THE ROLE OF GUT MICROBIOME ALTERATIONS IN THE PATHOPHYSIOLOGY AND MANAGEMENT OF POLYCYSTIC OVARY SYNDROME
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Keywords
Polycystic Ovary Syndrome, Gut Microbiota, Dietary Fiber, Physical Activity, Hormonal Balance
Abstract
Background: Polycystic Ovary Syndrome (PCOS) is a multifactorial endocrine disorder linked to hormonal imbalance, metabolic dysfunction, and low-grade inflammation. Emerging evidence implicates gut microbiota alterations in its pathogenesis.
Objectives: To assess the impact of dietary fiber intake and physical activity on gut microbiota diversity and related hormonal and metabolic outcomes in women with PCOS.
Methods: A prospective observational study was conducted over 12 months involving 54 women (18–35 years) with PCOS. Participants were stratified post hoc into low/high fiber (<15 g/day, ≥25 g/day) and low/high activity (<150, ≥150 min/week) groups. Clinical, dietary, physical activity, and microbiota data (16S rRNA sequencing) were collected at baseline and six months. Statistical analyses included t-tests, chi-square tests, correlations, and multivariate regression.
Results: High-fiber intake was associated with greater microbial diversity (Shannon Index: 3.6 vs. 2.8; p=0.001), lower testosterone (64 vs. 72 ng/dL; p=0.04), and reduced HOMA-IR (2.5 vs. 3.2; p=0.02). Higher activity correlated with reduced BMI (27.8 vs. 30.1 kg/m²; p=0.01), lower waist circumference (86.5 vs. 91.3 cm; p=0.03), and improved menstrual regularity (54% vs. 30%; p=0.045). Both fiber and activity independently predicted microbial diversity.
Conclusions: Dietary fiber and physical activity independently and synergistically improve gut microbiota diversity and metabolic-hormonal profiles in PCOS, supporting their role as non-pharmacological management strategies.
References
2. Ravat FK, Goswami J, Nair S, Thummar KN. A review of metabolic and microbial influences on women with polycystic ovarian syndrome. Steroids. 2024;212:109512. doi:10.1016/j.steroids.2024.109512
3. Singh S, Pal N, Shubham S, Sarma DK, Verma V, Marotta F, Kumar M. Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics. J Clin Med. 2023;12(4):1454. doi:10.3390/jcm12041454
4. Priya M, Varghese TP, Vijayan A, Elango K, John A. Probiotics as potential allies in hormonal harmony and metabolic management: unlocking the Gut–Polycystic Ovary Syndrome (PCOS). Res J Pharm Technol. 2024;17(5):—. doi:10.52711/0974-360x.2024.00913
5. Wang X, Xu T, Liu R, Wu G, Gu L, Zhang Y, et al. High-fiber diet or combined with acarbose alleviates heterogeneous phenotypes of polycystic ovary syndrome by regulating gut microbiota. Front Endocrinol (Lausanne). 2022;12:806331. doi:10.3389/fendo.2021.806331
6. Sivasankari R, Usha B. Reshaping the gut microbiota through lifestyle interventions in women with PCOS: A review. Indian J Microbiol. 2022;62(3):351-363. doi:10.1007/s12088-022-01019-8
7. Slack J, Kosyakova N, Pelkmans J, Houser MC, Dunbar SB, Spencer JB, Ferranti EP, Narapareddy SL. Association of gut microbiota with fatigue in Black women with polycystic ovary syndrome. Nurs Res. 2024;73(3):—. doi:10.1097/NNR.0000000000000788
8. Torres PJ. Role of the Gut Microbiome in Polycystic Ovary Syndrome [dissertation]. San Diego (CA): San Diego State University; 2019.
9. Zhang M, Hu R, Huang Y, Zhou F, Li F, Liu Z, Geng Y, Dong H, Ma W, Song K, Song Y. Present and future: crosstalks between polycystic ovary syndrome and gut metabolites relating to gut microbiota. Frontiers in endocrinology. 2022 Jul 19;13:933110.
10. Li YH, Fang YQ, Wang H, Zhang H. Balancing act: Exploring the gut microbiota–brown adipose tissue axis in PCOS pathogenesis and therapeutic frontiers. Front Biosci (Landmark Ed). 2024;29(6):208. doi:10.31083/j.fbl2906208
11. Fu Y, Zhang Y, Wang H, Shen Y, Jin Y, Jiang H. Gut microbiota dysbiosis and its associations with dietary patterns and metabolic parameters in women with polycystic ovary syndrome. Front Endocrinol (Lausanne). 2022;13:832133.
12. Leung K, El-Sohemy A. Dietary patterns and risk of polycystic ovary syndrome: A systematic review. Nutr Rev. 2022;80(5):994–1007.
13. Deehan EC, Yang C, Perez-Muñoz ME, Nguyen NK, Cheng CC, Triador L, et al. Precision microbiome modulation with inulin improves metabolic and reproductive parameters in women with PCOS. Cell Host Microbe. 2022;30(4):584–600.e5.
14. Feng Y, Xue X, Wang Y, Wu J, Zhang Q. Dietary fiber-mediated gut microbiota modulation improves insulin resistance in PCOS patients: A randomized controlled trial. Am J Clin Nutr. 2025;111(1):55–64.
15. Aoki Y, Sano M, Takahashi K, Yamamoto M, Kinoshita K, Nakamura T, et al. Exercise-induced changes in gut microbiota and metabolites improve PCOS symptoms in obese women. J Clin Endocrinol Metab. 2020;105(6):e2335–e2347.
16. Tan KY, Toh HT. The role of physical activity in modifying gut microbiota in PCOS: A mini-review. Sports Med Health Sci. 2021;3(3):132–8.
17. Sivasankari S, Usha R. Gut microbiota as a therapeutic target for metabolic and reproductive dysfunctions in polycystic ovary syndrome. J Obstet Gynaecol Res. 2022;48(2):263–70.
18. Wang X, Liu Y, Zhang M, Chen X, Zhao Y. The effects of lifestyle interventions on gut microbiota in women with PCOS: A review. Nutrients. 2022;14(6):1286.
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Dr Sana Shaukat
3rd year resident Department of Obstetrics and Gynecology, DY Patil University, Kolhapur, India
Dr Avantika Dhakre
3rd year resident Department of Obstetrics and Gynecology, DY Patil University, Kolhapur, India