Gut - Brain - Ovary Axis in Polycystic Ovary Syndrome: Microbiota, Metabolic Inflammation, and Reproductive Dysfunction

Abstract

Introduction
Polycystic ovary syndrome (PCOS) is a complex endocrine disorder characterized by reproductive, metabolic, and inflammatory disturbances. Increasing evidence suggests that gut microbiota plays a significant role in the regulation of metabolic and neuroendocrine pathways involved in PCOS.

Aim
The aim of this review was to summarize current knowledge on the gut-brain-ovary axis in PCOS, with particular focus on the contribution of gut microbiota dysbiosis to metabolic inflammation and reproductive dysfunction.

Material and methods
A narrative review of the literature was conducted using PubMed/MEDLINE, Scopus, and Web of Science databases. Peer-reviewed articles published in English up to March 2024 were analyzed. Studies addressing associations, underlying mechanisms, and therapeutic interventions linking gut microbiota with metabolic, inflammatory, neuroendocrine, and reproductive features of PCOS were included.

Results
Available evidence indicates that women with PCOS exhibit significant alterations in gut microbiota composition, including reduced microbial diversity, decreased abundance of short-chain fatty acid-producing bacteria, and increased prevalence of pro-inflammatory taxa. These changes are associated with insulin resistance, impaired intestinal barrier function, metabolic endotoxemia, chronic low-grade inflammation, hyperandrogenism, and disturbances in hypothalamic-pituitary-ovarian signaling.

Conclusions
Gut microbiota dysbiosis appears to play an important integrative role in the pathophysiology of PCOS by linking metabolic inflammation with neuroendocrine and ovarian dysfunction. The gut-brain-ovary axis represents a promising conceptual framework and therapeutic target; however, further well-designed longitudinal and mechanistic studies are required.