‘Help! I have PCOS and just can’t seem to lose more weight’


What can you do if you have a very hard time losing weight because of PCOS? Can you reverse premature ovarian failure on a keto diet? And does menstrual pain improve on low carb?

Get the answer to these questions in this week’s Q&A with the fertility specialist Dr. Fox:

PCOS and weight loss

I am almost 49 and was diagnosed with PCOS about 30 years ago. I have been doing keto for about two months now and lost 3 inches (8 cm) off my waist and 3 off my belly-button area, which is great since this is the area where you commonly store fat if you have PCOS. I’ve only lost 7 pounds (3 kilos) though and have another 13 pounds (6 kilos) to go (I want to be 14 pounds or 6 kilos more than my teens since it makes your face look younger), but just can’t seem to lose more.

I don’t eat a huge amount since I’m just not hungry most of the time, but I have tried the urine strips and they show that I’m in ketosis – am I possibly eating too little? I know that people with PCOS store fat more easily. The only thing I eat that may have more carbs is live Greek full-fat yoghurt (that I make myself) every day, since it helps to keep my gut healthy (I am rarely ill since having it daily for the last four years). I eat fat bombs with coconut and coconut oil daily to make sure my fat intake is high enough.

I am pleased with the loss of inches, but want to lose the weight. Currently, I only do light exercise like yoga and walking. Any suggestions?

Thank you,

Dr. Fox:

First, if you are only a little off your ideal body weight (BMI = 22/23), I would not stress over it. Stress, however, is often what hangs people up. Caffeine stimulates the stress system and increases cortisol production preventing weight loss. Poor sleep, often worsened by low estrogen, causes stress. Make sure to sleep for at least 7-8 hours per night. Furthermore, at 49, it’s likely that your estrogen is low and supplementation may help.

Working on these areas may help you dramatically. But do keep in mind that our metabolic systems do change as we age and we may find it difficult to go back to what we weighed at age 18. I have the same problem! Here is a guide with more detail about weight loss after after 40.

Good luck.

IVF and keto


My husband and I have just done an IVF cycle that was unsuccessful with donor eggs. I have been diagnosed with pre-mature ovarian failure. I am 39 years old. Is premature ovarian failure (POF) reversible, and is it good to be in a ketogenic state while doing an IVF cycle for future reference?

Thank you,

Dr. Fox:

I’m sorry you were unsuccessful. Donor egg is an involved process and tough to endure without success. The ketogenic nutrition approach will not reverse your POF and currently there is no cure.

In the future we’ll be able to take somatic cells, like skin cells, and reverse engineer them to eggs. For now, egg donation is likely your only option.

The diet does frequently improve all aspects of fertility, including the endometrium and its receptivity, which is important for egg donor cycles.

Hope this helps. You should do well with egg donor since it has a very high success rate.

Menstrual pain and keto

My 33 year-old daughter, who eats the standard American diet, has menstrual cramps severe enough to require hormone replacement therapy (HRT).

She was recently diagnosed with an inferior vena cava clot and has had to discontinue the HRT, leaving her with severe cyclical pain.

I don’t know of a formal diagnosis for the menstrual pain, but she is lean, fertile, and otherwise in excellent health. Is there any evidence that a keto diet might improve her severe monthly menstrual pain?


Dr. Fox:

Based on your description, she most likely has endometriosis and adenomyosis. I’ve had many patients who pursued ketogenic nutrition tell me their pain improved.

Surgery to excise the endometriosis and cut the uterine nerve could also be effective. Excision is the method I prefer at surgery to relieve pain. However, this technique is not found in many places in the U.S.

Good luck.

More questions and answers

Questions and answers about low carb

Videos with Dr. Fox



How to reverse PCOS with low carb

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