Gut microbiota in PCOS: key microbial changes, potential mechanisms and clinical applications

Polycystic Ovary Syndrome (PCOS) is a complex endocrine-metabolic disorder manifesting with reproductive and metabolic dysfunction. Its pathogenesis remains incompletely understood, prompting investigation beyond traditional frameworks. The gut microbiota, a key regulator of host metabolism and immunity, has emerged as a significant factor in PCOS development.

Patients with PCOS exhibit gut microbial dysbiosis, characterized by altered diversity, specific taxonomic shifts (e.g., reduced Lachnospira), and functional impairments including decreased short-chain fatty acid production. This ecological imbalance affects the pathology of PCOS through the "metabolism-immune-endocrine" network, exacerbating insulin resistance, chronic inflammation, and hormonal imbalances like hyperandrogenism, which in turn further disrupts microbial homeostasis. Targeting the microbiota through dietary strategies (e.g., Mediterranean, ketogenic diets), probiotics, prebiotics, and synbiotics shows therapeutic promise in ameliorating PCOS features.

The gut microbiota plays a pivotal role in PCOS pathophysiology and represents a novel therapeutic target. Current limitations include study heterogeneity and unresolved mechanistic details. Future research should focus on large-scale longitudinal studies and developing precise microbiota-based interventions to advance personalized management and improve outcomes in PCOS.