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(2021) is the first to report an increase in -aminobutyric acid (GABA)-producing species in PCOS, including Bacteroides thetaiotaomicron , Bacteroides fragilis , and Escherichia coli , which showed a significant positive correlation with serum luteinizing hormone (LH) levels and the LH: follicle-stimulating hormone (FSH) ratio ( Ruminococcus ), while depleting butyrate-producing bacteria (like Faecalibacterium ), thereby exacerbating intestinal barrier dysfunction ( 3 Role of intestinal barrier dysfunction in the pathogenesis of PCOS The intestinal barrier, composed of the mucus layer, epithelial cells with their tight junction proteins (e.g., Zonula Occludens-1 (ZO-1), occludin), and immune cells, serves as a critical structure for maintaining gut homeostasis and preventing the translocation of pathogens and toxins ( Figure 2 )