Siqi Liu, Rui Wang, Weili Yu, Chuanjing Shi, Xi Wang, Aifen Liu, Lei Zhang
Polycystic ovary syndrome (PCOS) is a prevalent endocrine and metabolic disorder, primarily characterized by reproductive dysfunction, insulin resistance (IR), and long-term metabolic complications. Current first-line pharmacological treatments, including oral contraceptives, anti-androgens, and insulin sensitizers, can alleviate clinical symptoms but often fail to fully address the underlying pathophysiology, and their long-term use is frequently limited by adverse effects. Natural products, owing to their multi-target regulatory properties and favorable safety profiles, have emerged a promising adjuvant therapeutic strategy. This review systematically summarizes how natural products exert beneficial effects through mechanisms such as improving metabolic homeostasis by enhancing insulin sensitivity and mitigating oxidative stress and chronic inflammation; restoring endocrine balance by modulating the hypothalamic-pituitary-gonadal axis to reduce hyperandrogenemia and promote ovulation; and utilizing emerging pathways including regulating gut microbiota homeostasis and epigenetic modifications as a novel avenue for PCOS drug development. Preclinical and clinical evidence collectively indicates that these agents hold significant translational potential to ameliorate metabolic disturbances and improve reproductive outcomes, providing a scientific foundation for future integrated intervention strategies in PCOS.