Probiotics and Polycystic Ovary Syndrome: A Perspective for Management in Adolescents with Obesity Original paper

What was reviewed?

This narrative review explored the potential role of probiotics and synbiotics in managing polycystic ovary syndrome (PCOS) in adolescents with obesity. The authors conducted a non-systematic analysis of meta-analyses, clinical trials, and reviews published in the past two decades, aiming to assess whether probiotic supplementation can improve hormonal balance, metabolic profiles, inflammation, and overall PCOS symptomatology. The review sought to consolidate findings about the interaction between obesity, dysbiosis, and PCOS, especially in adolescents, and how targeting the gut microbiome with probiotics could serve as a preventive or therapeutic intervention.

Who was reviewed?

The review focused on adolescent females aged 10–19 with obesity and PCOS, a group particularly susceptible to metabolic and reproductive dysfunction due to overlapping hormonal, genetic, and environmental factors. The included studies comprised both animal and human trials, with some focusing exclusively on adult women while others incorporated adolescent data. The microbiome’s role was assessed through its relationship with hyperandrogenism, insulin resistance, inflammatory markers, and hormonal modulation. The review emphasized evidence from randomized controlled trials and meta-analyses but acknowledged that many studies were conducted in adult populations, underscoring the need for adolescent-specific research.

What were the most important findings?

The review identified a clear link between obesity, PCOS, and gut dysbiosis. PCOS is associated with reduced microbial diversity, an imbalance in Firmicutes/Bacteroidetes ratio, and an overrepresentation of pathogenic bacteria like Escherichia and Shigella, accompanied by a reduction in beneficial Lactobacilli and Bifidobacteria. Dysbiosis appears to impair gut barrier integrity and promote systemic inflammation through increased intestinal permeability and lipopolysaccharide (LPS) translocation. These microbial alterations are connected to heightened insulin resistance, elevated testosterone, and disrupted follicular development.

Probiotic supplementation was shown to improve several PCOS-related outcomes. Studies reported reductions in serum testosterone, free androgen index (FAI), HOMA-IR, weight, and BMI. Simultaneously, increases in SHBG, nitric oxide, glutathione, and anti-inflammatory cytokines (e.g., IL-10) were observed. Notably, probiotic strains such as Lactobacillus acidophilus, L. rhamnosus, L. plantarum, Bifidobacterium bifidum, and B. lactis were associated with improved hormonal and metabolic outcomes. The production of short-chain fatty acids (SCFAs), particularly butyrate, played a key mechanistic role by reducing inflammation, improving insulin sensitivity, and restoring gut-ovary axis balance. Additionally, synbiotic supplementation (combining probiotics with prebiotics like inulin or FOS) yielded superior outcomes in some studies, especially in reducing testosterone levels.

What are the greatest implications of this review?

This review underscores the promising role of microbiome-targeted interventions, particularly probiotics and synbiotics, in managing PCOS among adolescents with obesity. While conventional treatments like metformin and oral contraceptives address insulin resistance and hyperandrogenism, they are often accompanied by side effects and limited adherence, especially in young patients. In contrast, probiotics offer a well-tolerated, non-invasive strategy to modulate gut microbiota, reduce systemic inflammation, and improve endocrine function. Clinicians should consider the gut–brain–ovary axis as a central pathway in PCOS pathophysiology and incorporate microbiome-informed interventions alongside dietary and lifestyle modifications. Given the preventive potential of early microbiome modulation, probiotic use in high-risk adolescent populations may help mitigate long-term metabolic and reproductive complications. However, further longitudinal and adolescent-focused clinical trials are essential to refine strain-specific recommendations, dosage, and duration for optimal therapeutic benefit.