Beyond the Ovary: Integrating the Gut-Ovary Axis with Grahani and Artavavaha Srotas in Polycystic Metabolic Ovarian Disease (PMOD): A Narrative Review

Abstract

Polycystic Metabolic Ovarian Disease (PMOD), formerly known as Polycystic Ovary Syndrome (PCOS), is a complex endocrine-metabolic disorder characterized by reproductive, hormonal, and metabolic abnormalities. Recent evidence suggests that PMOD is not merely an ovarian disease but a systemic disorder involving intricate interactions among insulin resistance, chronic inflammation, oxidative stress, and gut microbiota dysbiosis. The emerging concept of the gut ovary axis highlights the influence of intestinal microbial homeostasis on endocrine regulation, ovarian function, and female fertility. Although PMOD is not described as a distinct disease entity in Ayurved, its clinical manifestations can be understood through the concepts of Grahani Dushti, Agnimandya, Ama, