Gut Microbiota and Bile Acid Metabolism in the Pathogenesis of Polycystic Ovary Syndrome
10.13471/j.cnki.j.sun.yat-sen.univ（med.sci）.2025.0507
- VernacularTitle:肠道菌群和胆汁酸代谢在多囊卵巢综合征发病机制中的作用
- Author:
Kangyi LIN
1
;
Guoshu YIN
2
Author Information
1. Shantou University Medical College， Shantou 515000， China
2. The First Affiliated Hospital of Shantou University Medical College， Shantou 515000， China
- Publication Type:Review
- Keywords:
polycystic ovary syndrome;
gut microbiota;
bile acid metabolism;
hyperandrogenemia;
insulin resistance
- From:
Journal of Sun Yat-sen University(Medical Sciences)
2025;46(5):775-783
- CountryChina
- Language:Chinese
-
Abstract:
Polycystic ovary syndrome （PCOS）， one of the most prevalent endocrine disorders among women of reproductive age， is characterized by ovulatory dysfunction， hyperandrogenemia， and polycystic ovarian morphology. As a leading cause of female infertility， PCOS affects 6%-20% of women globally. The complex and heterogeneous nature of PCOS has hindered the full elucidation of its pathogenesis. Emerging evidence suggests that gut microbiota dysbiosis and abnormal bile acid metabolism may contribute to the development of PCOS. Patients with PCOS exhibit reduced alpha diversity of gut microbiota， marked by decreased butyrate-producing bacteria and the proliferation of harmful genera such as Bacteroides. This shift leads to intestinal barrier dysfunction， chronic inflammation， and exacerbation of insulin resistance and hyperandrogenemia through dysregulation of short-chain fatty acid and sex hormone metabolism. Additionally， PCOS patients display distinct bile acid metabolic abnormalities， including elevated total bile acids， impaired classical synthesis pathways， activated alternative pathways， and abnormal accumulation of primary unconjugated bile acids. A bidirectional regulatory axis exists between gut microbiota and bile acids： microbiota modulate bile acid synthesis and metabolism， while bile acids shape microbial composition and abundance. Dysregulation of this gut microbiota-bile acid axis promotes the pathogenesis of PCOS. Therefore， optimizing gut microbiota composition and modulating bile acid metabolism represent novel therapeutic targets for PCOS. Further mechanistic exploration requires integrated animal models and population-based cohort studies to address individualized variability and safety concerns. This review summarizes the roles of gut microbiota and bile acid metabolism in PCOS pathogenesis， highlights their interactions， and discusses therapeutic potential， aiming to provide insights for both theoretical research and clinical management.
