This is exactly how to modify the Keto diet for women 

Keto – it’s all the rage, but like many things in the wellness world, there is a lot of confusion surrounding the ketogenic diet. This 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 may help with acne. But female hormones can be sensitive to the change in carbohydrate intake, and the consequences can vary from woman to woman. In this article, I discuss how ketosis may effect 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 moderate protein. This usually means eating less than 50 grams of carbs each day, which 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 through the creation of 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 very sensitive to dietary and lifestyle changes, and the ketogenic diet is a drastic dietary change. Some women who try a ketogenic diet complain of changes in their menstrual cycle or little to no weight loss, sometimes even weight gain. This doesn’t mean that a keto diet is not suitable for women, but it may mean that if you aren’t careful, it can have negative impacts on hormonal health.

Here are some reasons for the hormonal changes seen on a ketogenic diet:
  • A sudden drop in carbohydrate intake can send a signal to the body that it is in “starvation mode”. The body responds by releasing cortisol, our stress hormone, which works to hold on and store 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. This 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 very sensitive to low calorie diets and this can lead to a drop in thyroid hormones. A low level of thyroid hormones also leads to low levels of sex-hormone binding globulin (SHBG) which can change hormone levels, leading to menstrual changes. An underactive thyroid gland is also linked 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 drastic drop in carbs and/or a reduction in overall calories, since fat intake decreases appetite. With time, cortisol levels should drop back to normal, but while they are elevated it can be more challenging to lose weight.


If you have tried keto and didn’t get the expected results, you may need to alter you plan of attack. For most women, it’s not being in ketosis that is the problem, it’s that they aren’t following the diet properly.

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 – there are some women who may need to slightly increase their carb intake:
    • 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 your 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 gradually carb restriction may help your body ease into a ketogenic state. Reduce carbs slowly over a 3 week time period 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. This can help reach ketosis faster, but it can also be used instead of a keto diet for those who want some of the benefits, like weight loss, without the commitment.
  • Lift Weights – increasing muscle mass boosts metabolism and improves metabolic flexibility, which 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. If you are underweight, this can explain the hormonal dysregulation and menstrual irregularities.
  • Reduce stress – As stated, stress increases cortisol output and cortisol leads to hormonal havoc. When starting out on the ketogenic diet, stress reduction becomes very important. Be sure to incorporate mindfulness into each day;. This could look like a daily meditation, journaling, yin yoga, slow deep breathing or going for a walk. Sleep is also very important when it comes to regulating our stress response – be sure to get deep, restful sleep.
  • Track your food – There are many apps out there that can help you reach your daily goals for macronutrients – carbs, protein, fats – and overall calories. It can be a pain, but it is instrumental for 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 problems that come with a ketogenic diet, in women specifically, appear 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 very sensitive to changes, and with the right adjustments, a ketogenic diet can be safely followed. If you aren’t sure if a ketogenic diet is right for you, speak to a healthcare professional. It can be a tricky one, but it can also produce amazing results.

To women thriving on a keto diet,

Dr. Bronwyn  


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Dr. Bronwyn is a naturopathic doctor in Toronto, Ontario with a clinical focus in Women's Health. She works with women transitioning off the oral contraceptive pill and those with specific fertility concerns, to reach a state of hormonal balance or in preparation for a healthy pregnancy. Dr. Bronwyn is passionate about empowering women to reclaim their hormonal health, to enable a full and vibrant life.


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