Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder characterized by reproductive, metabolic, and psychological dysfunction, often exacerbated by obesity (1,3). Core features include hyperandrogenism, insulin resistance, ovulatory dysfunction, and chronic low-grade inflammation (4,5). Emerging evidence implicates gut microbiome dysregulation in PCOS pathogenesis; however, existing models remain limited in integrating microbiome-endocrine interactions. This review synthesizes mechanistic and therapeutic evidence linking gut microbiome alterations to PCOS and evaluates their potential as treatment targets. A narrative review was conducted using peer-reviewed clinical and experimental studies published within the past decade. Databases included PubMed and Google Scholar, with search terms such as PCOS, gut microbiome, dysbiosis, and insulin resistance.†Studies were selected based on relevance to microbiome-mediated mechanisms or therapeutic interventions. Evidence indicates that increased intestinal permeability promotes endotoxemia and inflammation, contributing to insulin resistance (9,10). Reduced short-chain fatty acids and altered bile acid metabolism also disrupt metabolic and hormonal homeostasis (7,8). Microbiome-targeted therapies, including probiotics, prebiotics, GLP-1 receptor agonists, SGLT2 inhibitors, and fecal microbiota transplantation, show potential in improving metabolic outcomes and gut barrier integrity (3). However, findings are heterogeneous, with limited large-scale clinical trials and variability in study design. Current PCOS management emphasizes weight loss with modest long-term success (1). Targeting the gut microbiome may offer a more personalized adjunctive strategy. This review integrates mechanistic pathways with emerging therapies, highlighting microbiome modulation as a promising but evolving approach requiring further investigation.
