A recent review published in the Nutrients Journal examines the impact of probiotic/symbiotic supplementation in adolescents with obesity and polycystic ovary syndrome (PCOS), exploring their potential benefits on hormonal, metabolic, and inflammatory profiles.
Study: Probiotics and Polycystic Ovary Syndrome: A Perspective for Management in Adolescents with Obesity. Image Credit: AlenaMenshikova/Shutterstock.com
Background
PCOS is a prevalent disorder that affects a significant percentage of females of reproductive age. Obesity has been recognized as an important risk factor for the development and severity of PCOS.
It is well-documented that many women with PCOS are overweight or obese, contributing to the syndrome's progression.
Recent research has shed light on the role of gut dysbiosis in the pathogenesis of PCOS. Dysbiosis, an imbalance in the gut microbiota composition, has been observed in both human and animal models with PCOS.
In this context, probiotics and symbiotic supplementation have emerged as potential interventions for managing PCOS in obese adolescents.
About the study
PCOS in adolescents
PCOS is a complex endocrine disorder affecting 3.4–19.6% of adolescent girls and 5–10% of adult women, with variations based on diagnostic criteria and populations. Characteristics of PCOS include menstrual irregularity (amenorrhea or menometrorrhagia), enlarged smooth polycystic ovaries, infertility, and hirsutism.
Stress, overeating, and obesity are linked to PCOS development. Controlling PCOS involves lifestyle changes, weight loss, and pharmacological treatments like oral contraceptives and anti-androgens. Emerging therapies such as N-acetylcysteine and myoinositol show promise but require further research.
The intersection of polycystic ovary syndrome and obesity: implications and approaches
PCOS involves a self-sustaining hormonal imbalance, with an increased luteinizing hormone: follicle-stimulating hormone ratio and elevated testosterone levels due to reduced sex hormone-binding globulin (SHBG), impacting the ovaries and leading to hyperandrogenism.
Ovulatory dysfunction and menstrual irregularities are prevalent in PCOS, with anti-mullerian hormone (AMH) levels reflecting disruptions in folliculogenesis. Theca cells in the ovary show increased androgen production, contributing to hyperandrogenism.
A key factor in PCOS is obesity, particularly visceral obesity, affecting up to 80% of women with PCOS in the United States and 30–50% in other countries.
Adolescents with PCOS also exhibit a high prevalence of overweight or obesity, ranging from 30% to 40%. Adipose tissue produces adipokines, including pro-inflammatory and anti-inflammatory molecules, impacting metabolism and reproduction.
Obesity-induced insulin resistance (IR) and hyperinsulinemia contribute to PCOS pathogenesis, with IR prevalence ranging from 44% to 70% in PCOS patients. IR exacerbates metabolic and reproductive abnormalities, and insulin receptors in ovarian cells influence follicular development and steroidogenesis.
Co-existence of obesity and IR increases the risk of metabolic complications in PCOS, such as metabolic syndrome and type 2 diabetes.
Gut microbiota imbalance and polycystic ovary syndrome: exploring the link
The gut microbiome, comprising diverse microorganisms and metabolites, regulates host physiology, immune function, metabolism, and neurological processes.
Dysbiosis, or imbalances in the gut microbiome, has been associated with various diseases, including autoimmune disorders, cardiovascular issues, and metabolic impairments like PCOS. Several studies have explored the link between dysbiosis and PCOS, reporting reduced α diversity (variability of species) in PCOS patients compared to controls.
While no particular bacterium has been recognized as the causal factor, some studies suggest increased levels of pro-inflammatory bacteria like Prevotella and Escherichia coli in PCOS patients.
Dysbiosis in PCOS has been linked to various metabolic pathways, including energy absorption, bile acid and glucose metabolism, inflammation, and gut-brain interactions. Understanding these pathways could lead to more targeted treatments, like probiotics and prebiotics.
Additionally, two main hypotheses explain the relationship between dysbiosis and PCOS. One suggests that a high-fat and carbohydrate diet disrupts the intestinal barrier, triggering inflammation and immune system hyperactivation. The other proposes that hyperandrogenism directly affects the gut microbiome, independent of diet and obesity.
Gut health and PCOS: exploring the potential of probiotics
Numerous studies have explored the link between gut microbiota and PCOS, revealing lower microbial diversity in women with PCOS compared to controls. These imbalances are associated with hyperandrogenism and elevated inflammation levels.
Specific changes include reduced beneficial bacteria like Lactobacilli and Bifidobacteria and increased pathogenic bacteria like Escherichia and Shigella. Such alterations affect the synthesis of short-chain fatty acids, impacting metabolism, immunity, and gut barrier integrity.
Gut dysbiosis increases intestinal permeability, allowing lipopolysaccharides (LPS) to enter the bloodstream and activate immune systems. Consequently, insulin receptor function is disrupted, resulting in elevated insulin levels and androgen production in the ovaries, contributing to PCOS pathogenesis.
Probiotics proved to be a promising treatment for PCOS, as they possess various beneficial properties. Studies have shown that probiotic supplementation significantly improves hormonal and inflammatory indicators in PCOS patients.
For instance, supplementation leads to decreased free androgen index and malondialdehyde, increased SHBG and nitric oxide levels, and improvements in weight, body mass index (BMI), homeostatic model assessment for insulin resistance (HOMA-IR) insulin, hirsutism, and total testosterone.
Studies involving multi-strain probiotics have demonstrated similar results, with significant reductions in testosterone levels, waist circumference, and waist-to-hip ratio.
Probiotics have also been associated with positive effects on glycemic control, reducing insulin levels and improving lipid metabolism, characterized by lower serum triglycerides and increased high-density lipoprotein levels.
Conclusions
Obesity is strongly associated with PCOS, and dysbiosis has been linked to the condition. Many studies in this review have shown changes in the gut microbiota composition in women with PCOS compared to healthy individuals.
Probiotics and synbiotics have effectively improved PCOS's hormonal profiles, inflammation, and lipid metabolism. Additionally, probiotic supplementation has shown promise in enhancing weight, BMI, insulin, and HOMA-IR levels, which could help protect fertility.
While further research is needed, probiotics may be a potential solution for managing PCOS in obese adolescents. Early monitoring of the microbiome and probiotic supplementation during childhood and adolescence may be beneficial in preventing PCOS as a modifiable cause.
Managing diabetes with probiotics and synbiotics