Table of contents
What is PCOS?
Polycystic ovary syndrome (PCOS) is a common hormonal disorder affecting 8–13% of women of reproductive age worldwide. PCOS is not merely a gynaecological issue, but a complex internal medicine and endocrinological condition that disrupts the hormonal balance and functioning of the entire body. [1]
One of the most characteristic features of PCOS is the formation of numerous small fluid-filled cysts in the ovaries, instead of mature oocytes (Figure 1). These are, in fact, immature follicles that cannot reach the ovulation stage. This failure to ovulate prevents the release of eggs, which can result in long-term infertility. The hormonal imbalance further exacerbates menstrual irregularities and promotes the development of additional cysts, leading to symptoms such as irregular menstruation, excessive hair growth, and weight gain. [2]
PCOS not only affects reproductive health but is also linked to a range of serious comorbidities. It significantly increases the risk of developing type 2 diabetes, hypertension, and high cholesterol, all of which can lead to cardiovascular disease over time [3]. Persistently high oestrogen levels may also raise the risk of endometrial cancer [3]. Insulin resistance is often present, complicating the syndrome and requiring a holistic approach. Thus, therapy should go beyond gynaecological intervention and adopt a comprehensive internal medicine perspective.
Recent research has highlighted the potential role of the gut microbiome in the development and progression of PCOS. The connections between gut microbiome, hormonal balance, insulin resistance, and chronic inflammation may offer new therapeutic avenues. Lifestyle changes, particularly a healthy diet and regular exercise, are fundamental in managing PCOS. [4]
PCOS is often underdiagnosed, especially in women with mild or atypical symptoms, although early detection and timely treatment are crucial to avoid long-term complications. [1]
Figure 1. One of the most characteristic features of PCOS is the formation of numerous small fluid-filled cysts in the ovaries, instead of mature oocytes (the right side of the figure).
Symptoms of PCOS
The symptoms of PCOS are diverse and may present differently from person to person. Some women experience only a few symptoms, while others suffer from a broader range of issues (Figure 2). The severity of symptoms can also vary and may worsen over time.
Menstrual abnormalities
Women with PCOS frequently experience irregular menstruation, characterised by extended intervals between periods (more than 35 days) and fewer than nine periods per year. In some cases, menstruation may be entirely absent (amenorrhoea) or may involve prolonged bleeding. [2]
Hormonal imbalance
A defining symptom of PCOS is elevated levels of male sex hormones, particularly testosterone. This leads to hirsutism—excessive hair growth on the face, chest, and back. Acne, oily skin, and male-pattern hair loss are also common. [5]
Weight gain
Many women with PCOS experience weight gain, especially around the abdomen. This is closely linked to the insulin resistance often associated with the condition, making weight management particularly difficult. In this state, cells fail to respond properly to insulin, prompting the body to produce more insulin to compensate. [6]
Infertility
PCOS is one of the most common causes of female infertility. Irregular or absent ovulation (anovulation) makes conception difficult. With appropriate treatment, however, many women with PCOS are able to conceive. [7]
Skin lesions
PCOS is often accompanied by skin issues closely tied to hormonal imbalances, particularly insulin resistance and high androgen levels. For example, acanthosis nigricans—a condition marked by dark, thickened patches of skin in folds such as the neck and underarms—can result from elevated insulin levels. High androgen levels also increase sebum production, contributing to acne and skin growths. [7]
Mental health issues
The physical manifestations of PCOS—infertility, hirsutism, weight gain, and insulin resistance—can lead to significant psychological distress. Many women experience anxiety, depression, and low self-esteem, which can severely impact quality of life and affect personal and professional relationships. [6]
Figure 2. The symptoms of PCOS are diverse and may present differently from person to person. Some women experience only a few symptoms, while others suffer from a broader range of issues
How is PCOS diagnosed?
Diagnosing PCOS involves a comprehensive assessment of symptoms, medical history, and diagnostic tests. Accurate diagnosis is essential for appropriate treatment.
The Rotterdam criteria are the most widely used diagnostic guidelines. A diagnosis requires at least two of the following three features: hyperandrogenism, irregular menstruation or anovulation, and ultrasound-confirmed polycystic ovaries. [5]
Updated diagnostic guidelines
Thorough evaluation using imaging, blood tests, and clinical symptoms is vital. Transvaginal ultrasound is the gold standard for imaging the ovaries, detecting enlarged, immature follicles that appear as fluid-filled blisters in a bead-like pattern. However, in women on contraceptive pills, these follicles may not be visible—though this doesn’t exclude a PCOS diagnosis. While the Rotterdam criteria remain central, newer guidelines aim for more precise diagnosis and personalised care.
Anti-Müllerian hormone (AMH) measurement is gaining prominence, especially in adult women, for evaluating ovarian function. Diagnostic criteria for menstrual irregularities now define abnormal cycles as shorter than 21 days, longer than 35 days, or fewer than eight periods per year. Blood tests are essential for accurate diagnosis. [5]
Key blood test parameters:
- Testosterone
- DHEA-S
- Androstenedione
- Fasting insulin
- HbA1c
- Lipid profile
- LH/FSH ratio
- Progesterone
- Prolactin
- 17-hydroxyprogesterone
- Thyroid panel
Hormonal disturbances are a defining feature of PCOS and play a central role in both its symptoms and long-term effects. [5]
Elevated androgens
Women with PCOS often have elevated levels of male sex hormones such as testosterone and androstenedione. This excess of androgens disrupts normal follicle maturation, leading to ovulatory dysfunction and cyst formation. It also causes symptoms such as hirsutism, acne, and hair loss. [8]
Gonadotropin imbalance
The balance between luteinising hormone (LH) and follicle-stimulating hormone (FSH) is often disrupted in PCOS. LH levels tend to be elevated while FSH levels are lower. This imbalance impairs follicular development and ovulation, contributing to menstrual irregularities and infertility. Increased LH levels also stimulate greater androgen production, worsening hyperandrogenic symptoms. [9]
Insulin resistance and hyperinsulinaemia
Insulin resistance is one of the most common metabolic issues in PCOS. High insulin levels stimulate ovarian androgen production, further disrupting hormonal balance. This creates a vicious cycle that increases the risk of type 2 diabetes and cardiovascular disease. [10]
Low progesterone levels
The frequent absence of ovulation in PCOS results in reduced progesterone levels. Since progesterone is produced in greater amounts after ovulation, its deficiency can impair endometrial (uterine lining) health, increase the risk of endometrial hyperplasia (abnormal thickening of the endometrium) and cancer, and contribute to irregular periods. Low progesterone may also affect mood and emotional stability. [9]
Decreased SHBG levels
Sex hormone-binding globulin (SHBG) is often reduced in women with PCOS, especially those with insulin resistance. SHBG binds androgens in the bloodstream, limiting their activity. When SHBG levels are low, more free androgens circulate, intensifying symptoms of hyperandrogenism [11].
