Nutrition Recommendations for Athletes With PCOS

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Polycystic ovary syndrome (PCOS) appears to be more common among athletes and could explain why a large percentage of female athletes don’t menstruate. A study published in Fertility and Sterility showed a higher number of cases of hyperandrogenism (high testosterone levels) in adolescent swimmers compared with non-swimmers.

Young girl eating a oatmeal with berries after a workout . Fitness and healthy lifestyle concept.
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Amenorrhea (lack of three consecutive menstrual cycles or more) and oligomenorrhea (irregular periods at intervals of more than six weeks) have been found to be more prevalent among athletes than in the general population, and they are primarily due to hypothalamic amenorrhea. One-sixth of Iranian female athletes with amenorrhea or oligomenorrhea were diagnosed as having PCOS, according to findings published in Medicine and Science in Sports and Exercise.

Because of their unique nutritional needs, each athlete with PCOS should meet with a registered dietitian or nutritionist with experience in sports nutrition and PCOS to develop an individualized meal plan to optimize performance while managing health. The following are some nutritional concerns for athletes with PCOS:

Balance Carbohydrates

Carbohydrates are the preferred fuel for athletes but can pose a challenge for those with PCOS if they have insulin resistance. The condition requires that carbohydrates be balanced to manage insulin and glucose levels, weight, and athletic performance. Depending on the sport being played, season, and one's metabolic profile and body composition, women with PCOS may require slightly fewer carbohydrates than their fellow athletes.

Processed and refined carbohydrates such as white bread, sugary cereals, bagels, crackers, candy, cakes, and cookies can increase insulin levels and worsen insulin resistance. Likewise, too many carbohydrates eaten in one setting can also spike insulin levels.

Unprocessed whole grains such as fruits and vegetables, slow-cooked oats, quinoa, brown and wild rice, and sprouted grain bread tend to have more fiber and, thus, a slower impact on insulin levels.

Some athletes with PCOS may struggle with intense, almost urgent cravings for carbohydrate foods. This could be due to difficulty regulating blood sugar levels from exercise as well as an appetite-stimulating effect of high insulin levels.

To help manage blood sugar levels and cravings:

  • Eat small meals frequently rather than sitting down to three big meals a day.
  • Focus on spreading carbohydrate consumption out evenly throughout the day.
  • Combine carbohydrate foods with protein and healthy fats to manage cravings and blood sugar levels. For example, try a slice of wheat toast with natural peanut butter.

Eat Anti-Inflammatory Foods

Regular exercise can result in chronic oxidative stress on the muscles due to the increases in oxygen consumption. There is evidence that women with PCOS already have higher rates of oxidative stress and inflammation, which compounds the effect.

Antioxidants may be helpful in reducing inflammation and related muscle soreness. Eating a variety of anti-inflammatory foods such as nuts, fish, fruits, olive oil, vegetables, and legumes is encouraged.

Maintain Iron Levels

Menstrual cycles in women with PCOS can vary and could occur at monthly intervals, several times a month, every few months, or not at all. Athletes who have frequent or heavy bleeding, especially those in endurance sports, are at an increased risk for iron loss and developing iron deficiency.

Regular monitoring of iron levels may be necessary.

Manage Vitamin B12 Levels

Oral contraceptives and metformin, a common insulin-sensitizing medication, are frequently prescribed to women with PCOS. These drugs are associated with interfering with vitamin B12 absorption.

Women who take these medications should supplement their diets with vitamin B12. Monitoring for a vitamin B12 deficiency is necessary, especially for athletes who eat vegetarian and vegan diets.

Monitor Vitamin D Levels

While many women with PCOS have high bone mineral density, vitamin D, which is important for bone formation, is low in as many as 73% of women with PCOS. Low levels of vitamin D in women with PCOS is associated with poor mood, worsened insulin resistance, and weight gain.

Low levels of vitamin D can decrease physical performance and increase the incidence of stress fractures. Since few foods contain vitamin D (dairy foods are the main source), supplementation of vitamin D may be needed depending on blood levels.

7 Sources
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  2. Movaseghi S, Dadgostar H, Dahaghin S, et al. Clinical manifestations of the female athlete triad among some Iranian athletes. Med Sci Sports Exerc. 2012;44(9):1825. doi:10.1249/MSS.0b013e31823bd057

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  4. Barrea L, Marzullo P, Muscogiuri G, et al. Source and amount of carbohydrate in the diet and inflammation in women with polycystic ovary syndrome. Nutr Res Rev. 2018;31(2):291-301. doi:10.1017/S0954422418000136

  5. Mintz J, Mirza J, Young E, Bauckman K. Iron therapeutics in women’s health: past, present, and future. Pharmaceuticals. 2020;13(12):449. doi:10.3390/ph13120449

  6. Greibe E, Trolle B, Bor M, Lauszus F, Nexo E. Metformin lowers serum cobalamin without changing other markers of cobalamin status: a study on women with polycystic ovary syndrome. Nutrients. 2013;5(7):2475-2482. doi:10.3390/nu5072475

  7. Moin ASM, Sathyapalan T, Butler AE, Atkin SL. Vitamin D association with coagulation factors in polycystic ovary syndrome is dependent upon body mass index. J Transl Med. 2021;19(1):239. doi:10.1186/s12967-021-02897-0

By Angela Grassi, MS, RDN, LDN
 Angela Grassi, MS, RDN, LDN, is the founder of the PCOS Nutrition Center.