The stromal microenvironment of ovary: a novel area in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age. It is clinically characterized by a group of symptoms, including oligomenorrhea or amenorrhea, hyperandrogenism, and the presence of ovarian cysts. Recently, the ovarian stromal microenvironment has emerged as a critical focus of investigation. This review begins by delineating the key components of the ovarian stromal microenvironment, such as stromal cells, extracellular matrix (ECM), vasculature, nerves, and immune cells, and their respective roles in maintaining ovarian homeostasis. Subsequently, it elaborates on the pathological alterations in PCOS, including fibrosis, inflammation, stromal hyperplasia, and aberrant angiogenesis, and discusses how these changes relate to the components of this microenvironment. Furthermore, we present several potential therapeutic strategies that target these aberrant processes. Examining PCOS through the lens of its stromal microenvironment provides deeper insights into its pathogenesis, thereby unveiling novel avenues for the development of targeted prevention and treatment strategies.