Types of PCOS
PCOS can be categorised into four phenotypes based on the combination and severity of symptoms (Figure 3), allowing for more personalised diagnosis and treatment. [12]
Type A (Classic PCOS)
The most common and severe form, including all three diagnostic criteria:
- Hyperandrogenism
- Ovulatory dysfunction
- Polycystic ovaries
Typically linked with insulin resistance.
Type B (Non-classical PCOS)
This type has hormonal symptoms but no cysts:
- Hyperandrogenism
- Hyperthyroidism
- Absence of polycystic ovaries
Although hormonal imbalances are evident, the ovaries appear normal without cystic changes.
Type C (Ovulatory PCOS)
In this type, only two of the diagnostic criteria are present:
- Hyperandrogenism
- Polycystic ovaries
- Normal ovulation
Although ovulation occurs regularly, other PCOS symptoms may still develop due to elevated androgen levels and the presence of ovarian cysts.
Type D (Mild, Non-classical PCOS)
This is the mildest form of PCOS and is characterised by:
- Ovulatory disorders
- Polycystic ovaries
- Absence of hyperandrogenism
Hormonal symptoms are relatively mild. While menstrual irregularities and ovarian cysts are present, more severe hormonal imbalances typically do not occur. [13]
Figure 3. PCOS can be categorised into four phenotypes (Type A, B, C and D) based on the combination and severity of symptoms
What causes PCOS?
The exact cause of PCOS remains unclear, but several factors are believed to contribute (Figure 4). Genetics plays a key role—women with a family history of PCOS are more likely to develop the condition. However, genetic predisposition alone is not sufficient; environmental and lifestyle factors are also crucial.
Hormonal imbalances, often linked to insulin resistance, are central to the pathology. Chronic stress, which increases cortisol levels, may worsen hormonal disruptions and menstrual irregularities.
In addition, environmental factors, such as exposure to endocrine-disrupting chemicals (e.g., pesticides, phthalates) may also impair hormonal regulation and ovarian function. These factors work together to trigger and intensify PCOS symptoms. [7]
The role of the gut microbiome in PCOS
The gut microbiome—a diverse community of microbes in the gastrointestinal tract—plays a crucial role in regulating metabolism and immunity. Recent studies show that disruptions in gut microbiota composition significantly impact obesity, type 2 diabetes, and PCOS. The gut-PCOS link involves hormonal imbalance, insulin resistance, and chronic inflammation. Bacterial species such as Segatella copri and Phocaeicola vulgatus contribute to branched-chain amino acid (BCAA) biosynthesis, thus contributing to the development of insulin resistance. [4], [14]
The role of the gut microbiome in metabolism and the development of PCOS
The gut microbiome plays a crucial role in metabolic processes, particularly in glucose and lipid metabolism, both of which directly influence insulin resistance—a central feature of PCOS. In individuals with PCOS, changes in the composition of gut microbiome, known as dysbiosis, are often closely linked to reduced insulin sensitivity. An increased proportion of certain bacterial groups, such as Bacteroidetes and Firmicutes, has been associated with impaired sugar metabolism. [4]
These alterations in gut microbiome not only contribute to the development of insulin resistance but may also exacerbate broader metabolic dysfunctions, thereby increasing the risk of type 2 diabetes and cardiovascular disease. For women with PCOS, a fibre-rich diet can have a positive impact on gut microbiota balance and may enhance insulin sensitivity—an especially important factor in the treatment of the condition. [15]
The link between hyperandrogenism and the gut microbiome
Alterations in the gut microbiome may contribute to increased androgen production by influencing the metabolism of hormonal precursors and triggering inflammatory responses that stimulate androgen-producing glands. Additionally, damage to the intestinal barrier and disruption of enterohepatic circulation can enhance the recycling of androgen precursors, further elevating hormone levels. This exacerbates PCOS symptoms such as hirsutism and acne [16].
Animal studies have demonstrated that changes in gut microbiome can increase body fat composition, which indirectly promotes androgen overproduction. This relationship adds further complexity to PCOS treatment, as the interaction between gut microbiota and hormonal dysfunction represents another critical factor that must be addressed in therapy. [4]
Inflammation and leaky gut
A major feature of PCOS is chronic, low-grade inflammation associated with elevated inflammatory markers, (TNF-α, IL-6 and CRP). This can be even more severe in obesity. The inflammatory response contributes to the development of insulin resistance and other metabolic disorders, not only in obese women but also in women with PCOS of normal weight. The question is whether it is the disease itself or the metabolic disturbances that trigger this inflammatory process.
The health of the intestinal tract is of paramount importance, as the permeability of the intestinal wall increases during the ‘leaky gut’ phenomenon, allowing inflammation-causing substances such as lipopolysaccharides (LPS) to enter the bloodstream. This process, which causes systemic inflammation, can further worsen insulin resistance and exacerbate the symptoms of PCOS. An imbalance in the gut microbiome can also contribute to the development of leaky gut, as some harmful bacteria can also directly trigger inflammatory reactions. Restoring the balance of gut microbiome can reduce inflammation and improve the condition of people with PCOS. [4]
Gut-brain axis and PCOS
The gut microbiome affects not only metabolism and hormonal balance, but also the functioning of the nervous system through the brain-gut axis. This two-way communication system maintains a constant link between the gut microbiome and the brain, influencing the production of hormones and inflammatory factors. The enteric nervous system (ENS), a network of nerve cells in the gut wall, plays a key role in this relationship by communicating directly with the brain via the vagus nerve and other autonomic nerve pathways. Dysbiosis of the gut microbiome via the brain-gut axis can indirectly enhance the stress response, which may contribute to disruption of hormonal regulation, including androgen production. This mechanism is particularly relevant in the case of polycystic ovary syndrome (PCOS), where elevated androgen levels are often accompanied by neurological and psychological symptoms such as anxiety and depression, which may also be associated with gut-brain axis function. [4]
Figure 4. The exact cause of PCOS remains unclear, but several factors are believed to contribute
Treatments of PCOS
Conventional medical approaches
While PCOS currently has no cure, its symptoms can be effectively managed with proper treatment. The first step is to identify the root causes and tailor treatment to the individual’s specific needs [17]. Medical treatments often aim to relieve symptoms by improving insulin sensitivity, promoting ovulation, or regulating hormone levels [18]. Although these medications can be effective, they do not always address the underlying causes and may not provide a permanent solution.
