Gut Microbiome-Targeted Preventive Strategies for Polyendocrine Metabolic Ovarian Syndrome: Insights From the Prenatal and Early-Life Environment.

Background: Polyendocrine metabolic ovarian syndrome (PMOS), the proposed new name for polycystic ovary syndrome (PCOS), is a complex endocrine and metabolic disorder influenced by genetic and environmental factors. Despite its high prevalence and familial aggregation, no effective preventive strategy is available. Prenatal androgen exposure is considered a key factor in PMOS pathogenesis, with studies indicating a significant role for the gut microbiome. Methods: This review summarizes evidence from human and animal studies exploring the association between PMOS and the gut microbiome, spotlighting the impact of the intrauterine environment, including prenatal androgen exposure and maternal gut microbiome, in PMOS development. Main Findings: Gut microbiota dysbiosis is associated with features of PMOS pathophysiology, including hyperandrogenism, insulin resistance, neuroendocrine dysfunction, and ovarian dysfunction. Emerging evidence suggests that prenatal and early postnatal environments shape gut microbiota establishment and maturation, which may interact with multiple developmental pathways and potentially modify susceptibility to PMOS later in life. Conclusion: The gut microbiome may be involved in the developmental origins and pathophysiology of PMOS, although its precise role remains unclear. Understanding early-life host-microbiome interaction may provide a foundation for future preventive and personalized management strategies for PMOS, but further mechanistic studies and clinical validation are required.