Metabolic profiling of human follicular fluid to unravel the pathways involved in polycystic ovary syndrome – a systematic review

Dysregulated Acetate Metabolism and Cholesterol Biosynthesis in Cumulus Cells of Women with Polycystic Ovary Syndrome.

Integrative serum proteomic and metabolomic profiling in ovarian endometrioma: an exploratory multi-omics study

It is suggested that OEM is associated with concurrent immune-related and metabolic alterations detectable in the circulation and provides limited independent support for a platelet-associated circulating signal, with PPBP showing the most consistent validation.

An Exploratory Study on Transcriptomic Profiling of Circulating miRNA Associated with Hub Genes in the Development of Polycystic Ovary Syndrome

Pilot study results suggest potential miRNAs and their target pathway links with PCOS that need validation in larger cohorts for diagnostic or therapeutic applications need validation in larger cohorts for diagnostic or therapeutic applications.

High Variability in Traditional Polycystic Ovary Syndrome Biomarkers: Embracing the Need for Biomarkers Derived Through Integrative Approaches

Polycystic Ovary Syndrome (PCOS) is a complex reproductive disorder characterized by irregular menstrual cycles, polycystic ovaries, and hyperandrogenism. Diagnosis is often complicated by phenotype variability and inconsistent biomarker use. This metaanalysis, conducted according to PRISMA 2020 guidelines and based on studies published between 2010 and May 2023, investigates the heterogeneity in key PCOS biomarkers, testosterone and LH/FSH ratio, using a random-effects model. Thirteen studies were included in the meta-analysis. Biomarker-specific analyses were conducted using R to evaluate variations in testosterone and LH/FSH ratios. Sample sizes consisted of 500 PCOS cases and 592 controls for testosterone, and 1184 PCOS cases and 1410 controls for the LH/FSH ratio. Heterogeneity and subgroup variability were assessed independently for each biomarker. Marked heterogeneity was observed across studies, with I² values of 95% for testosterone and 99% for the LH/FSH ratio. Contributing factors included variability in population demographics, diagnostic criteria, and assay methodologies. Traditional assays often fail to sensitively detect testosterone in women, while visual scoring methods are vulnerable to observer bias The observed heterogeneity underscores the limitations of conventional biomarkers in diagnosing PCOS. A move toward standardised, sensitive, and phenotype-specific diagnostic tools is crucial. Multi-steroid panels and integrative omics-based approaches can address variability and enhance diagnostic accuracy. Integrating novel biomarkers such as DAPK2, S100A9, Bacteroides vulgatus, and microRNA-6767-5p holds promise for improved diagnosis of PCOS subtypes. AGP may help identify normoandrogenic presentations. Embracing immune-metabolic insights supports the development of diverse, accessible, and validated diagnostics aligned with the goals of precision medicine and improved women's reproductive health.

Distinct metabolomic profiles in lean and non-lean polyendocrine metabolic ovarian syndrome.

Gut microbiota and polyendocrine metabolic ovarian syndrome: an integrated gut–metabolism–endocrine–ovary axis

Polyendocrine metabolic ovarian syndrome (PMOS), previously known as polycystic ovary syndrome (PCOS), is a common endocrine and metabolic disorder in reproductive-age women, characterized by marked clinical and biological heterogeneity. Accumulating evidence suggests that gut microbiota dysbiosis is associated with metabolic disturbances, hormonal imbalance, and ovarian dysfunction in PMOS. However, the pathways linking gut microbiota alterations to PMOS pathogenesis remain incompletely understood, and most evidence remains associative. This review aims to summarize current evidence regarding interactions between gut microbiota and PMOS, clarify the roles of key microbiota-derived metabolites, and evaluate the potential and limitations of gut microbiota–targeted interventions. A major novelty is the proposal of an integrated gut–metabolism–endocrine–ovary axis incorporating phenotypic heterogeneity, methodological variability, and evidence grading across clinical and preclinical studies. A narrative review with a systematic literature search was conducted. PubMed, Web of Science, Embase, and CNKI were searched from inception to March 2026 using terms related to PMOS, gut microbiota, microbial metabolites, and microbiota-targeted interventions. Eligible studies included human observational or interventional studies, animal experiments exploring microbiota–PMOS mechanisms, and peer-reviewed full-text articles in English or Chinese. Case reports, letters, conference abstracts, non-English publications, and irrelevant studies were excluded. Duplicate records were removed. Two authors independently screened records and resolved disagreements by consensus. No meta-analysis was performed, and clinical registration was not applicable. Gut microbiota dysbiosis may contribute to PMOS through chronic low-grade inflammation, insulin resistance, and hyperandrogenism. Microbiota-derived metabolites link intestinal dysbiosis with metabolic and endocrine dysfunction. Bile acids and short-chain fatty acids exert regulatory effects, whereas amino acid disorders and LPS-mediated endotoxemia amplify metabolic and inflammatory abnormalities. Considerable heterogeneity exists across studies regarding obesity, insulin resistance, hyperandrogenism, diet, ethnicity, region, and methodology. Microbiota-targeted interventions show potential, although evidence quality varies and most findings remain associative. Gut microbiota dysbiosis is a critical regulatory node within the integrated gut–metabolism–endocrine–ovary axis in PMOS. This review highlights phenotypic stratification, evidence hierarchy, and clinical translation potential. Although microbiota-targeted strategies may serve as adjunctive therapies, their causal roles and long-term efficacy require confirmation in well-designed longitudinal and randomized controlled trials.