Hormonal regulation
Hormonal therapies are commonly used in women with PCOS to regulate menstrual cycles and alleviate symptoms of hyperandrogenism. Birth control pills are often prescribed to balance hormone levels, regulate menstruation, and reduce acne and excess hair growth. However, they do not treat the root cause of PCOS and are not suitable for women trying to conceive. [19]
Improving insulin sensitivity
Medications that enhance insulin sensitivity can stabilise blood sugar and reduce insulin levels. This, in turn, decreases ovarian androgen production and lowers LH levels—both of which contribute to androgen excess. Reduced insulin levels also boost SHBG production, which binds free androgens, improving ovulation and alleviating PCOS symptoms. Enhancing insulin sensitivity not only balances hormones but also reduces the risk of type 2 diabetes and other metabolic complications. [19]
Ovulation induction
For women trying to conceive, ovulation-inducing medications can help. These drugs stimulate the release of eggs, increasing the likelihood of pregnancy. Ovulation induction is especially helpful for women with PCOS who are not ovulating, though it requires close monitoring and may involve side effects. [19]
Functional approach to PCOS treatment
A core element of PCOS treatment is the implementation of lifestyle changes. A healthy diet and regular physical activity can help alleviate symptoms, support metabolic function, and reduce long-term health risks. [20]
Maintaining a healthy lifestyle not only aids in symptom management but also lowers the risk of developing chronic conditions associated with PCOS. The combined benefits of proper nutrition and exercise offer a sustainable, long-term approach to managing the condition. It is recommended to engage in at least 30 minutes of moderate to vigorous physical activity daily [21], incorporating both cardiovascular and strength-training exercises. Even small amounts of regular activity can have a positive impact—improving insulin sensitivity, restoring hormonal balance, supporting weight loss, reducing inflammation, and enhancing overall well-being, all of which are vital for long-term health. [20]
Weight loss and PCOS
A low-calorie, nutrient-dense diet combined with exercise is especially beneficial for individuals with PCOS who are overweight or obese. Even a modest 5–10% reduction in body weight can significantly improve symptoms such as irregular periods and insulin resistance. Weight loss also enhances medication efficacy and fertility. [6]
Importantly, weight reduction helps restore hormonal balance and protects against long-term complications such as endometrial cancer, diabetes, and heart disease. [6]
Diet and PCOS
The most effective diet for individuals with PCOS focuses on improving insulin sensitivity, reducing chronic inflammation, and supporting a healthy weight. Consuming foods with a low glycaemic index—such as vegetables and legumes—helps stabilise blood glucose levels. A diet rich in whole foods, including lean proteins, fruits, and vegetables, also contributes to better metabolic health. [22]
Foods high in omega-3 fatty acids, such as fatty fish, flaxseeds, and nuts, play an important role in reducing inflammation and supporting hormonal balance. Consuming a balanced amount of protein at each meal helps to maintain satiety and supports metabolic function. Conversely, refined carbohydrates and foods high in saturated fat should be avoided, as they can worsen insulin resistance.
A fibre-rich diet is also essential for hormonal balance and digestive health. This includes a wide variety of vegetables, fruits, pulses, seeds, and nuts, which help promote healthy digestion and maintain gut microbiome. Aim for a diverse and balanced intake of both micro- and macronutrients to support the endocrine and digestive systems.However, since individual responses to specific foods can vary, dietary strategies should be personalised to meet the unique needs of each person with PCOS. [22]
Modulating the gut microbiome
Understanding the relationship between the gut microbiome and PCOS has opened new treatment avenues, including the use of probiotics, prebiotics, synbiotics, and faecal microbiota transplantation (FMT).
Faecal transplantation (FMT): FMT is an emerging therapy involving the transfer of stool from healthy donors to patients, aiming to restore microbial balance. Animal studies suggest FMT can improve hormone levels, glucose and lipid metabolism, testosterone reduction, and insulin sensitivity. However, more research is needed to understand the exact mechanisms. [4]
Probiotics and prebiotics: Probiotics (live beneficial microorganisms) and prebiotics (substances that promote their growth) are increasingly used in PCOS treatment. Clinical studies show that probiotics can enhance microbiome diversity, improve reproductive function, and reduce symptoms like hirsutism and insulin resistance. [4]
Dietary supplements in PCOS management
Dietary supplements play an important role in addressing insulin resistance, hormonal imbalance, and inflammation in PCOS. While medical treatments and lifestyle changes are primary, supplements can offer additional support. [23]
Vitamin A
Vitamin A plays a crucial role in cell protection and egg maturation due to its antioxidant properties. In individuals with PCOS—particularly those who are overweight—vitamin A metabolism may be impaired, contributing to hormonal imbalances. Retinol derivatives can help restore hormonal balance, reduce inflammation, and enhance ovarian function [24]. Retinyl palmitate is considered the most bioavailable form of vitamin A, especially for individuals who are genetically less efficient at converting beta-carotene (a plant-based precursor) into its active form. This inefficiency is more common among people of Caucasian descent, where the enzyme responsible for this conversion may function suboptimally. For such individuals, animal-derived retinyl palmitate is a more effective option, directly supporting vision, skin health, and immune function. [25]
B vitamins
B vitamins—particularly B6, B12, and folate (B9)—are essential for homocysteine metabolism, which is often disrupted in individuals with PCOS. Elevated homocysteine levels are associated with increased cardiovascular risk and fertility issues. Vitamins B12 and folic acid contribute to hormonal balance, helping to reduce the risk of anovulation and infertility. Folate, in particular, supports progesterone production and improves egg quality [20]. Many people have a reduced genetic ability to convert synthetic folic acid into its active, biologically useful form. Many people carry variants in the MTHFR gene, which impair this conversion. For these individuals, vitamin B9 in the form of methyl folate is more effective, as it is already in its active state and readily used by the body. This form can help lower homocysteine levels and, in turn, reduce the associated cardiovascular risks. [26]
Vitamin D
