Relationship between Gut Microbiota and Hyperandrogenism in Saudi Women with PCOS

Abstract

Gut dysbiosis is related to the pathophysiology of PCOS, an endocrine disorder in women of reproductive age, characterized by hormonal imbalances, metabolic issues, hyperandrogenism, insulin sensitivity, and metabolic dysfunction. This study explores the gut microbiome composition and diversity in women with PCOS, focusing on relationships between clinical, hormonal, and metabolic parameters. We examined women diagnosed with PCOS based on the Rotterdam criteria (n = 90) and compared them to healthy controls (n = 50). Gut microbiomes were analyzed using 16S rRNA v3-v4 hypervariable regions for bacteria and ITS for fungi, with diversity assessed using α and β diversity indices. Species richness and phylogenetic diversity were analyzed alongside microbial community structure using Bray-Curtis and Jaccard indices. Regression models and canonical correspondence analysis evaluated associations between microbial diversity and clinical and biochemical parameters, including hyperandrogenism, testosterone levels, and insulin resistance. Results indicated that women with PCOS exhibited significantly reduced α diversity (species richness) compared to controls (P < 0.05), while phylogenetic diversity was higher in the PCOS group (P < 0.05). Hyperandrogenism and testosterone levels showed a strong inverse association with α diversity metrics, whereas insulin resistance exhibited weak but significant negative correlations. β diversity analysis revealed compositional differences influenced by hyperandrogenism, though overall between-group differences were statistically significant. Taxonomic analysis identified altered abundances of key microbial taxa, with Bacteroides, Phocaeicola, and Blautia enriched in healthy controls, while Sutterella and Agathobacter were more abundant in PCOS. These findings highlight significant alterations in the gut microbiome of women with PCOS, including reduced species richness, altered phylogenetic diversity, and compositional shifts strongly linked to hyperandrogenism and metabolic dysfunction. This study underscores the role of gut dysbiosis in PCOS pathophysiology, providing a foundation for future research on microbiome-targeted therapies to manage the condition.