FiberNEW2026

The gut microbiome in polycystic ovary syndrome: mechanistic pathways and therapeutic potential of microbiota-targeted interventions.

Elhennawy Farah, Naji Basmalah, Butler Alexandra E — Frontiers in endocrinology

Summary

Polycystic Ovary Syndrome (PCOS) is a common condition affecting many women, and new research suggests a connection between PCOS and the health of the gut microbiome. This review explores how changes in gut bacteria might influence PCOS symptoms and discusses potential treatments like dietary changes or supplements that aim to improve gut health. Early findings indicate these approaches could help manage some aspects of PCOS, such as insulin sensitivity and inflammation.

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Key points

Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder affecting many women.
The health of the gut microbiome may play a role in the development and symptoms of PCOS.
Interventions targeting the gut, such as diet changes or specific supplements, show potential for improving PCOS symptoms like insulin resistance and inflammation.
More research, especially long-term clinical trials, is needed to confirm these findings and guide treatment.

What the study looked at

This paper reviewed existing research to understand if and how the gut microbiome (the community of bacteria in our intestines) might be connected to Polycystic Ovary Syndrome (PCOS). It also explored whether interventions aimed at improving gut health could help manage PCOS symptoms. This was a literature review, meaning the authors analyzed and summarized findings from many previously published studies. They looked at various types of research, including studies on humans and animal models, to identify patterns and potential mechanisms linking the gut microbiome to PCOS. They also examined different gut-targeted interventions like prebiotics, probiotics, specific diets, and even fecal microbiota transplantation. The review found growing evidence suggesting that imbalances in the gut microbiome might contribute to PCOS by influencing hormones, metabolism, and inflammation. It highlighted that interventions designed to improve gut health were associated with improvements in insulin sensitivity, reduced inflammation, and more balanced hormone levels in some studies. However, the authors noted that the strength of this evidence varies, and more rigorous, long-term human studies are needed to confirm these benefits and understand how different PCOS characteristics might affect treatment response.

Dietary takeaway

While this review highlights the potential role of gut health in PCOS, it reinforces the general recommendation to prioritize a fiber-rich diet. Foods like fruits, vegetables, whole grains, and legumes provide prebiotics that nourish beneficial gut bacteria, potentially supporting overall metabolic health. Remember, this is a review of existing research, and while promising, individual studies are not definitive; always consult a healthcare professional for personalized advice regarding PCOS management.

Abstract

Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders worldwide, affecting 6-13% of reproductive-aged women and exerting a profound metabolic, reproductive and psychological toll. Emerging evidence suggests that the gut microbiome may be a potentially critical, yet under-recognized, contributor to the pathophysiology of PCOS. Alterations in microbial composition and function appear to influence hormonal imbalance, metabolic dysfunction and inflammatory processes that characterize the condition. However, much of the current evidence remains associative or derived from preclinical models, and the causal nature of these relationships is only beginning to be established through approaches such as Mendelian randomization. This literature review examines the evolving relationship between the gut microbiome and PCOS through a mechanism-guided, evidence-stratified framework, with particular focus on how microbiota-targeted interventions - including prebiotics, probiotics, synbiotics, dietary modifications and fecal microbiota transplantation, may modulate gut health and mitigate symptom severity. Across the reviewed studies, microbiome-targeted supplementation was associated with improvements in insulin sensitivity, reductions in systemic inflammation and favorable hormonal changes, although the strength of evidence varies across outcomes and intervention types. Importantly, PCOS heterogeneity, including differences in body mass index (BMI), insulin resistance status and phenotype, may influence both gut microbiota composition and therapeutic response, underscoring the need for phenotype-stratified research. These findings suggest that targeting the gut microbiome may serve as a promising adjunct to conventional PCOS management. Though further rigorous, long-term clinical trials are needed to advance both understanding and clinical translation.

View on PubMed →DOI: 10.3389/fendo.2026.1900535