Vitamin D plays a key role in improving insulin sensitivity and reducing inflammation. Deficiency in vitamin D is common among women with PCOS, particularly those who are overweight or obese, and is linked to worsened insulin resistance, menstrual irregularities, and ovulatory dysfunction. Supplementation with vitamin D has been shown to improve menstrual cycle regulation, enhance ovarian function, and support oocyte maturation [24]. Adequate vitamin D status can also be assessed through parathyroid hormone (PTH) levels—optimal vitamin D levels typically correspond to a PTH level around 20. However, effective utilisation of vitamin D requires sufficient magnesium, as low magnesium can impair vitamin D metabolism and prevent PTH levels from stabilising. Magnesium supplementation is especially recommended for individuals who are overweight, as their bodies often have increased requirements for proper vitamin D metabolism. [27]
Vitamin E
Vitamin E is a powerful antioxidant and helps to reduce oxidative stress, which may contribute to worsening the symptoms of PCOS. Vitamin E supplementation may improve triglyceride and cholesterol reduction and insulin sensitivity, thereby helping to restore hormonal balance. [24]
Inositol
Myo-inositol (MI) and d-chiro-inositol (DCI) improve ovulation, insulin sensitivity, and hormone regulation. Together, they enhance menstrual cycle regularity and fertility. [20]
Omega-3 (Fish oil)
Omega-3 fatty acids reduce inflammation, lower androgen levels, help reduce oxidative stress, improve lipid profiles, and support hormone balance and fertility. [7]
Chromium
Chromium aids insulin regulation and glucose metabolism, helping reduce insulin levels and improving hormonal balance and metabolic function. [20]
Zinc
Zinc is a vital antioxidant and mineral involved in numerous essential biological processes, including hormone regulation, cell growth, and reproductive health. It plays a key role in reducing insulin resistance, enhancing glucose metabolism, and supporting hormonal balance. Zinc supplementation may also help alleviate common PCOS symptoms such as acne and excessive hair growth (hirsutism). [20]
A deficiency in zinc can negatively affect both insulin sensitivity and hormone regulation, making supplementation beneficial in managing the metabolic and hormonal disturbances associated with PCOS. In addition, zinc strengthens the immune system, promotes skin health, and contributes to optimal reproductive system function—supporting overall fertility. [28]
N-acetylcysteine (NAC)
NAC is a potent antioxidant that improves insulin sensitivity, reduces inflammation, and supports hormonal balance. It may regulate ovulation and reduce testosterone. [29]
Herbs and plant extracts
The herb Vitex (Chasteberry) can be used to increase progesterone levels and improve hormonal balance. It can improve fertility and reduce menstrual cycle disorders [30]. Fenugreek extracts can also help improve insulin sensitivity and reduce androgen levels, while curcumin supports hormonal balance through its anti-inflammatory effects [31]. Saw palmetto is a natural herb that is often used to treat male hormone imbalances. In women with PCOS, saw palmetto may help to reduce androgen levels [32]. In addition, it helps to balance estrogen levels, thus improving hormonal balance. Berberine is a natural compound found in several medicinal plants, such as goldenseal and barberry. It has an outstanding effect in regulating blood sugar levels and reducing insulin resistance. Berberine improves metabolic function and lowers blood sugar levels, so it may help to alleviate the symptoms of PCOS, with similar efficacy to metformin. [33]
Figure 5. Dietary supplements in the treatment of PCOS
Figure 6 provides an overview of how various vitamins, minerals, and supplements contribute to the prevention and management of PCOS-related complications. The figure illustrates that interactions between genetic predispositions and nutrient deficiencies can lead to issues such as elevated homocysteine (Hcy) levels, oxidative stress, hyperandrogenism, and hyperinsulinaemia. Supplementation with vitamin D, bioflavonoids, calcium, chromium, NAC, probiotics, magnesium, zinc, and selenium has been shown to improve insulin resistance (IR). Additionally, inositol, vitamin A, carnitine, omega-3 fatty acids, and NAC help alleviate symptoms related to hyperandrogenism. Among these, inositol and omega-3 supplements are especially beneficial for metabolic health and fertility. Moreover, vitamins B6, B12, and folic acid effectively reduce elevated homocysteine levels, while vitamin E, alpha-linolenic acid, bioflavonoids, selenium, NAC, and melatonin contribute to reducing oxidative stress. While the benefits of many of these supplements are promising, the safety and efficacy of most nutrient and plant-based therapies still require further clinical investigation—though inositol and omega-3 fatty acids have already demonstrated well-established positive effects. [23]
Figure 6. An overview of how various vitamins, minerals, and supplements contribute to the prevention and management of PCOS-related complications
Forward-looking therapeutic approaches in the treatment of PCOS
Beyond conventional treatments, emerging therapies are focusing on addressing the underlying physiological mechanisms of PCOS. These forward-looking strategies offer hope for more personalised and effective care.
MicroRNA (miRNA) therapy
MicroRNAs (miRNAs) are short, non-coding RNA molecules that regulate gene expression. Altered miRNA expression has been observed in women with PCOS, indicating a potential role in the syndrome’s development and progression. [3]
MiRNAs may influence hormonal regulation, insulin resistance, and inflammation—all of which are central to PCOS. MiRNA-based therapies aim to target specific miRNAs involved in worsening PCOS symptoms, either by restoring normal levels or inhibiting harmful ones. This therapeutic approach could provide a highly personalised and precise method for treating the condition. [3]
Interleukin-22 (IL-22) therapy
Interleukin-22 (IL-22) is a cytokine critical for maintaining gut lining integrity and metabolic balance. Women with PCOS often have reduced IL-22 levels, which may contribute to insulin resistance, inflammation, and impaired ovarian function.
IL-22 therapy seeks to restore healthy levels of this cytokine, potentially improving metabolic health, reducing inflammation, and supporting ovarian function. Additionally, IL-22 may help rebalance gut microbiome, further benefiting PCOS management. [3]
The treatment of polycystic ovary syndrome is personalised and aimed at alleviating symptoms and minimising long-term health risks. As PCOS is a complex hormonal and metabolic disorder, effective treatment often requires a combined approach involving both lifestyle changes and medical treatments.
References
[1] ‘Polycystic ovary syndrome’ https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
[2] ‘Polycystic ovary syndrome (PCOS) – Symptoms and causes’, Mayo Clinic https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439
[3] S. Singh et al., ‘Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics’, J. Clin. Med., vol. 12, no. 4, p. 1454, Feb. 2023, DOI: https://doi.org/10.3390/jcm12041454
[4] Y. Sun, S. Gao, C. Ye, and W. Zhao, ‘Gut microbiota dysbiosis in polycystic ovary syndrome: Mechanisms of progression and clinical applications’, Front. Cell. Infect. Microbiol., vol. 13, Feb. 2023, DOI: https://doi.org/10.3389/fcimb.2023.1142041
[5] E. K. Barthelmess and R. K. Naz, ‘Polycystic ovary syndrome: current status and future perspective’, Front. Biosci. Elite Ed., vol. 6, p. 104, 0 2014, DOI: https://doi.org/10.2741/e695
↓ Read More ↓Table of contents
What is PCOS?
