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Pharmacol Res 168:105580

1 Introduction 1.1 PCOS: a multifaceted endocrine disorder Polycystic ovary syndrome (PCOS) is a common and heterogeneous endocrinemetabolic disorder affecting 5%25% of reproductive-aged women worldwide ( 1.2 The vicious cycle of insulin resistance and hyperandrogenism Building upon the interconnected roles of IR and gut dysbiosis in PCOS, the relationship between IR and hyperandrogenism is not merely associative but constitutes a self-perpetuating vicious cycle that underlies the syndromes progression ( 1.3 The gut-ovary axis: a new frontier in PCOS pathophysiology Emerging evidence has revolutionized our understanding of PCOS, highlighting the role of gut microbiota as a critical environmental factor that amplifies the IR-hyperandrogenism cycle ( 1.4 Metformin and probiotics: two interventions converging on the gut Metformin, an oral biguanide, remains the first-line pharmacologic therapy for managing metabolic disturbances in PCOS, particularly in patients with insulin resistance or obesity ( Probiotics, defined as live microorganisms conferring a health benefit, offer a direct approach to counteract dysbiosis and restore gut health ( 1.5 Rationale and objectives of the review Building on the mechanistic and therapeutic frameworks established in see sections 1.3 The gut-ovary axis: a new frontier in PCOS pathophysiology and 1.4 Metformin and probiotics: two ointerventions cnverging on the gut, the recognition of the gutovary axis and the established roles of both metformin and probiotics provide a compelling rationale for their combined use

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