Microbial dysbiosis, obesity, and insulin Resistance: Understanding gut-ovary association in polycystic ovary syndrome

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder, affecting 5–10 % of women of reproductive age, and is characterized by complex etiology involving reproductive and metabolic disturbances. The core clinical features include anovulation, irregular ovulation, polycystic ovarian morphology, and hyperandrogenism (HA), with frequent accompaniments of metabolic dysfunctions such as dyslipidemia, insulin resistance (IR), abdominal obesity, and impaired glucose metabolism. The available evidence shows significant involvement of gut microbiota in the pathogenesis and progression of PCOS. Alterations in gut, PCOS axis-including changes in gut microbiota composition as contributed by such alterations in the pathogenesis of PCOS and its complications like obesity, IR, and type 2 diabetes mellitus (T2DM), will be discussed in this review. This review covers such aspects that gut dysbiosis, HA, chronic inflammation, and non-alcoholic fatty liver disease are related to the pathology of PCOS, thereby amplifying it. Lifestyle-related interventions include physical activity, yoga, therapeutic strategies in terms of gut microbiota including fecal microbiota transplantation (FMT), prebiotics, probiotics, synbiotics, and psychobiotics, which are reviewed for improving metabolic as well as reproductive outcomes in PCOS. Rather, this review focuses on the pressing need for further research into understanding the roles of gut microbiota in PCOS as well as optimizing gut-targeted therapies aimed at better managing this complex condition.