Ketosis is the ultimate goal of the ketogenic diet. It’s defined as a metabolic state of greater ketone production and enhanced fat burning. But it also comes with a plethora of health benefits. For women, however, ketosis apparently triggers a range of unpleasant side effects. This makes many female keto-ers think twice about jumping on the keto bandwagon.
From menstrual irregularities to excess weight gain, it can seem like keto is messing with female hormones. But are these problems really a result of ketosis or is it something else? The short answer is that, yes, ketosis can affect female hormones. The long answer is that much of it depends on your health and eating patterns. There are also ways to troubleshoot ketosis for women so you can safely reap all the benefits of keto.
In this article, we explain how ketosis affects female hormones and women's health in general. We also explain what else in your keto journey can cause hormonal problems and offer some tips to troubleshoot ketosis for women.
When your body is not getting enough glucose to make energy, it starts to burn fats instead. The result of this is a buildup of molecules called ketones. Having more ketones in your body is known as ketosis. The mitochondria in your liver produce these ketones mostly to fuel your brain. But even your muscles and heart can run on ketones when necessary.
Evolution designed ketosis to help us thrive in times of starvation. Luckily, you don’t need to starve to get into ketosis. A long time ago, researchers discovered that simply restricting carbs to below 50 grams per day is enough to put you in this metabolic state . This is at the core of ketogenic diets along with a higher fat intake to keep you feeling full and energized.
But ketosis provides benefits beyond mere fat-burning. One large systematic review of ketogenic research shows that ketogenic diets :
- Improved cardiovascular health
- Control type II diabetes
- Treat epilepsy
- Reduce cancer risk
- Treat PCOS
- Treat brain diseases
- And reduce acne
There's also ample evidence that keto increases mental and physical performance . With all these benefits to reap, keto can seem like the next magic bullet. But keto is not all sunshine and rainbows; side effects on a keto diet do happen, and women can find this diet especially difficult to stick to.
Ketosis for women can be tricky because any change in nutrients has a profound effect on female hormones. Besides that, the delicate balance of sex hormones is closely tied to a woman's overall health; any disruption in this balance is bound to cause trouble. To help you understand why this is so, let's start by listing some fast facts on how female sex hormones affect health:
- Estrogen and progesterone affect your levels of neurotransmitters, explaining why changes in hormones impact mood, sleep, and mental functioning.
- Estrogen is a key factor in bone metabolism, and drops in this hormone during menopause increase the risk of osteoporosis.
- The levels of progesterone in your body affect thyroid hormones.
- Estrogen protects your cardiovascular health and metabolism.
- Progesterone suppresses your immune system, especially during pregnancy
The balance of these two major female sex hormones is controlled by your pituitary gland, a small gland in the base of your brain. However, your lifestyle and diet can also have a strong impact on this balance. Here's how ketosis, in particular, can affect your hormones:
- Ketosis lowers the levels of insulin, a pancreatic hormone essential for your body to use glucose. Ketosis also increases the levels of leptin, a hunger suppressing hormone .
- Eating 5% more fat than usual increases estrogen and androgen levels by 12% in women after menopause .
- Ketosis activates the hypothalamic–pituitary–adrenal axis (HPA axis). The HPA axis refers to the hormonal interaction between the hypothalamus, the pituitary gland, and the adrenal glands.
- Studies show that fasting, which can induce ketosis, increases the levels od cortisol, a stress hormone . That's because your body perceives fasting as a threat.
- Insulin sensitivity has a profound effect on sex hormone balance. Ketosis can help improve your insulin sensitivity.
Other Ways Ketosis for Women is Different
The health of your thyroid gland also has an effect on your reproductive health. Women with thyroid diseases, for example, often suffer from infertility and progesterone deficiency. That's because thyroid diseases disrupt pituitary gland functioning, and reproductive and overall hormonal health starts with this gland.
The thyroid is particularly sensitive to nutritional deficiencies. Studies show that low-calorie diets and ketosis can cause a drop in thyroid hormones (T3) in some people . However, people who eat at least 50 grams of carbs a day don't seem to experience such problems.
Having low levels of certain thyroid hormones also reduces sex hormone binding globulin (SHBG) levels. This leads to your ovaries producing more estrogen than necessary, which causes heavy and prolonged periods. In contrast, abnormally high thyroid hormone levels increase SHBG, causing light periods.
This happens because ketosis and low-carb diets mimic starvation, and the thyroid gland reacts to starvation by lowering the levels of certain hormones. If this happens to you, then you could try carb cycling or boosting your fat intake. The goal is to give your body enough energy other than carbs to run on and this will help normalize thyroid functioning.
Women on keto diets often notice changes in their menstrual cycle. Some also complain that the diet is not helping them lose weight or that they've even gained weight. Does this mean that the keto diet disrupts female hormones and is not suitable for the female sex?
