{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T09:27:44Z","timestamp":1787304464602,"version":"build-2736575974"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:p>Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders worldwide, affecting 6\u201313% of reproductive-aged women and exerting a profound metabolic, reproductive and psychological toll. Emerging evidence suggests that the gut microbiome may be a potentially critical, yet under-recognized, contributor to the pathophysiology of PCOS. Alterations in microbial composition and function appear to influence hormonal imbalance, metabolic dysfunction and inflammatory processes that characterize the condition. However, much of the current evidence remains associative or derived from preclinical models, and the causal nature of these relationships is only beginning to be established through approaches such as Mendelian randomization. This literature review examines the evolving relationship between the gut microbiome and PCOS through a mechanism-guided, evidence-stratified framework, with particular focus on how microbiota-targeted interventions \u2014 including prebiotics, probiotics, synbiotics, dietary modifications and fecal microbiota transplantation, may modulate gut health and mitigate symptom severity. Across the reviewed studies, microbiome-targeted supplementation was associated with improvements in insulin sensitivity, reductions in systemic inflammation and favorable hormonal changes, although the strength of evidence varies across outcomes and intervention types. Importantly, PCOS heterogeneity, including differences in body mass index (BMI), insulin resistance status and phenotype, may influence both gut microbiota composition and therapeutic response, underscoring the need for phenotype-stratified research. These findings suggest that targeting the gut microbiome may serve as a promising adjunct to conventional PCOS management. Though further rigorous, long-term clinical trials are needed to advance both understanding and clinical translation.<\/jats:p>","DOI":"10.3389\/fendo.2026.1900535","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T09:05:00Z","timestamp":1787303100000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The gut microbiome in polycystic ovary syndrome: mechanistic pathways and therapeutic potential of microbiota-targeted interventions"],"prefix":"10.3389","volume":"17","author":[{"given":"Farah","family":"Elhennawy","sequence":"first","affiliation":[{"name":"School of Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain","place":["Busaiteen, Bahrain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basmalah","family":"Naji","sequence":"additional","affiliation":[{"name":"School of Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain","place":["Busaiteen, Bahrain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra E.","family":"Butler","sequence":"additional","affiliation":[{"name":"Research Department, Royal College of Surgeons in Ireland-Medical University of Bahrain","place":["Busaiteen, Bahrain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.18370\/2309-4117.2026.83.79-87","article-title":"Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process","volume":"407","author":"Teede","year":"2026","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.36877\/pmmb.a0000475","article-title":"Unveiling the connection between gut microbiome and polycystic ovary syndrome (PCOS)","volume":"8","author":"Li","year":"2025","journal-title":"Prog In Microbes Mol Biol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1210\/jendso\/bvaa177","article-title":"Intersection of polycystic ovary syndrome and the gut microbiome","volume":"5","author":"Rizk","year":"2021","journal-title":"J Endocr Soc"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics13091559","article-title":"Polycystic ovary syndrome: pathophysiology and controversies in diagnosis","volume":"13","author":"Fahs","year":"2023","journal-title":"Diagnostics (Basel)"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12041454","article-title":"Polycystic ovary syndrome: etiology, current management, and future therapeutics","volume":"12","author":"Singh","year":"2023","journal-title":"J Clin Med"},{"key":"B6","article-title":"Polycystic ovarian syndrome","volume-title":"Statpearls","author":"Shukla","year":"2026"},{"key":"B7","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1186\/s12967-025-06315-7","article-title":"Gut microbiota: a hidden player in polycystic ovary syndrome","volume":"23","author":"Senthilkumar","year":"2025","journal-title":"J Transl Med"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2023.1203902","article-title":"The association between gut microbiome and PCOS: evidence from meta-analysis and two-sample mendelian randomization","volume":"14","author":"Min","year":"2023","journal-title":"Front Microbiol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1526468","article-title":"Metabolic disorders in polycystic ovary syndrome: from gut microbiota biodiversity to clinical intervention","volume":"16","author":"Li","year":"2025","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1186\/s13048-026-02162-2","article-title":"Bridging gut microbiota and polycystic ovary syndrome: the mediating role of metabolites and immune pathways via mendelian randomization and mediation analysis","author":"Li","year":"2026","journal-title":"J Ovarian Res"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.12944\/crnfsj.13.2.2","article-title":"Role of diet and gut microbiome composition in women with polycystic ovarian syndrome (PCOS): a systematic review","volume":"13","author":"Krishnan","year":"2025","journal-title":"Curr Res Nutr Food Sci J"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2026.1713408","article-title":"Dietary interventions for modulating the gut microbiome in PCOS