The impact of gut microbiota on insulin resistance in polycystic ovary syndrome: mechanisms and therapeutic prospects.

Polycystic ovary syndrome (PCOS) is a prevalent endocrine and metabolic disorder, with insulin resistance (IR) serving as its core pathophysiological feature and a key driver of long-term metabolic complications. Recent studies have revealed that the gut microbiota, as a critical environmental factor, plays a significant role in the pathogenesis of PCOS. The gut microbiota profoundly engages in the pathophysiology of PCOS-IR through multiple pathways and networked interactions. This review provides a comprehensive narrative synthesis of the latest evidence on gut microbiota dysbiosis in PCOS-IR, with a particular focus on its molecular mechanisms, and evaluates therapeutic strategies based on gut microbiota modulation. It seeks to provide theoretical foundations and forward-looking perspectives for precision microbiome therapies. Importantly, this is a narrative review with a mechanistic focus, rather than a formal systematic review or meta-analysis.