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Central to ovarian function and follicular development is the extracellular matrix (ECM), which undergoes significant remodeling facilitated by matrix metalloproteinases (MMPs). In PCOS, the ovarian cortex becomes thickened and collagen\u2010rich, creating a rigid environment that disrupts normal follicular growth and oocyte maturation. Altered MMP activity further complicates this scenario by impairing ECM degradation, leading to the accumulation of small, quiescent follicles, and elevated androgen levels. This review aims to explore the intricate roles of ECM and MMP alterations in PCOS pathogenesis, highlighting their impact on folliculogenesis and steroidogenesis. 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