If you’ve been exploring ways to support your hormonal health—whether for PCOS, fertility, postpartum recovery, or just better energy—you’ve probably come across the ketogenic diet. But can keto actually help balance your hormones? And if so, how should you approach it to work with your body, not against it?

Let’s take a closer look at how keto affects your hormones, what benefits (and risks) to watch for, and how to make it work in a nourishing, sustainable way.

What Is Keto, and Why Does It Matter for Hormones?

Keto is a type of diet that focuses on the inclusion of high healthy fats and restriction of carbohydrates. When in following a keto diet, you're body transitions to using fat as it's core energy source rather than it's usual source of energy glucose (from carbohydrates). The end result of fat metabolizing into energy creates ketones- activating ketosis and mimicking a metabolic fasting state for the body.

The standard keto ratio is about 70–80% fat, 15–20% protein, and less than 10% carbohydrates (usually fewer than 50 grams a day). While that sounds intense, many women find they feel more stable, focused, and less hungry when they’re in ketosis—especially if they’re dealing with insulin resistance.

How Keto Affects Insulin and Blood Sugar

Insulin is a hormone that primarily plays a role in blood sugar regulation. However, insulin doesn’t only influence blood sugar—it also affects ovulation and androgenic activity. If you have insulin resistance (which is common with PCOS, prediabetes and Type 2 Diabetes), your cells are

less likely to take in  glucose from your bloodstream. This means that the body can get confused and release more insulin. This build up of glucose and insulin in the bloodstream is what is known as insulin resistance. High androgen levels (testosterone) and insulin levels have a synergistic relationship. In PCOS, these high insulin and testosterone levels poorly impact ovulation regularity and contribute to cyst formation. 

On a keto diet, insulin levels typically drop. This can be a good thing. In one 12-week study, women with PCOS who followed a ketogenic diet had lower insulin, reduced testosterone, and more regular ovulation (Paoli et al., 2020) [8]. Another review showed that within just 45 days, following a keto diet improved LH/FSH ratios (relative levels of two hormones in the bloodstream) and increased SHBG, a protein that helps regulate estrogen and testosterone (Khalid et al., 2023) [6].

This reset in insulin sensitivity can also support more regular cycles, better energy, and a reduced risk of long-term issues like Type 2 diabetes.

How Keto Affects Hunger and Cravings

One surprising benefit of the keto diet is how it changes your appetite. If you’ve ever felt like you’re constantly fighting cravings, it’s likely your hunger hormones were out of sync. Keto tends to reduce ghrelin (the hunger hormone) and increase satiety hormones like GLP-1 and CCK (Sumithran et al., 2013; Gibson et al., 2015) [9][4].

That means you feel full longer. And, when you're not constantly battling hunger, your energy feels more stable throughout the day. That steadiness can also lead to fewer emotional highs and lows, helping you feel more grounded both physically and mentally.

What About Cortisol and Stress—Especially for Women?

When women begin a ketogenic diet, the body goes through an adjustment phase. It’s common to feel more fatigued, edgy, or wired at first. That’s because cortisol, your primary stress hormone, can rise temporarily as your body shifts from burning carbs to using ketones.

For women, this early “keto flu” may trigger a sharper cortisol response, especially if paired with low calorie intake or over-exercising. Research shows that short-term ketogenic diets can increase resting and post-exercise cortisol levels in the first two weeks of adaptation (Whitaker et al., 2022) [10]. However, the study shows these effects tended to normalize after about three weeks.

Distinguishing the type of PCOS you may have will help you make the right decision in starting a keto diet if questioning its impact on cortisol levels. PCOS is traditionally viewed as an insulin and testosterone issue—however, many women experience adrenal dysfunction and/or may have what’s called Adrenal PCOS (where cortisol drives high testosterone levels, not so much insulin) [12]. 

Bottom line? A keto diet can be a therapeutic dietary approach to metabolic conditions. When done thoughtfully—with enough calories, rest, and support—it can be an exploratory diet to reduce inflammation related to insulin resistance. On the other end, long-term research on the keto diet for women is not yet as abundant as findings on keto diets for men.