Polycystic ovary syndrome (PCOS) is a common hormonal disorder affecting 8–13% of women of reproductive age worldwide. PCOS is not merely a gynaecological issue, but a complex internal medicine and endocrinological condition that disrupts the hormonal balance and functioning of the entire body. [1]
One of the most characteristic features of PCOS is the formation of numerous small fluid-filled cysts in the ovaries, instead of mature oocytes (Figure 1). These are, in fact, immature follicles that cannot reach the ovulation stage. This failure to ovulate prevents the release of eggs, which can result in long-term infertility. The hormonal imbalance further exacerbates menstrual irregularities and promotes the development of additional cysts, leading to symptoms such as irregular menstruation, excessive hair growth, and weight gain. [2]
PCOS not only affects reproductive health but is also linked to a range of serious comorbidities. It significantly increases the risk of developing type 2 diabetes, hypertension, and high cholesterol, all of which can lead to cardiovascular disease over time [3]. Persistently high oestrogen levels may also raise the risk of endometrial cancer [3]. Insulin resistance is often present, complicating the syndrome and requiring a holistic approach. Thus, therapy should go beyond gynaecological intervention and adopt a comprehensive internal medicine perspective.
Recent research has highlighted the potential role of the gut microbiome in the development and progression of PCOS. The connections between gut microbiome, hormonal balance, insulin resistance, and chronic inflammation may offer new therapeutic avenues. Lifestyle changes, particularly a healthy diet and regular exercise, are fundamental in managing PCOS. [4]
PCOS is often underdiagnosed, especially in women with mild or atypical symptoms, although early detection and timely treatment are crucial to avoid long-term complications. [1]
Figure 1. One of the most characteristic features of PCOS is the formation of numerous small fluid-filled cysts in the ovaries, instead of mature oocytes (the right side of the figure).
Symptoms of PCOS
The symptoms of PCOS are diverse and may present differently from person to person. Some women experience only a few symptoms, while others suffer from a broader range of issues (Figure 2). The severity of symptoms can also vary and may worsen over time.
Menstrual abnormalities
Women with PCOS frequently experience irregular menstruation, characterised by extended intervals between periods (more than 35 days) and fewer than nine periods per year. In some cases, menstruation may be entirely absent (amenorrhoea) or may involve prolonged bleeding. [2]
Hormonal imbalance
A defining symptom of PCOS is elevated levels of male sex hormones, particularly testosterone. This leads to hirsutism—excessive hair growth on the face, chest, and back. Acne, oily skin, and male-pattern hair loss are also common. [5]
Weight gain
Many women with PCOS experience weight gain, especially around the abdomen. This is closely linked to the insulin resistance often associated with the condition, making weight management particularly difficult. In this state, cells fail to respond properly to insulin, prompting the body to produce more insulin to compensate. [6]
Infertility
PCOS is one of the most common causes of female infertility. Irregular or absent ovulation (anovulation) makes conception difficult. With appropriate treatment, however, many women with PCOS are able to conceive. [7]
Skin lesions
PCOS is often accompanied by skin issues closely tied to hormonal imbalances, particularly insulin resistance and high androgen levels. For example, acanthosis nigricans—a condition marked by dark, thickened patches of skin in folds such as the neck and underarms—can result from elevated insulin levels. High androgen levels also increase sebum production, contributing to acne and skin growths. [7]
Mental health issues
The physical manifestations of PCOS—infertility, hirsutism, weight gain, and insulin resistance—can lead to significant psychological distress. Many women experience anxiety, depression, and low self-esteem, which can severely impact quality of life and affect personal and professional relationships. [6]
Figure 2. The symptoms of PCOS are diverse and may present differently from person to person. Some women experience only a few symptoms, while others suffer from a broader range of issues
How is PCOS diagnosed?
Diagnosing PCOS involves a comprehensive assessment of symptoms, medical history, and diagnostic tests. Accurate diagnosis is essential for appropriate treatment.
The Rotterdam criteria are the most widely used diagnostic guidelines. A diagnosis requires at least two of the following three features: hyperandrogenism, irregular menstruation or anovulation, and ultrasound-confirmed polycystic ovaries. [5]
Updated diagnostic guidelines
Thorough evaluation using imaging, blood tests, and clinical symptoms is vital. Transvaginal ultrasound is the gold standard for imaging the ovaries, detecting enlarged, immature follicles that appear as fluid-filled blisters in a bead-like pattern. However, in women on contraceptive pills, these follicles may not be visible—though this doesn’t exclude a PCOS diagnosis. While the Rotterdam criteria remain central, newer guidelines aim for more precise diagnosis and personalised care.
Anti-Müllerian hormone (AMH) measurement is gaining prominence, especially in adult women, for evaluating ovarian function. Diagnostic criteria for menstrual irregularities now define abnormal cycles as shorter than 21 days, longer than 35 days, or fewer than eight periods per year. Blood tests are essential for accurate diagnosis. [5]
Key blood test parameters:
- Testosterone
- DHEA-S
- Androstenedione
- Fasting insulin
- HbA1c
- Lipid profile
- LH/FSH ratio
- Progesterone
- Prolactin
- 17-hydroxyprogesterone
- Thyroid panel
Hormonal disturbances are a defining feature of PCOS and play a central role in both its symptoms and long-term effects. [5]
Elevated androgens
Women with PCOS often have elevated levels of male sex hormones such as testosterone and androstenedione. This excess of androgens disrupts normal follicle maturation, leading to ovulatory dysfunction and cyst formation. It also causes symptoms such as hirsutism, acne, and hair loss. [8]
Gonadotropin imbalance
The balance between luteinising hormone (LH) and follicle-stimulating hormone (FSH) is often disrupted in PCOS. LH levels tend to be elevated while FSH levels are lower. This imbalance impairs follicular development and ovulation, contributing to menstrual irregularities and infertility. Increased LH levels also stimulate greater androgen production, worsening hyperandrogenic symptoms. [9]
Insulin resistance and hyperinsulinaemia
Insulin resistance is one of the most common metabolic issues in PCOS. High insulin levels stimulate ovarian androgen production, further disrupting hormonal balance. This creates a vicious cycle that increases the risk of type 2 diabetes and cardiovascular disease. [10]
Low progesterone levels
The frequent absence of ovulation in PCOS results in reduced progesterone levels. Since progesterone is produced in greater amounts after ovulation, its deficiency can impair endometrial (uterine lining) health, increase the risk of endometrial hyperplasia (abnormal thickening of the endometrium) and cancer, and contribute to irregular periods. Low progesterone may also affect mood and emotional stability. [9]
Decreased SHBG levels
Sex hormone-binding globulin (SHBG) is often reduced in women with PCOS, especially those with insulin resistance. SHBG binds androgens in the bloodstream, limiting their activity. When SHBG levels are low, more free androgens circulate, intensifying symptoms of hyperandrogenism [11].