management","volume":"17","author":"Patel","year":"2026","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3390\/ph16020197","article-title":"Interplay of gut microbiota in polycystic ovarian syndrome: role of gut microbiota, mechanistic pathways and potential treatment strategies","volume":"16","author":"Corrie","year":"2023","journal-title":"Pharm (Basel)"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2025.1549499","article-title":"Systematic review of gut microbiota composition, metabolic alterations, and the effects of treatments on PCOS and gut microbiota across human and animal studies","volume":"16","author":"Hanna","year":"2025","journal-title":"Front Microbiol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3390\/nu16223916","article-title":"Effectiveness of probiotics, prebiotics, and synbiotics in managing insulin resistance and hormonal imbalance in women with polycystic ovary syndrome (PCOS): a systematic review of randomized clinical trials","volume":"16","author":"Martinez Guevara","year":"2024","journal-title":"Nutrients"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2025.1680840","article-title":"Effect of probiotic-derived metabolites on hormonal and metabolic profiles in women with polycystic ovary syndrome: a systematic review and meta-analysis","volume":"15","author":"Maddirevula","year":"2025","journal-title":"Front Cell Infect Microbiol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1093\/nutrit\/nuac075","article-title":"Effects of nutrition on metabolic and endocrine outcomes in women with polycystic ovary syndrome: an umbrella review of meta-analyses of randomized controlled trials","volume":"81","author":"Moslehi","year":"2023","journal-title":"Nutr Rev"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1141355","article-title":"The effects of probiotics, prebiotics, and synbiotics on polycystic ovarian syndrome: an overview of systematic reviews","volume":"10","author":"Angoorani","year":"2023","journal-title":"Front Med (Lausanne)"},{"key":"B19","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1007\/s11010-025-05409-6","article-title":"Journey through the gut-inflammation axis in polycystic ovary syndrome: the microbiota's role in shaping inflammatory pathways","volume":"481","author":"Sharma","year":"2026","journal-title":"Mol Cell Biochem"},{"key":"B20","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1002\/ajum.12096","article-title":"Rotterdam criteria, the end","volume":"21","author":"Smet","year":"2018","journal-title":"Australas J Ultrasound Med"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1210\/js.2019-00078","article-title":"Polycystic ovary syndrome: pathophysiology, presentation, and treatment with emphasis on adolescent girls","volume":"3","author":"Witchel","year":"2019","journal-title":"J Endocr Soc"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1136\/bmjmed-2023-000548","article-title":"Polycystic ovary syndrome: pathophysiology and therapeutic opportunities","volume":"2","author":"Dong","year":"2023","journal-title":"BMJ Med"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2026.1734041","article-title":"BMI-stratified phenotypes of polycystic ovary syndrome: advances in gut microbiota research and personalized management strategies","volume":"17","author":"Su","year":"2026","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2017-02799","article-title":"Gut microbiota and the polycystic ovary syndrome: influence of sex, sex hormones, and obesity","volume":"103","author":"Insenser","year":"2018","journal-title":"J Clin Endocrinol Metab"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-019-0509-0","article-title":"Gut microbiota-bile acid-interleukin-22 axis orchestrates polycystic ovary syndrome","volume":"25","author":"Qi","year":"2019","journal-title":"Nat Med"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgz263","article-title":"Obese adolescents with PCOS have altered biodiversity and relative abundance in gastrointestinal microbiota","volume":"105","author":"Jobira","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2022.911992","article-title":"Alterations of gut microbiome and fecal fatty acids in patients with polycystic ovary syndrome in central China","volume":"13","author":"Li","year":"2022","journal-title":"Front Microbiol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.2337\/db11-1019","article-title":"Short-chain fatty acids stimulate glucagon-like peptide-1 secretion via the G-protein-coupled receptor FFAR2","volume":"61","author":"Tolhurst","year":"2012","journal-title":"Diabetes"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1007\/s11154-014-9288-6","article-title":"Gut microbiota and GLP-1","volume":"15","author":"Everard","year":"2014","journal-title":"Rev Endocr Metab Disord"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1002\/mnfr.202300688","article-title":"From gut to hormones: unraveling the role of gut microbiota in (phyto)estrogen modulation in health and disease","volume":"68","author":"Kumari","year":"2024","journal-title":"Mol Nutr Food Res"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1210\/er.2014-1100","article-title":"TLR4 at the crossroads of nutrients, gut microbiota, and metabolic inflammation","volume":"36","author":"Velloso","year":"2015","journal-title":"Endocr Rev"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1038\/nature05414","article-title":"An obesity-associated gut microbiome with increased capacity for energy harvest","volume":"444","author":"Turnbaugh","year":"2006","journal-title":"Nature"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jri.2025.104648","article-title":"Linking altered gut microbiome to polycystic ovarian syndrome through immune mediated pathway","volume":"172","author":"Pathak","year":"2025","journal-title":"J Reprod Immunol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1210\/jc.2013-3092","article-title":"Toll-like