Gut microbiota, a new approach to management of polycystic ovary syndrome: a systematic review, meta-analysis and meta-evidence of 26 randomized controlled trials

Evidence regarding the beneficial effects of biotics supplementation in polycystic ovary syndrome (PCOS) remains inconsistent. To address this discrepancy, this study aimed to investigate the impact of biotics on health outcomes in women with PCOS by conducting a systematic review and meta-analysis. Web of Science ISI, Scopus, PubMed, Cochrane, and Embase databases were comprehensively searched up to October 2025 to identify RCTs on prebiotics, probiotics and synbiotics on health outcomes. Twenty-six RCTs with participants aged 25 to 29 were included in the current meta-analysis. All participants were followed up for 8 weeks to 24 weeks. Results showed that prebiotics or probiotics and synbiotics are effective in reducing weight (SMD: -0.57, 95% CI: -1.05, -0.08) and body mass index (BMI) (SMD: -0.42, 95% CI: -0.75, -0.09), waist circumference (WC) (SMD: -0.78, 95% CI: -1.28, -0.28), insulin (SMD: -0.60, 95%CI: -1.12, -0.08), HOMA-IR (SMD: -0.79, 95%CI: -1.48, -0.11), malondialdehyde (MDA) (SMD: -0.77, 95% CI: -1.17, -0.37), and triglyceride (TG) (SMD: -0.62, 95% CI: -1.08, -0.16), low-density lipoprotein-cholesterol (LDL-C) (SMD:-0.71, 95%CI: -1.21, -0.20), and total testosterone (SMD: -1.47, 95% CI: -2.32, -0.62), and led to a significant increase for total antioxidant capacity (TAC) (SMD: 0.58, 95% CI: 0.14, 1.01), and high-density lipoprotein-cholesterol (HDL-C) (SMD: 0.38, 95% CI: 0.15, 0.61). This meta-analysis suggests that prebiotic, probiotic, or synbiotic supplementation may have beneficial effects on several health outcomes in women with PCOS.