Types of PCOS
PCOS can be categorised into four phenotypes based on the combination and severity of symptoms (Figure 3), allowing for more personalised diagnosis and treatment. [12]
Type A (Classic PCOS)
The most common and severe form, including all three diagnostic criteria:
- Hyperandrogenism
- Ovulatory dysfunction
- Polycystic ovaries
Typically linked with insulin resistance.
Type B (Non-classical PCOS)
This type has hormonal symptoms but no cysts:
- Hyperandrogenism
- Hyperthyroidism
- Absence of polycystic ovaries
Although hormonal imbalances are evident, the ovaries appear normal without cystic changes.
Type C (Ovulatory PCOS)
In this type, only two of the diagnostic criteria are present:
- Hyperandrogenism
- Polycystic ovaries
- Normal ovulation
Although ovulation occurs regularly, other PCOS symptoms may still develop due to elevated androgen levels and the presence of ovarian cysts.
Type D (Mild, Non-classical PCOS)
This is the mildest form of PCOS and is characterised by:
- Ovulatory disorders
- Polycystic ovaries
- Absence of hyperandrogenism
Hormonal symptoms are relatively mild. While menstrual irregularities and ovarian cysts are present, more severe hormonal imbalances typically do not occur. [13]
Figure 3. PCOS can be categorised into four phenotypes (Type A, B, C and D) based on the combination and severity of symptoms
What causes PCOS?
The exact cause of PCOS remains unclear, but several factors are believed to contribute (Figure 4). Genetics plays a key role—women with a family history of PCOS are more likely to develop the condition. However, genetic predisposition alone is not sufficient; environmental and lifestyle factors are also crucial.
Hormonal imbalances, often linked to insulin resistance, are central to the pathology. Chronic stress, which increases cortisol levels, may worsen hormonal disruptions and menstrual irregularities.
In addition, environmental factors, such as exposure to endocrine-disrupting chemicals (e.g., pesticides, phthalates) may also impair hormonal regulation and ovarian function. These factors work together to trigger and intensify PCOS symptoms. [7]
The role of the gut microbiome in PCOS
The gut microbiome—a diverse community of microbes in the gastrointestinal tract—plays a crucial role in regulating metabolism and immunity. Recent studies show that disruptions in gut microbiota composition significantly impact obesity, type 2 diabetes, and PCOS. The gut-PCOS link involves hormonal imbalance, insulin resistance, and chronic inflammation. Bacterial species such as Segatella copri and Phocaeicola vulgatus contribute to branched-chain amino acid (BCAA) biosynthesis, thus contributing to the development of insulin resistance. [4], [14]
The role of the gut microbiome in metabolism and the development of PCOS
The gut microbiome plays a crucial role in metabolic processes, particularly in glucose and lipid metabolism, both of which directly influence insulin resistance—a central feature of PCOS. In individuals with PCOS, changes in the composition of gut microbiome, known as dysbiosis, are often closely linked to reduced insulin sensitivity. An increased proportion of certain bacterial groups, such as Bacteroidetes and Firmicutes, has been associated with impaired sugar metabolism. [4]
These alterations in gut microbiome not only contribute to the development of insulin resistance but may also exacerbate broader metabolic dysfunctions, thereby increasing the risk of type 2 diabetes and cardiovascular disease. For women with PCOS, a fibre-rich diet can have a positive impact on gut microbiota balance and may enhance insulin sensitivity—an especially important factor in the treatment of the condition. [15]
The link between hyperandrogenism and the gut microbiome
Alterations in the gut microbiome may contribute to increased androgen production by influencing the metabolism of hormonal precursors and triggering inflammatory responses that stimulate androgen-producing glands. Additionally, damage to the intestinal barrier and disruption of enterohepatic circulation can enhance the recycling of androgen precursors, further elevating hormone levels. This exacerbates PCOS symptoms such as hirsutism and acne [16].
Animal studies have demonstrated that changes in gut microbiome can increase body fat composition, which indirectly promotes androgen overproduction. This relationship adds further complexity to PCOS treatment, as the interaction between gut microbiota and hormonal dysfunction represents another critical factor that must be addressed in therapy. [4]
Inflammation and leaky gut
A major feature of PCOS is chronic, low-grade inflammation associated with elevated inflammatory markers, (TNF-α, IL-6 and CRP). This can be even more severe in obesity. The inflammatory response contributes to the development of insulin resistance and other metabolic disorders, not only in obese women but also in women with PCOS of normal weight. The question is whether it is the disease itself or the metabolic disturbances that trigger this inflammatory process.
The health of the intestinal tract is of paramount importance, as the permeability of the intestinal wall increases during the ‘leaky gut’ phenomenon, allowing inflammation-causing substances such as lipopolysaccharides (LPS) to enter the bloodstream. This process, which causes systemic inflammation, can further worsen insulin resistance and exacerbate the symptoms of PCOS. An imbalance in the gut microbiome can also contribute to the development of leaky gut, as some harmful bacteria can also directly trigger inflammatory reactions. Restoring the balance of gut microbiome can reduce inflammation and improve the condition of people with PCOS. [4]
Gut-brain axis and PCOS
The gut microbiome affects not only metabolism and hormonal balance, but also the functioning of the nervous system through the brain-gut axis. This two-way communication system maintains a constant link between the gut microbiome and the brain, influencing the production of hormones and inflammatory factors. The enteric nervous system (ENS), a network of nerve cells in the gut wall, plays a key role in this relationship by communicating directly with the brain via the vagus nerve and other autonomic nerve pathways. Dysbiosis of the gut microbiome via the brain-gut axis can indirectly enhance the stress response, which may contribute to disruption of hormonal regulation, including androgen production. This mechanism is particularly relevant in the case of polycystic ovary syndrome (PCOS), where elevated androgen levels are often accompanied by neurological and psychological symptoms such as anxiety and depression, which may also be associated with gut-brain axis function. [4]
Figure 4. The exact cause of PCOS remains unclear, but several factors are believed to contribute
Treatments of PCOS
Conventional medical approaches
While PCOS currently has no cure, its symptoms can be effectively managed with proper treatment. The first step is to identify the root causes and tailor treatment to the individual’s specific needs [17]. Medical treatments often aim to relieve symptoms by improving insulin sensitivity, promoting ovulation, or regulating hormone levels [18]. Although these medications can be effective, they do not always address the underlying causes and may not provide a permanent solution.
