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PCOS affects metabolic health and increases the risk of obesity, insulin resistance, and cardiovascular disease, in addition to infertility. This review delves deeper into the connections of gut microbiota with PCOS pathophysiology, particularly into its impact on hormone metabolism, obesity, inflammation, and insulin resistance by way of short-chain fatty acids, lipopolysaccharides, and gut-brain axis. Studies also show that changes in the metabolic processes and immune responses are seen in changes in the gut microbiota in PCOS subjects, such as changes in the\n                    <jats:italic>Bacteroidetes<\/jats:italic>\n                    and\n                    <jats:italic>Firmicutes<\/jats:italic>\n                    groups. Some bacteria, like\n                    <jats:italic>Escherichia<\/jats:italic>\n                    and\n                    <jats:italic>Shigella<\/jats:italic>\n                    , have been associated with dysbiosis in patients with PCOS, leading to systemic inflammation and changed hormone levels, which further worsen the clinical symptoms. Therapeutic interventions targeting the gut microbiota comprise probiotics, prebiotics, and fecal microbiota transplantation; these have potential to alleviate the symptoms of PCOS. Other precision microbiome-based therapies include postbiotics, and CRISPR-Cas9 genome editing, which are relatively new avenues toward precision treatment. This complex interlink of gut microbiota and PCOS pathophysiology will open the avenues for possible treatments for hormonal imbalances and metabolic problems that characterize these complex disorders. The review here focuses on the requirement of further studies to be able to elucidate the specific pathways relating gut microbiota dysregulation to PCOS and, thus, improve microbiome-based therapies for better clinical outcomes in affected individuals.\n                  <\/jats:p>","DOI":"10.1186\/s12967-025-06315-7","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T06:48:01Z","timestamp":1744699681000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":84,"title":["Gut microbiota: a hidden player in polycystic ovary syndrome"],"prefix":"10.1186","volume":"23","author":[{"given":"Harshini","family":"Senthilkumar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1647-3182","authenticated-orcid":false,"given":"Mohanapriya","family":"Arumugam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,15]]},"reference":[{"issue":"9","key":"6315_CR1","doi-asserted-by":"publisher","first-page":"1602","DOI":"10.1093\/humrep\/dey256","volume":"33","author":"HJ Teede","year":"2018","unstructured":"Teede HJ, Misso ML, Costello MF, et al. 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