Unveiling the Connection between Gut Microbiome and Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a multifactorial endocrine metabolic disorder affecting up to one in ten women of reproductive age, with implications on fertility, metabolic health, and quality of life. Recent evidence has shown that gut microbiota dysbiosis plays a role in the PCOS pathophysiology. Based on the 25 articles extracted from PubMed, Ovid Medline, and Scopus (2020–2025), this review reveals that PCOS is consistently associated with reduced gut microbial α-diversity, distinct β-diversity clustering, and compositional shifts marked by depletion of beneficial taxa. These dysbiosis correlate with PCOS phenotypes such as insulin resistance, hyperandrogenism, dyslipidemia, and chronic inflammation via mechanisms involving impaired short-chain fatty acid production, disrupted bile acid metabolism, increased intestinal permeability, and immune-mediated dysregulation of the hypothalamic–pituitary–ovarian axis. Recognising the increasing role of the gut microbiome in PCOS highlights its systemic pathology and points towards the opportunities for microbiota-targeted therapies that address underlying pathophysiological mechanisms rather than symptomatic care alone.