Hormonal regulation
Hormonal therapies are commonly used in women with PCOS to regulate menstrual cycles and alleviate symptoms of hyperandrogenism. Birth control pills are often prescribed to balance hormone levels, regulate menstruation, and reduce acne and excess hair growth. However, they do not treat the root cause of PCOS and are not suitable for women trying to conceive. [19]
Improving insulin sensitivity
Medications that enhance insulin sensitivity can stabilise blood sugar and reduce insulin levels. This, in turn, decreases ovarian androgen production and lowers LH levels—both of which contribute to androgen excess. Reduced insulin levels also boost SHBG production, which binds free androgens, improving ovulation and alleviating PCOS symptoms. Enhancing insulin sensitivity not only balances hormones but also reduces the risk of type 2 diabetes and other metabolic complications. [19]
Ovulation induction
For women trying to conceive, ovulation-inducing medications can help. These drugs stimulate the release of eggs, increasing the likelihood of pregnancy. Ovulation induction is especially helpful for women with PCOS who are not ovulating, though it requires close monitoring and may involve side effects. [19]
Functional approach to PCOS treatment
A core element of PCOS treatment is the implementation of lifestyle changes. A healthy diet and regular physical activity can help alleviate symptoms, support metabolic function, and reduce long-term health risks. [20]
Maintaining a healthy lifestyle not only aids in symptom management but also lowers the risk of developing chronic conditions associated with PCOS. The combined benefits of proper nutrition and exercise offer a sustainable, long-term approach to managing the condition. It is recommended to engage in at least 30 minutes of moderate to vigorous physical activity daily [21], incorporating both cardiovascular and strength-training exercises. Even small amounts of regular activity can have a positive impact—improving insulin sensitivity, restoring hormonal balance, supporting weight loss, reducing inflammation, and enhancing overall well-being, all of which are vital for long-term health. [20]
Weight loss and PCOS
A low-calorie, nutrient-dense diet combined with exercise is especially beneficial for individuals with PCOS who are overweight or obese. Even a modest 5–10% reduction in body weight can significantly improve symptoms such as irregular periods and insulin resistance. Weight loss also enhances medication efficacy and fertility. [6]
Importantly, weight reduction helps restore hormonal balance and protects against long-term complications such as endometrial cancer, diabetes, and heart disease. [6]
Diet and PCOS
The most effective diet for individuals with PCOS focuses on improving insulin sensitivity, reducing chronic inflammation, and supporting a healthy weight. Consuming foods with a low glycaemic index—such as vegetables and legumes—helps stabilise blood glucose levels. A diet rich in whole foods, including lean proteins, fruits, and vegetables, also contributes to better metabolic health. [22]
Foods high in omega-3 fatty acids, such as fatty fish, flaxseeds, and nuts, play an important role in reducing inflammation and supporting hormonal balance. Consuming a balanced amount of protein at each meal helps to maintain satiety and supports metabolic function. Conversely, refined carbohydrates and foods high in saturated fat should be avoided, as they can worsen insulin resistance.
A fibre-rich diet is also essential for hormonal balance and digestive health. This includes a wide variety of vegetables, fruits, pulses, seeds, and nuts, which help promote healthy digestion and maintain gut microbiome. Aim for a diverse and balanced intake of both micro- and macronutrients to support the endocrine and digestive systems.However, since individual responses to specific foods can vary, dietary strategies should be personalised to meet the unique needs of each person with PCOS. [22]
Modulating the gut microbiome
Understanding the relationship between the gut microbiome and PCOS has opened new treatment avenues, including the use of probiotics, prebiotics, synbiotics, and faecal microbiota transplantation (FMT).
Faecal transplantation (FMT): FMT is an emerging therapy involving the transfer of stool from healthy donors to patients, aiming to restore microbial balance. Animal studies suggest FMT can improve hormone levels, glucose and lipid metabolism, testosterone reduction, and insulin sensitivity. However, more research is needed to understand the exact mechanisms. [4]
Probiotics and prebiotics: Probiotics (live beneficial microorganisms) and prebiotics (substances that promote their growth) are increasingly used in PCOS treatment. Clinical studies show that probiotics can enhance microbiome diversity, improve reproductive function, and reduce symptoms like hirsutism and insulin resistance. [4]
Dietary supplements in PCOS management
Dietary supplements play an important role in addressing insulin resistance, hormonal imbalance, and inflammation in PCOS. While medical treatments and lifestyle changes are primary, supplements can offer additional support. [23]
Vitamin A
Vitamin A plays a crucial role in cell protection and egg maturation due to its antioxidant properties. In individuals with PCOS—particularly those who are overweight—vitamin A metabolism may be impaired, contributing to hormonal imbalances. Retinol derivatives can help restore hormonal balance, reduce inflammation, and enhance ovarian function [24]. Retinyl palmitate is considered the most bioavailable form of vitamin A, especially for individuals who are genetically less efficient at converting beta-carotene (a plant-based precursor) into its active form. This inefficiency is more common among people of Caucasian descent, where the enzyme responsible for this conversion may function suboptimally. For such individuals, animal-derived retinyl palmitate is a more effective option, directly supporting vision, skin health, and immune function. [25]
B vitamins
B vitamins—particularly B6, B12, and folate (B9)—are essential for homocysteine metabolism, which is often disrupted in individuals with PCOS. Elevated homocysteine levels are associated with increased cardiovascular risk and fertility issues. Vitamins B12 and folic acid contribute to hormonal balance, helping to reduce the risk of anovulation and infertility. Folate, in particular, supports progesterone production and improves egg quality [20]. Many people have a reduced genetic ability to convert synthetic folic acid into its active, biologically useful form. Many people carry variants in the MTHFR gene, which impair this conversion. For these individuals, vitamin B9 in the form of methyl folate is more effective, as it is already in its active state and readily used by the body. This form can help lower homocysteine levels and, in turn, reduce the associated cardiovascular risks. [26]
Vitamin D
