The Role of Gut Microbiome Alterations in the Pathophysiology and Management of Polycystic Ovary Syndrome

Background: Polycystic Ovary Syndrome (PCOS) is a multifactorial endocrine disorder linked to hormonal imbalance, metabolic dysfunction, and low-grade inflammation. Emerging evidence implicates gut microbiota alterations in its pathogenesis. Objectives: To assess the impact of dietary fiber intake and physical activity on gut microbiota diversity and related hormonal and metabolic outcomes in women with PCOS. Methods: A prospective observational study was conducted over 12 months involving 54 women (18–35 years) with PCOS. Participants were stratified post hoc into low/high fiber (<15 g/day, ≥25 g/day) and low/high activity (<150, ≥150 min/week) groups. Clinical, dietary, physical activity, and microbiota data (16S rRNA sequencing) were collected at baseline and six months. Statistical analyses included t-tests, chi-square tests, correlations, and multivariate regression. Results: High-fiber intake was associated with greater microbial diversity (Shannon Index: 3.6 vs. 2.8; p=0.001), lower testosterone (64 vs. 72 ng/dL; p=0.04), and reduced HOMA-IR (2.5 vs. 3.2; p=0.02). Higher activity correlated with reduced BMI (27.8 vs. 30.1 kg/m²; p=0.01), lower waist circumference (86.5 vs. 91.3 cm; p=0.03), and improved menstrual regularity (54% vs. 30%; p=0.045). Both fiber and activity independently predicted microbial diversity. Conclusions: Dietary fiber and physical activity independently and synergistically improve gut microbiota diversity and metabolic-hormonal profiles in PCOS, supporting their role as non-pharmacological management strategies.