The Role of Intermittent Fasting in Modulating Hormonal Biomarkers in Women With Polycystic Ovary Syndrome: A Review

Abstract

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age, associated with hormonal imbalance, insulin resistance, and metabolic dysfunction. Recent interest has emerged around intermittent fasting (IF) as a non-pharmacological approach to managing PCOS-related symptoms. This review aims to evaluate the effects of IF interventions, including time-restricted feeding (TRF), alternate-day fasting (ADF), and the 5:2 fasting model, on hormonal, metabolic, and inflammatory biomarkers in women with PCOS. The review specifically focuses on insulin resistance indices (e.g., Homeostatic Model Assessment for Insulin Resistance), androgen-related markers such as testosterone and sex hormone-binding globulin (SHBG), gonadotropins (luteinizing hormone (LH) and follicle-stimulating hormone (FSH)), and inflammatory biomarkers reported in human studies and relevant mechanistic research. Evidence suggests that IF, particularly TRF, significantly improves insulin sensitivity, reduces hyperandrogenism, and supports weight loss, all of which are critical in PCOS management. IF also influences circadian rhythms, reproductive hormone regulation, and inflammatory markers such as C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α). Some studies indicate enhanced menstrual regularity and ovulation with IF regimens. However, hormonal changes in estrogen, LH, and FSH levels remain inconsistently reported. Molecular mechanisms involve activation of AMP-activated protein kinase (AMPK), sirtuin 1 (SIRT1), and suppression of the mechanistic target of rapamycin (mTOR) pathway, contributing to improved metabolic and hormonal balance. IF shows promise as an adjunct therapy for managing PCOS by targeting metabolic, hormonal, and reproductive dysfunctions. Nevertheless, further long-term, large-scale human trials are necessary to establish standardized IF protocols and confirm safety and efficacy.