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ABSTRACTPCOS is the most prevalent female endocrine disorder and is characterized by polycystic ovaries, hyperandrogenism, and protracted anovulation. In PCOS, obesity, low-grade chronic inflammation, and insulin resistance (IR) frequently coexist. The Mediterranean diet (MD) and Ketogenic diet act as an anti-inflammatory eating plan that is high in complex carbohydrates, fiber, and monounsaturated fat, whereas the Keto diet is high in fat content. PCOS is associated with obesity, low-grade chronic inflammation, insulin resistance, and hormonal imbalances. The aim of the present study was to measure the metabolic and endocrine effects of a ketogenic and hypocaloric Mediterranean diet in women with polycystic ovarian syndrome. For this purpose, 80 participants were divided into two groups. Group 1 was on the ketogenic diet and Group 2 was on the Mediterranean diet for 9 weeks. The result of the present study showed that significant weight was reduced among the keto group (−10.9 kg) as compared to the Mediterranean group (−5.1 kg). Total cholesterol and Low-Density Lipoprotein among the keto group was 181. 5 ± 22.2 and 85.3 ± 16.2 U/L whereas, in the Mediterranean group 190.3 ± 22.7 and 91.3 ± 15.9 U/L were observed. Blood glucose levels among the Keto and Mediterranean groups reduced significantly 83.47 ± 5.81 and 91.7 ± 5.8 (mg/dl). C-peptide, LH, and FSH also improved more significantly as compared to the Mediterranean group respectively. This study revealed that a ketogenic diet is superior to a hypocaloric Mediterranean diet for lowering Triglyceride, Cholesterol, LDL, blood glucose, insulin, C peptide, HOMA-IR, LH/FSH, Serum Albumin, Facilitating Hormone, and Sex hormone-binding globulin levels. Females having PCO may improve health with the ketogenic diet