Reactive oxygen species in polycystic ovary syndrome: Mechanistic insights into pathogenesis and therapeutic opportunities

Abstract

Polycystic ovary syndrome (PCOS), a common yet intricate endocrine disorder, presents persistent clinical challenges due to its complex pathogenesis. Reactive oxygen species (ROS), highly reactive molecules, have emerged as critical contributors to PCOS development and represent potential therapeutic targets. This review comprehensively explores the diverse roles of ROS in PCOS pathogenesis, particularly their contributions to metabolic dysfunction and hormonal imbalance. It further assesses the therapeutic potential of ROS-targeted interventions, summarizing antioxidant therapy advancements, underlying mechanisms, and current challenges. By consolidating recent research, this review highlights the profound significance of ROS in PCOS, aiming to inspire innovative pathogenesis research, improve clinical management, and establish a robust theoretical foundation for more effective PCOS treatment strategies.

Keywords: Metabolism; Polycystic ovary syndrome; Reactive oxygen species; Targets.

Fig. 1

Physiological and Pathological Roles of ROS. The left panel depicts physiological ROS: balanced by antioxidants (SOD, GSH), ROS support essential processes like immune defense (phagocyte) and mitophagy. The right panel illustrates ROS dysregulation: mitochondrial dysfunction (e.g., Complex III block) leads to excessive ROS, triggering oxidative stress, cellular damage, inflammation, and ferroptosis (via lipid peroxidation and MDA).

Fig. 2

Mechanisms of ROS in PCOS Pathogenesis. This schematic illustrates the central role of ROS in driving key pathological features of PCOS. The circular framework highlights ROS as a hub interacting with four major PCOS phenotypes.

Fig. 3

Emerging Therapeutic Strategies for PCOS Targeting Oxidative Stress-Related Dysregulation. This figure illustrates recent advances in PCOS treatment, categorized into six interconnected therapeutic approaches. Those clinically applied are highlighted in blue.