Ketogenic diet combined with probiotics for polyendocrine metabolic ovarian syndrome: research progress from the perspective of the gut microbiota–host metabolic axis

Polyendocrine metabolic ovarian syndrome (PMOS), formerly known as polycystic ovary syndrome (PCOS), is a common endocrine-metabolic disorder characterized by insulin resistance, androgen excess, chronic inflammation, and gut microbial dysbiosis. Increasing evidence suggests that the gut microbiota–metabolite–host axis contributes to the interaction between metabolic dysfunction, immune imbalance, and reproductive endocrine abnormalities. The ketogenic diet (KD) may improve PMOS by restricting carbohydrate intake, promoting ketone production, reducing body weight, enhancing insulin sensitivity, and alleviating inflammation. However, KD may also decrease beneficial bacteria, including Bifidobacterium , potentially disrupting intestinal microbial homeostasis. Probiotics may counteract these effects by restoring beneficial microbial populations, increasing short-chain fatty acid production, strengthening the intestinal barrier, regulating bile acid metabolism, and reducing systemic inflammation. These changes may further improve glucose and lipid metabolism and reproductive endocrine function. This review summarizes the potential mechanisms and current evidence regarding the combined use of KD and probiotics in PMOS, with particular emphasis on the gut microbiota–host metabolic axis. However, no randomized controlled trial has directly evaluated this combined approach in women with PCOS. Therefore, its potential complementary effects remain hypothetical and require clinical validation.