Gut microbiota and the polycystic ovary syndrome: influence of sex, sex hormones, and obesity
Open accessAbstract
Context: Gut microbiota play a major role in health and disease by influencing physiology, metabolism, nutrition, and immune function. Objective: To evaluate the composition of gut microbiota in women with polycystic ovary syndrome (PCOS), focusing on the influence of sex, sex hormones and obesity on the associations found. Design: Cross-sectional study. Setting: Academic hospital. Participants: We recruited 15 women with PCOS, 16 nonhyperandrogenic control women, and 15 control men. Participants were classified as nonobese (<30 kg/m2) or obese (≥30 kg/m2) according to their body mass index. Interventions: Standardization of diet for 3 consecutive days (at least 300 g of carbohydrates per day) followed by fecal sampling and a standard 75-g oral glucose tolerance test. Main Outcome Measures: Analysis of bacterial abundance and composition of gut microbiota by massive sequencing of 16S ribosomal DNA amplicons in a MiSeq platform (Illumina). Results: α Bacterial diversity was reduced in women compared with men, and β diversity was reduced particularly in obese patients with PCOS. Women with PCOS presented with specific abnormalities in gut microbiota consisting of an increased abundance of the Catenibacterium and Kandleria genera. When all participants as a whole were considered, indexes of bacterial diversity and the abundance of several bacterial genera correlated positively with serum androgen concentrations and negatively with estradiol levels. Conclusions: The diversity and composition of the gut microbiota of young adults are influenced by the combined effects of sex, sex hormone concentrations, and obesity, presenting with specific abnormalities in women with PCOS.
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Dysbiosis is a consistent finding in the microbiome of women with PCOS.
“Dysbiosis is a consistent finding when looking at the microbiome of women with PCOS [140,141,142,143].”
From Polycystic Ovary Syndrome: An Evolutionary Adaptation to Lifestyle and the Environment (2022) · cites this paper as [141]
The Abstract reports specific gut-microbiota abnormalities in women with PCOS, and the Discussion describes differences reported in other human studies. But the Discussion also notes differing results across studies and says the available data suggest an association; it does not establish dysbiosis as a consistent finding across women with PCOS. (LLM, conf=0.82)
Experimental — accuracy not yet measuredDysbiosis has consistently been found to correlate with different physiological parameters, such as obesity, sex hormones and metabolic defects, although most studies are small.
“Although most studies are small, dysbiosis has consistently been found to correlate with different physiological parameters, such as obesity, sex hormones and metabolic defects [140,141,143].”
From Polycystic Ovary Syndrome: An Evolutionary Adaptation to Lifestyle and the Environment (2022) · cites this paper as [141]
The Results report correlations between bacterial abundance and BMI, fat mass, glucose, insulin, and insulin sensitivity; the Discussion reports correlations between bacterial diversity and sex-hormone levels. But the Discussion says prior findings on obesity and bacterial diversity conflict, so this paper does not support the claim that such correlations have been found consistently. It also does not establish that most studies are small. (LLM, conf=0.86)
Experimental — accuracy not yet measuredHe et al. did not find a statistically significant association between estradiol and alpha diversity (richness and Shannon indexes) in a cohort of healthy women and women with osteopenia or osteoporosis.
“He et al.(26) did not find a statistically significant association between estradiol and alpha diversity (richness and Shannon indexes) in a cohort of healthy women and women affected by either osteopenia or osteoporosis (see Tables 2-3).”
From Association Between Sex Hormone Levels and Gut Microbiota Composition and Diversity—A Systematic Review (2022) · cites this paper as [26]
Two included studies did not find an association between estrogens and microbiota composition.
“Two studies did not find an association between estrogens and the microbiota composition (see Tables 2-3).(26, 32)”
From Association Between Sex Hormone Levels and Gut Microbiota Composition and Diversity—A Systematic Review (2022) · cites this paper as [26]
Decreased α-diversity has been described in women with PCOS.
“Decreased α-diversity has been described in women with PCOS [109, 110].”
From Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls (2019) · cites this paper as [109]
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- Authors
- Insenser, M., Murri, M., del Campo, R., Martínez-García, M. Á., Fernández-Durán, E., & Escobar-Morreale, H. F.
- Affiliations
- Universidad de Alcalá (ES)
- Department of Microbiology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Diabetes Obesity and Human Reproduction Research Group, Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal & Universidad de Alcalá, Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Corresponding author
- Escobar-Morreale, Héctor F
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2018-04-20
- Volume
- 103
- Issue
- 7
- Pages
- 2552-2562
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2799415441
- Cited by
- 312
- References
- 52
- Citations by year
- 2026: 37 · 2025: 40 · 2024: 51 · 2023: 54 · 2022: 41 · 2021: 42 · 2020: 29 · 2019: 16 · 2018: 1
- FWCI
- 7.82
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- European Commission
- Ministerio de Economía y Competitividad
- Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas
- Instituto de Salud Carlos III (PI11/, PIE1600050, PI1100357)
- European Regional Development Fund (PIE16/00050)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Keywords
- gut microbiota, polycystic ovary syndrome, sex differences, sex hormones, obesity, bacterial diversity, androgens, estradiol, Catenibacterium, hyperandrogenism
- MeSH terms
- Gastrointestinal Microbiome, Adult, Androgens, Cross-Sectional Studies, Diet, Estradiol, Feces, Female, Glucose Tolerance Test, Humans, Male, Obesity, Polycystic Ovary Syndrome, Sex Factors, Gonadal Steroid Hormones, Body Mass Index, Case-Control Studies, Young Adult
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