Vitamin D plays a key role in improving insulin sensitivity and reducing inflammation. Deficiency in vitamin D is common among women with PCOS, particularly those who are overweight or obese, and is linked to worsened insulin resistance, menstrual irregularities, and ovulatory dysfunction. Supplementation with vitamin D has been shown to improve menstrual cycle regulation, enhance ovarian function, and support oocyte maturation [24]. Adequate vitamin D status can also be assessed through parathyroid hormone (PTH) levels—optimal vitamin D levels typically correspond to a PTH level around 20. However, effective utilisation of vitamin D requires sufficient magnesium, as low magnesium can impair vitamin D metabolism and prevent PTH levels from stabilising. Magnesium supplementation is especially recommended for individuals who are overweight, as their bodies often have increased requirements for proper vitamin D metabolism. [27]
Vitamin E
Vitamin E is a powerful antioxidant and helps to reduce oxidative stress, which may contribute to worsening the symptoms of PCOS. Vitamin E supplementation may improve triglyceride and cholesterol reduction and insulin sensitivity, thereby helping to restore hormonal balance. [24]
Inositol
Myo-inositol (MI) and d-chiro-inositol (DCI) improve ovulation, insulin sensitivity, and hormone regulation. Together, they enhance menstrual cycle regularity and fertility. [20]
Omega-3 (Fish oil)
Omega-3 fatty acids reduce inflammation, lower androgen levels, help reduce oxidative stress, improve lipid profiles, and support hormone balance and fertility. [7]
Chromium
Chromium aids insulin regulation and glucose metabolism, helping reduce insulin levels and improving hormonal balance and metabolic function. [20]
Zinc
Zinc is a vital antioxidant and mineral involved in numerous essential biological processes, including hormone regulation, cell growth, and reproductive health. It plays a key role in reducing insulin resistance, enhancing glucose metabolism, and supporting hormonal balance. Zinc supplementation may also help alleviate common PCOS symptoms such as acne and excessive hair growth (hirsutism). [20]
A deficiency in zinc can negatively affect both insulin sensitivity and hormone regulation, making supplementation beneficial in managing the metabolic and hormonal disturbances associated with PCOS. In addition, zinc strengthens the immune system, promotes skin health, and contributes to optimal reproductive system function—supporting overall fertility. [28]
N-acetylcysteine (NAC)
NAC is a potent antioxidant that improves insulin sensitivity, reduces inflammation, and supports hormonal balance. It may regulate ovulation and reduce testosterone. [29]
Herbs and plant extracts
The herb Vitex (Chasteberry) can be used to increase progesterone levels and improve hormonal balance. It can improve fertility and reduce menstrual cycle disorders [30]. Fenugreek extracts can also help improve insulin sensitivity and reduce androgen levels, while curcumin supports hormonal balance through its anti-inflammatory effects [31]. Saw palmetto is a natural herb that is often used to treat male hormone imbalances. In women with PCOS, saw palmetto may help to reduce androgen levels [32]. In addition, it helps to balance estrogen levels, thus improving hormonal balance. Berberine is a natural compound found in several medicinal plants, such as goldenseal and barberry. It has an outstanding effect in regulating blood sugar levels and reducing insulin resistance. Berberine improves metabolic function and lowers blood sugar levels, so it may help to alleviate the symptoms of PCOS, with similar efficacy to metformin. [33]
Figure 5. Dietary supplements in the treatment of PCOS
Figure 6 provides an overview of how various vitamins, minerals, and supplements contribute to the prevention and management of PCOS-related complications. The figure illustrates that interactions between genetic predispositions and nutrient deficiencies can lead to issues such as elevated homocysteine (Hcy) levels, oxidative stress, hyperandrogenism, and hyperinsulinaemia. Supplementation with vitamin D, bioflavonoids, calcium, chromium, NAC, probiotics, magnesium, zinc, and selenium has been shown to improve insulin resistance (IR). Additionally, inositol, vitamin A, carnitine, omega-3 fatty acids, and NAC help alleviate symptoms related to hyperandrogenism. Among these, inositol and omega-3 supplements are especially beneficial for metabolic health and fertility. Moreover, vitamins B6, B12, and folic acid effectively reduce elevated homocysteine levels, while vitamin E, alpha-linolenic acid, bioflavonoids, selenium, NAC, and melatonin contribute to reducing oxidative stress. While the benefits of many of these supplements are promising, the safety and efficacy of most nutrient and plant-based therapies still require further clinical investigation—though inositol and omega-3 fatty acids have already demonstrated well-established positive effects. [23]
Figure 6. An overview of how various vitamins, minerals, and supplements contribute to the prevention and management of PCOS-related complications
Forward-looking therapeutic approaches in the treatment of PCOS
Beyond conventional treatments, emerging therapies are focusing on addressing the underlying physiological mechanisms of PCOS. These forward-looking strategies offer hope for more personalised and effective care.
MicroRNA (miRNA) therapy
MicroRNAs (miRNAs) are short, non-coding RNA molecules that regulate gene expression. Altered miRNA expression has been observed in women with PCOS, indicating a potential role in the syndrome’s development and progression. [3]
MiRNAs may influence hormonal regulation, insulin resistance, and inflammation—all of which are central to PCOS. MiRNA-based therapies aim to target specific miRNAs involved in worsening PCOS symptoms, either by restoring normal levels or inhibiting harmful ones. This therapeutic approach could provide a highly personalised and precise method for treating the condition. [3]
Interleukin-22 (IL-22) therapy
Interleukin-22 (IL-22) is a cytokine critical for maintaining gut lining integrity and metabolic balance. Women with PCOS often have reduced IL-22 levels, which may contribute to insulin resistance, inflammation, and impaired ovarian function.
IL-22 therapy seeks to restore healthy levels of this cytokine, potentially improving metabolic health, reducing inflammation, and supporting ovarian function. Additionally, IL-22 may help rebalance gut microbiome, further benefiting PCOS management. [3]
The treatment of polycystic ovary syndrome is personalised and aimed at alleviating symptoms and minimising long-term health risks. As PCOS is a complex hormonal and metabolic disorder, effective treatment often requires a combined approach involving both lifestyle changes and medical treatments.
References
[1] ‘Polycystic ovary syndrome’ https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
[2] ‘Polycystic ovary syndrome (PCOS) – Symptoms and causes’, Mayo Clinic https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439
[3] S. Singh et al., ‘Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics’, J. Clin. Med., vol. 12, no. 4, p. 1454, Feb. 2023, DOI: https://doi.org/10.3390/jcm12041454
[4] Y. Sun, S. Gao, C. Ye, and W. Zhao, ‘Gut microbiota dysbiosis in polycystic ovary syndrome: Mechanisms of progression and clinical applications’, Front. Cell. Infect. Microbiol., vol. 13, Feb. 2023, DOI: https://doi.org/10.3389/fcimb.2023.1142041
[5] E. K. Barthelmess and R. K. Naz, ‘Polycystic ovary syndrome: current status and future perspective’, Front. Biosci. Elite Ed., vol. 6, p. 104, 0 2014, DOI: https://doi.org/10.2741/e695
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