Microbiome-Modulating Dietary Interventions for the Treatment of Insulin Resistance in Polyendocrine Metabolic Ovarian Syndrome (PMOS)

Polycystic ovary syndrome (PCOS) is increasingly reframed as polyendocrine metabolic ovarian syndrome (PMOS) to better reflect its systemic and cardiometabolic nature.This review investigates the role of the gut microbiome and microbiome-modulating dietary interventions in PMOS management.Observational studies have demonstrated gut dysbiosis in individuals with PMOS, suggesting a potential role in the development of the condition.Mediterranean and other fiber-rich dietary patterns, including those without carbohydrate restriction, improve microbiome composition, weight, insulin resistance, and hyperandrogenism.While low-carbohydrate dietary patterns have also demonstrated improvements in PMOS outcomes, fiber-rich dietary patterns may address underlying gut dysfunction by supporting beneficial short-chain fatty acid (SCFA)-producing bacteria and limiting pro-inflammatory bacteria.However, more studies combining dietary assessment, gut microbiome measurements, and metabolic outcomes in individuals with PMOS are necessary.Prebiotic and probiotic supplements have also been associated with improved outcomes, although standardized strains, doses, and post-intervention microbiome measurements are needed.Insufficient evidence limits guidance on the best dietary patterns for PMOS.Although more research on diet in the PMOS population is needed, this review supports non-restrictive, microbiome-modulating dietary interventions as reasonable strategies to support patient goals in the holistic management of PMOS.