THE ROLE OF GUT MICROBIOTA IN THE PATHOGENESIS OF POLYCYSTIC OVARY SYNDROME
DOI:
https://doi.org/10.31435/ijitss.1(49).2026.4524Keywords:
Polycystic Ovary Syndrome, Gut Microbiota, Dysbiosis, Insulin Resistance, Hormonal Imbalance, HyperandrogenismAbstract
Introduction and aim of the study: Polycystic ovary syndrome (PCOS) is a multifactorial endocrine–metabolic condition affecting a significant proportion of women of reproductive age. Recent scientific evidence suggests that disturbances in gut microbiota composition may play an important role in the metabolic, hormonal and inflammatory abnormalities characteristic of PCOS. The aim of this review was to summarize current knowledge on the relationship between gut microbiota and PCOS, with particular emphasis on pathophysiological mechanisms and potential therapeutic implications.
Materials and Methods: This review was conducted through a systematic search of the PubMed database, using keywords related to PCOS, gut microbiota, dysbiosis, insulin resistance and hormonal imbalance. Relevant original research articles were analyzed to identify common mechanisms and clinically meaningful associations.
Results: Findings indicate that gut dysbiosis in PCOS is closely linked to increased intestinal permeability, chronic low-grade inflammation, altered short-chain fatty acid (SCFA) production and disturbances in bile acid and tryptophan metabolism. These changes interact with key endocrine pathways regulating insulin sensitivity, androgen excess and estrogen conversion. Recent studies also highlight the therapeutic potential of dietary interventions, probiotics, prebiotics, synbiotics and bioactive nutrients, which can help restore microbial balance and improve metabolic and hormonal outcomes.
Conclusions: Understanding the role of the gut microbiota in PCOS pathogenesis opens new perspectives for adjunctive therapeutic strategies. Microbiota-targeted interventions may provide meaningful support alongside conventional treatment, helping to address underlying mechanisms rather than only managing symptoms.
References
Yang, J., & Chen, C. (2024). Hormonal changes in PCOS. Journal of Endocrinology, 261(1), e230342. https://doi.org/10.1530/JOE-23-0342
Naz, M. S. G., Tehrani, F. R., Majd, H. A., Ahmadi, F., Ozgoli, G., Fakari, F. R., & Ghasemi, V. (2019). The prevalence of polycystic ovary syndrome in adolescents: A systematic review and meta-analysis. International Journal of Reproductive Biomedicine, 17(8), 533–542. https://doi.org/10.18502/ijrm.v17i8.4818
Shahid, R., Iahtisham-Ul-Haq, Mahnoor, Awan, K. A., Iqbal, M. J., Munir, H., & Saeed, I. (2022). Diet and lifestyle modifications for effective management of polycystic ovarian syndrome (PCOS). Journal of Food Biochemistry, 46(7), e14117. https://doi.org/10.1111/jfbc.14117
Qi, X., Yun, C., Pang, Y., & Qiao, J. (2021). The impact of the gut microbiota on the reproductive and metabolic endocrine system. Gut Microbes, 13(1), 1–21. https://doi.org/10.1080/19490976.2021.1894070
Yang, Y., et al. (2024). Gut microbiota in women with polycystic ovary syndrome: An individual based analysis of publicly available data. eClinicalMedicine, 77, 102884. https://doi.org/10.1016/j.eclinm.2024.102884
Babu, A., Devi Rajeswari, V., Ganesh, V., et al. (2024). Gut microbiome and polycystic ovary syndrome: Interplay of associated microbial-metabolite pathways and therapeutic strategies. Reproductive Sciences, 31, 1508–1520. https://doi.org/10.1007/s43032-023-01450-2
Qi, X., Yun, C., Sun, L., et al. (2019). Gut microbiota–bile acid–interleukin-22 axis orchestrates polycystic ovary syndrome. Nature Medicine, 25(8), 1225–1233. https://doi.org/10.1038/s41591-019-0509-0
He, F. F., & Li, Y. M. (2020). Role of gut microbiota in the development of insulin resistance and the mechanism underlying polycystic ovary syndrome. Journal of Ovarian Research, 13, 73. https://doi.org/10.1186/s13048-020-00670-3
Lindheim, L., Bashir, M., Münzker, J., Trummer, C., Zachhuber, V., Leber, B., et al. (2017). Alterations in gut microbiome composition and barrier function are associated with reproductive and metabolic defects in women with PCOS. PLoS ONE, 12(1), e0168390. https://doi.org/10.1371/journal.pone.0168390
Torres, P. J., Siakowska, M., Banaszewska, B., Pawelczyk, L., Duleba, A. J., Kelley, S. T., & Thackray, V. G. (2018). Gut microbial diversity in women with polycystic ovary syndrome correlates with hyperandrogenism. Journal of Clinical Endocrinology & Metabolism, 103(4), 1502–1511. https://doi.org/10.1210/jc.2017-02153
