Gut Microbiota Dysbiosis and Insulin Resistance in Polycystic Ovary Syndrome: Pathophysiological Links and Therapeutic Perspectives

Abstract

Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine and metabolic conditions in women of reproductive age, and is commonly characterized by insulin resistance, hyperandrogenism and reproductive dysfunction (1,2). Recent studies have provided increasing evidence regarding the involvement of gut microbiota alterations in the pathogenesis of PCOS, acting via intricate metabolic, endocrine, inflammatory and immune pathways. Cellular changes in the gut associated with these factors such as an increase in intestinal permeability, inflammation due to lipopolysaccharide, changes in the production of short-chain fatty acids, and bile acid metabolism (7,12,32) have all been proposed as mechanisms by which gut dysbiosis contributes to the development of insulin resistance.

This narrative review aims to provide a synthesis of the available evidence and make a critical appraisal of the link between gut microbiota dysbiosis and insulin resistance in PCOS. The literature was accessed from PubMed, Scopus and Google Scholar from the year 2015 to 2025 with the keywords such as “PCOS”, “gut microbiota”, “gut microbiome”, “dysbiosis”, and “insulin resistance”. Special focus was given to the pathophysiological mechanisms linking alterations of the gut microbiome to metabolic dysfunction, the role of host–microbiome interactions, and novel therapeutic strategies based on the gut microbiome.

The evidence reviewed here showed a close relationship between insulin resistance and gut dysbiosis, and gut dysbiosis may play a role in the metabolic and reproductive symptoms of PCOS. Other microbiome-targeting strategies like probiotics, prebiotics, synbiotics, and metformin have shown promise in enhancing insulin sensitivity, inflammatory markers, hormonal regulation, and metabolic health. Other novel methods, such as postbiotics and FMT are promising, but clinical evidence is limited (22,27).

Finally, gut microbiota dysbiosis may be an important element of the pathophysiology of PCOS and a therapeutic target. More well-designed clinical trials are needed to better understand the mechanisms and long-term effects and safety of microbiome-based interventions for PCOS.