receptor status in obesity and metabolic syndrome: a translational perspective","volume":"99","author":"Jialal","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1111\/obr.70107","article-title":"Toll like receptor 4: a potential link between obesity and metabolic diseases","volume":"27","author":"Alhamar","year":"2026","journal-title":"Obes Rev"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1679","DOI":"10.1053\/j.gastro.2017.01.055","article-title":"Bile acid control of metabolism and inflammation in obesity, type 2 diabetes, dyslipidemia, and nonalcoholic fatty liver disease","volume":"152","author":"Ch\u00e1vez-Talavera","year":"2017","journal-title":"Gastroenterology"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.m117.784322","article-title":"Farnesoid X receptor induces Takeda G-protein receptor 5 cross-talk to regulate bile acid synthesis and hepatic metabolism","volume":"292","author":"Pathak","year":"2017","journal-title":"J Biol Chem"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.3390\/cells13242127","article-title":"Unveiling GATA3 signaling pathways in health and disease: mechanisms, implications, and therapeutic potential","volume":"13","author":"Bacha","year":"2024","journal-title":"Cells"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-026-71365-4","article-title":"Sialic acid exacerbates polycystic ovary syndrome in mice by modulating gut microbiota-mediated bile acid metabolism and FXR activation","volume":"17","author":"Zhao","year":"2026","journal-title":"Nat Commun"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19053089","article-title":"Neuroendocrine determinants of polycystic ovary syndrome","volume":"19","author":"Szeliga","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.3390\/ijms262311412","article-title":"The role of the gut microbiome in type 2 diabetes mellitus","volume":"26","author":"Mashal","year":"2025","journal-title":"Int J Mol Sci"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-019-01139-x","article-title":"The effect of synbiotics pomegranate juice on cardiovascular risk factors in PCOS patients: a randomized, triple-blinded, controlled trial","volume":"43","author":"Esmaeilinezhad","year":"2020","journal-title":"J Endocrinol Invest"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.3390\/nu17020310","article-title":"The role of lifestyle interventions in PCOS management: a systematic review","volume":"17","author":"Gautam","year":"2025","journal-title":"Nutrients"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.3390\/nu18030372","article-title":"Prebiotics and gut health: mechanisms, clinical evidence, and future directions","volume":"18","author":"Monteiro","year":"2026","journal-title":"Nutrients"},{"key":"B45","first-page":"1","article-title":"Effects of probiotic supplementation on hormonal profiles, biomarkers of inflammation and oxidative stress in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial","volume":"21","author":"Karamali","year":"2018","journal-title":"Arch Iran Med"},{"key":"B46","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1186\/s13048-018-0457-1","article-title":"The effects of probiotic and selenium co-supplementation on parameters of mental health, hormonal profiles, and biomarkers of inflammation and oxidative stress in women with polycystic ovary syndrome","volume":"11","author":"Jamilian","year":"2018","journal-title":"J Ovarian Res"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0153196","article-title":"Association between polycystic ovary syndrome and gut microbiota","volume":"11","author":"Guo","year":"2016","journal-title":"PloS One"},{"key":"B48","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1007\/s00404-024-07833-3","article-title":"Six-month randomized, placebo controlled trial of synbiotic supplementation in women with polycystic ovary syndrome undergoing lifestyle modifications","volume":"311","author":"Chudzicka-Struga\u0142a","year":"2025","journal-title":"Arch Gynecol Obstet"},{"key":"B49","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/s12902-018-0248-0","article-title":"The effects of synbiotic supplementation on hormonal status, biomarkers of inflammation and oxidative stress in subjects with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial","volume":"18","author":"Nasri","year":"2018","journal-title":"BMC Endocr Disord"},{"key":"B50","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/s12905-023-02868-1","article-title":"Synbiotic as an ameliorating factor in the health-related quality of life in women with polycystic ovary syndrome. A randomized, triple-blind, placebo-controlled trial","volume":"24","author":"Hariri","year":"2024","journal-title":"BMC Womens Health"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1016\/s2468-1253(21)00303-4","article-title":"Roles of the gut virome and mycobiome in faecal microbiota transplantation","volume":"7","author":"Lam","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.1128\/cmr.00060-22","article-title":"Fecal microbiota transplantation: current challenges and future landscapes","volume":"37","author":"Yadegar","year":"2024","journal-title":"Clin Microbiol Rev"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1016\/j.fct.2019.04.032","article-title":"Reappraisal of probiotics' safety in human","volume":"129","author":"Sotoudegan","year":"2019","journal-title":"Food Chem Toxicol"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1900535\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T09:05:02Z","timestamp":1787303102000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1900535\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,21]]},"references-count":53,"alternative-id":["10.3389\/fendo.2026.1900535"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1900535","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,21]]},"article-number":"1900535"}}