Reproductive Hormones: Estrogen, Progesterone, and Ovulation

Body fat plays a role in estrogen production, so when you reduce fat mass through dietary changes, your stored estrogen levels may drop. This is helpful if you’re dealing with estrogen dominance (which is common if you have  PCOS or endometriosis), but it needs to be done gradually. Changes that are too rapid can lead to drops in estrogen that may disrupt your cycle. 

It’s also important to note that fiber plays a very important role in detoxing estrogen levels by binding to estrogen in the intestines. A restrictive carbohydrate diet may decrease your total fiber intake, hindering the process of estrogen detox. 

Keto can also help regulate your LH and FSH levels and lower elevated testosterone, which are often at the root of irregular periods and ovulatory dysfunction in PCOS. In fact, women with PCOS who followed a keto diet for a few months were more likely to resume ovulation and improve fertility outcomes (Endocrine Society, 2023) [3].

You may also notice improvements in skin, PMS symptoms, and even mood stability as your androgen levels (testosterone) rebalance.

When Can a Keto Diet Work for You

You might benefit from a keto diet if you’re navigating:

• PCOS: Especially if insulin resistance and elevated testosterone are part of your picture (Mavropoulos et al., 2005) [7].
  

• Cycle irregularity linked to metabolic dysfunction: Keto supports insulin sensitivity—an important factor in hormonal regulation and ovulation.

Here’s what our RD has to say: 

• “Chiyo’s hormone balance program mindfully and clinically takes into consideration the impact of carbohydrates on insulin resistance and sustainable eating habits. For women with PCOS, a moderate carbohydrate with the abundance of fiber, moderate to high protein and healthy fats in the diet is an effective way to promote symptom relief and improve existing metabolic conditions. Our hormone balance program is not keto, and that’s on purpose. The program follows the minimum of 130 grams of carbohydrates per day for the body to support brain function and the inclusion of micronutrients such as CoQ10, inositol, NAC, b6 and more in favor of hormone balance. The elimination of refined carbohydrates across all nutrition programs is in favor of reducing insulin resistance risks.”
  

That said, a keto diet isn’t for everyone. If you’re currently pregnant, breastfeeding, trying to conceive or recovering from an eating disorder, talk to a healthcare provider before trying keto. A moderate, whole-foods-based approach might be a better fit.

 

How to Follow a Keto Diet in a Hormone-Supportive Way

Keto diets don’t have to be restrictive or meat-heavy. In fact, they work best when they are personalized and nutrient-dense. Here’s how to make keto work for your hormones:

• Eat quality fats like olive oil, avocado, pasture-raised ghee, and fatty fish for anti-inflammatory support.
  

• Get enough protein to support ovulation, thyroid function, and muscle repair (especially if you are recently postpartum).
  

• Prioritize non-starchy veggies like leafy greens, cruciferous veggies, mushrooms, and zucchini for fiber and hormone detox.
  

• Don’t skimp on electrolytes—especially sodium, magnesium, and potassium. These are crucial during the keto diet.

• Try cycle syncing: If you still have a menstrual cycle, adding more carbs during the luteal phase can help support progesterone and prevent burnout.
  
  

How You’ll Know It’s Helping

Every woman’s experience is different, but here are some signs your hormones are responding well to following a keto diet:

• More consistent cycles
  

• Less PMS and cramping
  

• Stable energy and mood throughout the day
  

• Fewer cravings or emotional eating episodes
  

• Improved skin, especially if you had acne related to PCOS
  

• Better lab results (insulin, fasting glucose, lipids, SHBG)
  

If your period disappears or you start feeling cold, anxious, or exhausted, that’s a sign to reevaluate. You may need more carbs, calories, or a different approach altogether.

How Chiyo Can Support You

At Chiyo, we take a whole-body approach to hormone health. Our Hormone Balance Program includes a low to moderate carbohydrate diet, low-glycemic meals made with nutrient-rich ingredients and guidance rooted in both modern nutrition and Traditional Chinese Medicine. For example, one of our hormone-supportive meals might include sesame-ginger braised salmon with sautéed leafy greens and cauliflower rice—a nutrient-dense, anti-inflammatory combination rich in omega-3s, fiber, and essential minerals. It’s the kind of food that supports your metabolism and helps stabilize hormones naturally.

Explore Chiyo’s Hormone Balance Program to learn how we can support you on your journey.