Society of Diabetic Nephropathy Prevention Journal of Preventive Epidemiology 2476-3934 11 1 2026 01 01 Recent advances in gut microbiota alterations in polycystic ovary syndrome; an updated review e39297 e39297 10.34172/jpe.2025.39297 EN Abnoos Mokhtariardekani https://orcid.org/0000-0003-4939-2976 Farzin Banei https://orcid.org/0000-0001-5197-6335 Zahra Boshagh https://orcid.org/0009-0007-8307-2307 Pegah Ranjbari https://orcid.org/0009-0008-7189-5565 Zahra Hamidi Madani https://orcid.org/0000-0002-7903-8364 Elahe Zaremoghadam https://orcid.org/0000-0002-0550-0122 Sara Abutalebi Nasrabad https://orcid.org/0009-0006-1445-761X Journal Article 10.34172/jpe.2025.39297 2025 09 09 2025 10 18 The gut microbiome, a complex ecosystem of trillions of microorganisms, has a critical role in metabolic regulation, immune function, and hormonal balance, systems all implicated in polycystic ovary syndrome (PCOS). Evidence suggests that women with PCOS exhibit distinct gut microbial profiles, including reduced microbial diversity, decreased abundance of beneficial bacteria, and increased levels of pro-inflammatory and endotoxin-producing species. These shifts are associated with insulin resistance, obesity, low-grade inflammation, and androgen excess—hallmarks of PCOS. Furthermore, gut microbiota influences bile acid metabolism, short-chain fatty acid production, and gut barrier integrity, thereby modulating systemic inflammation and endocrine function. Interventions such as probiotics, prebiotics, dietary modifications, and fecal microbiota transplantation show promise in ameliorating PCOS symptoms through microbiota modulation. Despite these advances, challenges remain, including heterogeneity in study designs, small sample sizes, and the need for longitudinal data.