An Update on PCOS Pathophysiology in Reference to Oxidative Stress (Os), Ferroptosis: A Comprehensive Narrative Review on Part of N-Acetylcysteine (Nac), & Selenium in Tackling Ferroptosis, Os & PCOS

ABSTRACT: Previously we reviewed articles on polycystic ovary syndrome (PCOS) pathophysiology, classification /therapy inclusive of insulin sensitizers like (D-chiro (DCI)- Myoinositol (M). N-acetylcysteine (NAC), a compound recognized for its cysteine and glutathione precursor characteristics, has been used as therapeutic applications for2 decades. Recently, an escalating attraction in evaluating the plausible advantages of NAC in tackling PCOS . Nonetheless, the precise mechanistic modes behind NAC’s therapeutic, and clinical utility continue to be uncharted. The objective of this narrative review was to investigate the manner NAC yields protection against PCOS and part of oxidative stress( OS) and oxidative reductive stress in the pathophysiology of PCOS and ferroptosis in PCOS. Therefore as a corollary Selenium, is a crucial constituent of glutathione peroxidase(GPx),an enzyme significant in ferroptosis and Thyroid hormone generation . Here we conducted a narrative review utilizing search engine pubmed,google scholar ;web of science ;embase; Cochrane review library utilizing the MeSH terms like polycystic ovary syndrome (PCOS); N-acetylcysteine (NAC); Selenium; oxidative stress( OS); ferroptosis from 2000 onwards till date in 2025. We found a total of 300 articles out of which we selected 71 articles for this review.No meta-analysis was done. Maximum studies point that NAC, if used alone or in combination with other medications, has the plausibility of countering OS, utilize its anti-inflammatory and anti-apoptotic characteristics, and yield advantages in PCOS management. Furthermore, NAC might possess the capability of impacting particular signaling pathways in insulin target cells and β cells. Variable biological actions of NAC suggest its plausible utility as a supplementary /therapeutic strategy for PCOS management. Therefore, further work is needed for evaluating plausible usefulness of NAC in tackling PCOS. Additionally, we detail how ferroptosis might be implicated in the pathophysiology of PCOS and Selenium is one more antioxidant of utility in PCOS therapy. Key Words; polycystic ovary syndrome (PCOS); Nacetylcysteine (NAC); ); Selenium; oxidative stress( OS); ferroptosis.