Gut dysbiosis, blood pressure regulation, and cardiometabolic risk in polyendocrine metabolic ovarian syndrome (PMOS)

Polyendocrine metabolic ovarian syndrome (PMOS), formerly known as polycystic ovary syndrome (PCOS), is a common endocrine-metabolic disorder associated with increased hypertension and cardiometabolic risk. Gut dysbiosis is also frequently reported in affected women, raising the question of whether microbiome-linked pathways contribute to blood pressure elevation or vascular risk in this syndrome. To evaluate and synthesize the available evidence linking gut dysbiosis, gut microbial function, and microbiome-related mechanisms to hypertension, blood pressure regulation, and cardiovascular risk in women with PMOS, we conducted a narrative review of the literature in PubMed, Scopus, Web of Science, Google Scholar, and citation tracking. Search terms included PCOS, PMOS, gut microbiota, gut dysbiosis, hypertension, blood pressure, cardiovascular risk, microbial metabolites, bile acids, intestinal permeability, inflammation, renin-angiotensin signaling, renal sodium handling, and autonomic regulation. Human studies, animal models, interventional studies, and mechanistic investigations relevant to PMOS and hypertension were reviewed according to predefined inclusion and exclusion criteria. Eligible publications were preclinical studies, human studies, English language, adult females, and peer-reviewed original or review articles. Clarifying whether gut dysbiosis contributes to hypertension in PMOS may improve understanding of the mechanisms underlying cardiometabolic risk in affected women and inform the development of microbiome-targeted diagnostic and therapeutic strategies. Achieving this goal will require well-phenotyped clinical studies integrating PMOS, blood pressure and vascular assessments with functional microbiome analyses.