in women suffering from Polycystic Ovary Syndrome. International Journal of Food Properties, 26, 3187–3196.
Malik, T. H., Ali, H., Hassan, A., Qayyum, J., & Naseem, A. (2021). Pharmacotherapy and neoteric dietary approaches for polycystic ovary syndrome: A systematic review. Turkish Journal of Endocrinology and Metabolism, 25, 113–122.
Malini, N., & Roy, G. K. (2021). Influence of insulin on LH, testosterone and SHBG in various PCOS categories based on the mode of secretion of LH in relation to FSH levels. Acta Endocrinologica, 17(3), 313–318.
Mizgier M, Jarząbek-Bielecka G, Opydo-Szymaczek J, Wendland N, Więckowska B, Kędzia W. Risk Factors of Overweight and Obesity Related to Diet and Disordered Eating Attitudes in Adolescent Girls with Clinical Features of Polycystic Ovary Syndrome. J Clin Med. 2020 Sep 21;9(9):3041.
Mishra, Mridula & Samant, Parineeta & Patil, Shaifali. (2024). A case-control study unravelling the prognostic significance of oxidative markers in polycystic ovary syndrome (PCOS) patients. Journal of Applied and Natural Science. 16. 805-811. 10.31018/jans.v16i2.5618.
Nomamiukor, F. O., Smethurst, M. A., Franz, M. R., Hamilton, E. G., Garza, A., Padilla-Medina, D. M., Davis, M., & Taft, C. T. (2024). Is trauma associated with plant-based diet choice? Appetite, 206, Article 107841.
Samarasinghe SNS, Ostarijas E, Long MJ, Erridge S, Purkayastha S, Dimitriadis GK, Miras AD. Impact of insulin sensitization on metabolic and fertility outcomes in women with polycystic ovary syndrome and overweight or obesity-A systematic review, meta-analysis, and meta-regression. Obes Rev. 2024 Jul;25(7):e13744.
Semenyna H, Fartushok T, Fartushok N, Dumanchuk N, Yurchyshyn O. The role of diet therapy in insulin resistance in women with polycystic ovary syndrome. Med. perspekt. [Internet]. 2025Jan.8 [cited 2025Apr.14];29(4):39-47.
Shahinfar, H., Amini, M., Payandeh, N., Naghshi, S., Sheikhhossein, F., Djafarian, K., & Shab-Bidar, S. (2021). The link between plant‐based diet indices with biochemical markers of bone turnover, inflammation, and insulin in Iranian older adults. Food Science & Nutrition, 9, 3000–3014.
Tholiya, S., Kumari, A., Mahey, R., Kalaivani, M., Sati, H. C., Sharma, M., Jayraj, A. K., & Malhotra, N. (2024). Evaluation of predictors of response to ovulation induction using letrozole in women with polycystic ovary syndrome: A prospective cohort study. Journal of Human Reproductive Sciences, 17, 240–245.
TUREMKA, Mariola, MANDZIUK, Aneta, CYGNAROWICZ, Aleksandra, WOJTAS, Aneta Klaudia, ZABOJSKA, Krystyna, KOROTKO, Urszula, WITOWSKA, Kinga, BISKUPSKI, Mikołaj, HOSSEINNEJAD, Negar and SACHER, karolina. The Impact of the Ketogenic Diet on the Metabolic Profile, Hormonal Balance and Fertility in Women with PCOS: A Literature Review. Quality in Sport. Online. 20 December 2024. Vol. 36, p. 56601.
Urpi-Sarda M, Casas R, Sacanella E, Corella D, Andrés-Lacueva C, Llorach R, Garrabou G, Cardellach F, Sala-Vila A, Ros E, Ruiz-Canela M, Fitó M, Salas-Salvadó J, Estruch R. The 3-Year Effect of the Mediterranean Diet Intervention on Inflammatory Biomarkers Related to Cardiovascular Disease. Biomedicines. 2021 Jul 22;9(8):862.
Verde L, Dalamaga M, Capó X, Annunziata G, Hassapidou M, Docimo A, Savastano S, Colao A, Muscogiuri G, Barrea L. The Antioxidant Potential of the Mediterranean Diet as a Predictor of Weight Loss after a Very Low-Calorie Ketogenic Diet (VLCKD) in Women with Overweight and Obesity. Antioxidants (Basel). 2022 Dec 22;12(1):18.
Wagh, Sheetal & Deshmukh, Jayashri. (2024). Ayurvedic management of PCOS: A case study. Journal of Ayurveda and Holistic Medicine (JAHM). 12. 10.70066/jahm.v12i3.1311.
Wang YX, Shan Z, Arvizu M, Pan A, Manson JE, Missmer SA, Sun Q, Chavarro JE. Associations of Menstrual Cycle Characteristics Across the Reproductive Life Span and Lifestyle Factors With Risk of Type 2 Diabetes. JAMA Netw Open. 2020 Dec 1;3(12):e2027928.
Xing, C., Li, C., & He, B. (2020). Insulin sensitizers for improving the endocrine and metabolic profile in overweight women with PCOS. The Journal of Clinical Endocrinology and Metabolism, 105, 2950–2963.
Xu Y, Qiao J. Association of Insulin Resistance and Elevated Androgen Levels with Polycystic Ovarian Syndrome (PCOS): A Review of Literature. J Healthc Eng. 2022 Mar 21;2022:9240569.