Qi, X., Yun, C., Sun, L., et al. (2019). Gut microbiota–bile acid–interleukin-22 axis orchestrates polycystic ovary syndrome. Nature Medicine, 25, 1225–1233. https://doi.org/10.1038/s41591-019-0509-0
Pedersen, H., Gudmundsdottir, V., Nielsen, H., et al. (2016). Human gut microbes impact host serum metabolome and insulin sensitivity. Nature, 535, 376–381. https://doi.org/10.1038/nature18646
Baker, J. M., Al-Nakkash, L., & Herbst-Kralovetz, M. M. (2017). Estrogen–gut microbiome axis: Physiological and clinical implications. Maturitas, 103, 45–53. https://doi.org/10.1016/j.maturitas.2017.06.025
Plottel, C. S., & Blaser, M. J. (2011). Microbiome and malignancy. Cell Host & Microbe, 10(4), 324–335. https://doi.org/10.1016/j.chom.2011.10.003
Giampaolino, P., Foreste, V., Di Filippo, C., et al. (2021). Microbiome and PCOS: State-of-art and future aspects. International Journal of Molecular Sciences, 22(4), 2048. https://doi.org/10.3390/ijms22042048
Martinez Guevara, D., Vidal Cañas, S., Palacios, I., Gómez, A., Estrada, M., Gallego, J., & Liscano, Y. (2024). Effectiveness of probiotics, prebiotics, and synbiotics in managing insulin resistance and hormonal imbalance in women with PCOS: A systematic review. Nutrients, 16(22), 3916. https://doi.org/10.3390/nu16223916
Miao, C., Guo, Q., Fang, X., Chen, Y., Zhao, Y., & Zhang, Q. (2021). Effects of probiotic and synbiotic supplementation on insulin resistance in women with PCOS. Journal of International Medical Research, 49(7), 3000605211031758. https://doi.org/10.1177/03000605211031758
Chudzicka-Strugała, I., Kubiak, A., Banaszewska, B., et al. (2025). Six-month randomized, placebo-controlled trial of synbiotic supplementation in women with PCOS undergoing lifestyle modifications. Archives of Gynecology and Obstetrics, 311, 499–506. https://doi.org/10.1007/s00404-024-07833-3
Borzan, V., Riedl, R., & Obermayer-Pietsch, B. (2023). Probiotic vs. placebo and metformin: A randomized controlled trial in PCOS. BMC Endocrine Disorders, 23, 82. https://doi.org/10.1186/s12902-023-01294-6
Krishnan, S., Ding, Y., Saedi, N., et al. (2018). Gut microbiota-derived tryptophan metabolites modulate inflammatory response. Cell Reports, 23(4), 1099–1111. https://doi.org/10.1016/j.celrep.2018.03.109
Roager, H. M., & Licht, T. R. (2018). Microbial tryptophan catabolites in health and disease. Nature Communications, 9, 3294. https://doi.org/10.1038/s41467-018-05470-4
Flores, R., Shi, J., Fuhrman, B., et al. (2012). Fecal microbial determinants of estrogens and estrogen metabolites. Journal of Translational Medicine, 10, 253. https://doi.org/10.1186/1479-5876-10-253
Ervin, S. M., Li, H., Lim, L., et al. (2019). Gut microbial β-glucuronidases reactivate estrogens. Journal of Biological Chemistry, 294(49), 18586–18599. https://doi.org/10.1074/jbc.RA119.010950
Ridlon, J. M., Kang, D. J., Hylemon, P. B., & Bajaj, J. S. (2014). Bile acids and the gut microbiome. Current Opinion in Gastroenterology, 30(3), 332–338. https://doi.org/10.1097/MOG.0000000000000057
Org, E., Mehrabian, M., Parks, B. W., et al. (2016). Sex differences and hormonal effects on gut microbiota composition. Gut Microbes, 7(4), 313–322. https://doi.org/10.1080/19490976.2016.1203502
Wang, X., Qi, Y., & Zheng, H. (2022). Dietary polyphenols, gut microbiota and health benefits. Antioxidants, 11(6), 1212. https://doi.org/10.3390/antiox11061212
Ozdal, T., Sela, D. A., Xiao, J., et al. (2016). Reciprocal interactions between polyphenols and gut microbiota. Nutrients, 8(2), 78. https://doi.org/10.3390/nu8020078
Wahlström, A., Sayin, S. I., Marschall, H. U., & Bäckhed, F. (2016). Intestinal crosstalk between bile acids and microbiota. Cell Metabolism, 24(1), 41–50. https://doi.org/10.1016/j.cmet.2016.05.005
Hu, Q., Niu, Y., Yang, Y., et al. (2022). Polydextrose alleviates adipose tissue inflammation and modulates the gut microbiota. Frontiers in Pharmacology, 12, 795483. https://doi.org/10.3389/fphar.2021.795483
Luo, X., et al. (2022). Inulin-type fructans improve metabolic outcomes in PCOS. Nutrients, 14(3), 512. https://doi.org/10.3390/nu14030512
Yang, K., Zeng, L., Bao, T., & Ge, J. (2018). Effectiveness of omega-3 fatty acids for PCOS. Reproductive Biology and Endocrinology, 16(1), 27. https://doi.org/10.1186/s12958-018-0346-x
Zhang, Y., et al. (2021). Resistant starch and metabolic outcomes. Nutrition & Metabolism, 18, 14. https://doi.org/10.1186/s12986-021-00562-7
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Copyright (c) 2026 Aleksandra Stępień, Marcelina Podleśna, Kacper Bączek, Karol Chromiak, Kacper Curzytek, Kacper Bluczak, Katarzyna Czechowicz, Julia Radziwiłko, Andżelika Pastuszak, Anna Kozińska
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