Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder linked to insulin resistance, metabolic dysfunction, and hormonal imbalances. Dietary interventions, particularly low- carbohydrate (low-carb) and balanced diets, play a crucial role in managing PCOS symptoms. However, the optimal dietary approach remains debated. Methods: A review of relevant studies, including randomized controlled trials and meta-analyses, was conducted to compare the effects of low-carb and balanced diets on insulin sensitivity, weight management, lipid profile, and hormonal regulation in women with PCOS. Results: Low-carb diets significantly improve insulin sensitivity, reduce fasting insulin levels, and promote weight loss. They may also lower androgen levels and enhance menstrual regularity but raise concerns regarding long-term adherence and nutrient deficiencies. Balanced diets support gradual, sustainable metabolic and hormonal improvements, offering cardiovascular benefits and long- term viability. Conclusion: Both dietary approaches show promise in PCOS management. Low-carb diets yield faster metabolic improvements but pose sustainability challenges, whereas balanced diets provide long-term benefits. Further research is needed to determine individualized dietary recommendations for PCOS management.