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Keto – it's all the rage, but like many things in the wellness world, there is a lot of confusion surrounding the ketogenic diet. It is especially true when it comes to women on a keto diet. Some experts believe a ketogenic diet can negatively impact female health, while others say it is perfectly safe. When it comes down to it, it depends on the individual and how she follows the diet. For women specifically, a ketogenic diet can be very beneficial for managing PCOS, can help enhance weight loss, and help with acne. Still, female hormones can be sensitive to the change in carbohydrate intake, and the consequences can vary from to woman. This article discusses how ketosis may affect a woman's health and ways to reap the benefits without risking hormonal balance.



In short, the ketogenic diet is a strict, very-low-carb diet with ample fat and even protein. It usually means eating less than 50 grams of carbs each day. It essentially means there is only room for carbs from things like vegetables and nuts (with a few fruits you can eat in moderation). The goal of the diet is to switch from carb-burning mode into fat-burning mode. To enter a state of ketosis by creating ketone bodies as fuel. This diet is not just about what you can and can't eat. It is about entering a unique metabolic state – and so this diet looks a bit different for everyone.


Female hormones are sensitive to dietary and lifestyle changes, and the ketogenic diet is a radical dietary change. Some women who try a ketogenic diet complain of changes in their menstrual cycle. Slight to no weight loss, sometimes even weight gain. It doesn't mean that a keto diet is not suitable for women. But it may mean that if you aren't careful, it can negatively impact hormonal health.

Here are some reasons for the hormonal changes seen on a ketogenic diet:

  • A sudden drop in carbohydrate intake can signal the body that it is in "starvation mode." The body responds by releasing cortisol, a stress hormone. That holds on and stores excess fat, especially in the belly region. It also tells the body that it's not time to make a baby, thus leading to changes in menstruation.
  • Being in ketosis often leads to rapid weight loss. It can decrease estrogen levels and lead to amenorrhea or a missed period. 
  • A ketogenic diet naturally decreases appetite and can lead to eating too few calories. The body needs enough calories to perform all of its necessary functions. The thyroid gland is susceptible to low-calorie diets, leading to a drop in thyroid hormones. A low level of thyroid hormones also leads to intense sex hormone-binding globulin (SHBG). That can change hormone levels to menstrual changes. An underactive thyroid gland can lead to infertility.
  • The keto diet is stressful on the body in the initial stages, which leads to increased cortisol, as stated previously. The stress comes from the radical drop in carbs and overall calories since fat intake decreases appetite. With time, cortisol levels should drop back to normal, but losing weight can be more challenging. 


If you have tried keto and didn't get the expected results, you may need to change your plan of attack. For most women, it's not in ketosis that is the problem. It's that they aren't following the diet correctly.


Here are some ways to improve hormone control while in ketosis:

  • Increase fat intake - you need to eat enough high-calorie fat, so your body doesn't think it is starving.
  • Increase carb intake - some women may need to increase their carb intake slightly: 

    • Those with thyroid problems – if you are unsure, all you need is a simple blood test.
    • Athletes or highly active women – can use carbs strategically to fuel their workouts to spare muscle and improve performance.
    • Pregnant or breastfeeding women – those who are pregnant or breastfeeding should not follow a keto diet.
  • Reduce carbs slowly – a gradual carb restriction may help your body ease into a ketogenic state. Reduce carbs slowly over three weeks until you get to 20-50g daily.
  • Try Intermittent Fasting – this is when you go 14-18 hours without eating any food. The most common approach is the 16:8 hour method – fasting for 16 hours and eating for 8. It can help reach ketosis faster, but ketosis can also use it instead of a keto diet for those who want some benefits, like weight loss, without the commitment.
  • Lift Weights – increasing muscle mass boosts metabolism and improves metabolic flexibility. It means your body can burn fat more effectively, and it won't be as stressful for your body. 
  • Maintain a healthy body weight – For most women, body fat should be around 20-25% for optimal reproductive function.
  • Reduce stress – As stated, stress increases cortisol output, and cortisol leads to hormonal havoc. When starting the ketogenic diet, stress reduction becomes very important. Be sure to incorporate mindfulness into each day. It could look like daily meditation, journaling, or going for a walk. Sleep is also essential for regulating our stress response – be sure to get restful sleep.
  • Track your food – Many apps can help you reach your daily goals for macronutrients and overall calories. It can be a pain, but it is instrumental to your success during the initial stages of a ketogenic diet. This blog goes into detail about the top 5 apps for tracking macronutrients. 
The ketogenic diet is a safe and beneficial tool for many women. The problem with a ketogenic diet, in women specifically, appears to be caused by not getting enough calories or carbohydrates. It doesn't seem to be from being in ketosis itself. The female body is susceptible to changes and with the proper adjustments. If you aren't sure if a ketogenic diet is appropriate for you, speak to a healthcare professional. It can be a tricky one, but it can also produce excellent results.

To women thriving on a keto diet,

Dr. Bronwyn

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