Polycystic ovary syndrome PCOS is a prevalent endocrine - metabolic disorder primarily affecting women of reproductive age. It is an autosomal dominant genetic disease characterized initially by metabolic abnormalities followed by reproductive anomalies. Current genetic studies suggest that PCOS associated with metabolic syndrome can be interpreted as a unique manifestation of metabolic syndrome within the female reproductive system now referred to as Metabolic Associated Polycystic Ovary Syndrome. The key to treating PCOS lies in the improvement of metabolic syndrome. Currently the ketogenic diet is recognized as an effective strategy for improving metabolic syndrome managing weight and ameliorating PCOS. Emerging as a novel therapeutic approach the ketogenic diet has demonstrated significant potential in PCOS management such as regulating menstrual cycles reducing hepatic damage and elevating Vitamin D levels among others. We recommend implementing an optimized ketogenic diet treatment plan under the guidance of a physician involving stages of "flexible ketosis" "targeted keto withdrawal" and "balanced diet lifelong maintenance". It is emphasized that dietary plans should be individualized to enhance patient compliance.