Not really. The ketogenic diet has the same strong effect on male hormones as it does on female. It's just that the effects are more outwardly noticeable in women. Women experiencing menstrual irregularities and weight gain on keto diets are not necessarily going through these things due to ketosis. Here's what could be causing these problems:
- Weight loss– Ketosis often leads to quick weight loss, which is great if you started your keto journey overweight. Studies show that sharp drops in weight cause sharp drops in estrogen . This, in turn, causes anovulation and missed periods.
- Low fat intake – Eating more fat should boost estrogen levels, right? Yes, that is true, but a lot of the fat you eat gets used to make ketones. If you are eating too little fat for fear of gaining weight, this can negatively affect your cycles.
- Insulin resistance – There's ample evidence that changes in sex hormones changes insulin sensitivity . Insulin sensitivity affects your body's ability to use glucose. Not being sensitive to insulin can lead to sugar cravings and weight gain.
- Not being in ketosis – To get into ketosis, you absolutely must make sure you are not eating more than 30 grams of net carbs per day. Otherwise, you run the risk of storing all that extra fat you are eating and causing hormonal disruption.
- Stress– The keto diet is stressful on your body only initially, which can lead to menstrual irregularities. But once you become keto-adapted, cortisol levels should drop  and your periods should become regular. If that doesn't happen, outside stressors can be the problem.
As far as the research on ketosis for women goes, most studies actually show that it improves female health. There are at least 7 studies examining the effects of keto on menstruation, and all show that low-carb diets improve regularity of ovulation and menstruation .
Ketosis for Women Benefits
Now that we've covered the potential downsides of ketosis for women, it's time to talk about the benefits. Some women can benefit from ketosis more than others. Women who are obese, sedentary, have PCOS, epilepsy, insulin resistance, or other health problems, should definitely consider going keto.
Metabolic disorders like obesity, PCOS, and diabetes respond well to ketosis . That's because ketosis lowers insulin, glucose, and weight. High levels of glucose and insulin and excessive body weight can disrupt your metabolism. These problems are more often than not a result of diets too high in unhealthy carbs and low in beneficial fats.
Ketosis can also normalize menstrual irregularities in women with PCOS. One study shows that after 24 weeks of being on keto, women with PCOS lost weight, had lower testosterone levels, and had balanced female hormones . But even if you don't suffer any metabolic disorders, you can have menstrual problems when you are overweight.
Having too much body fat increases your estrogen levels. That's because fat tissue also functions as an endocrine organ with estrogen being produced in fat cells. The more fat you have, the more estrogen your body makes. Having too much estrogen can worsen PMS symptoms .
If you're a woman experiencing problems on a keto diet, there are some things you can do to change that. Most women following keto experience problems for reasons not related to ketosis. Ketosis for women is actually beneficial. However, if you're any of the following things, you may want to up your carb intake at least slightly:
- Are an athlete or highly active– To spare your muscles and boost your metabolism, carbs before and after workouts are important.
- Have thyroid problems– Both hyper and hypothyroidism can get worse on low-carb diets. Make sure you're eating at least 50 grams of carbs per day if you suffer from these issues.
- Are pregnant or breastfeeding – We don't suggest going keto when you are pregnant or breastfeeding. Ketosis can be taxing on a body going through such major changes and possibly harmful to the baby.
With that out of the way, here is how you can troubleshoot hormonal problems while going keto:
Eat more fat – Many problems on a keto diet are the result of not eating enough fat. Fat is your friend on keto; you absolutely need it to get enough energy and nutrients. If you don't keep your intake at the recommended levels, you'll put your body under immense stress and develop hormonal problems.
Eat more carbs – 30 grams of net carbs per day is enough to keep you in ketosis. However, you may need to eat more if you are highly active. Just make sure you are eating some carbs on keto to support normal thyroid functioning.
De-stress – Stress raises cortisol levels, and cortisol messes with your hormones and metabolism. When starting the keto diet, you need to keep stress at bay for the diet to work. Get 8 hours a sleep every day, try relaxation techniques, take long walks through the park, or listen to some relaxing music at the end of the day.
Exercise– Exercising enhances metabolic flexibility, which is your body's ability to switch to fat burning . It does so by increasing your muscle mass and muscles are efficient fat burners. This tip, obviously, applies if you're sedentary.
Maintain a healthy weight– Women need some amount of fat in their bodies for reproductive health. Generally, around 20-30 percent of body fat is the healthy range for most women. If you are underweight or have a low body fat percentage, then that could explain any menstrual irregularities you may be tackling.
Ketosis for women is safe and even beneficial. Women with metabolic disorders like obesity and PCOS benefit from being in ketosis. Ketosis helps them shed extra body fat and improve metabolism functioning, which, in turn, balances out female hormones.
Women who are highly active, underweight, losing weight rapidly, or not eating enough fats may experience menstrual irregularities on a keto diet. That's because the production of female sex hormones relies on body fat and nutrition. Luckily, there are ways to correct this problem and that we mention in this article.
By eating enough carbs, not losing too much weight, and keeping stress at bay, you can reap the benefits of ketosis without worrying about your reproductive health. Studies show that keto works for women as well as it does for men. But you have to take the differences between the sexes into account when starting your keto journey.