Samia Bennani, Karen Foote
Background: Polyendocrine metabolic ovarian syndrome (PMOS) is a prevalent endocrine disorder affecting 10-13% of reproductive-aged women. Characterized by hyperandrogenism, ovulatory dysfunction, and metabolic disturbances, its management is increasingly focused on the gut-brain-ovary axis and chronic low-grade inflammation. This review examines current evidence for lifestyle-based, nutritional, and pharmacologic interventions in PMOS management. Methods: A review of current literature and clinical guidelines was conducted, focusing on pathophysiology, including genetic, hormonal, and inflammatory drivers, and therapeutic strategies. Results: Lifestyle modification remains the primary therapy, improving insulin sensitivity, menstrual regularity, and psychological well-being. Pharmacologic adjuncts like metformin and oral contraceptives address specific metabolic and reproductive symptoms. Nutritional supplementation, particularly a 40:1 ratio of myo-inositol to D-chiro-inositol, shows significant efficacy in restoring ovarian function. Emerging research highlights the role of gut dysbiosis in driving systemic inflammation and hormonal dysregulation. Conclusion: Effective PMOS management requires an individualized, multimodal approach that integrates lifestyle medicine with targeted supplementation and pharmacotherapy to address the complex metabolic and reproductive features of the syndrome.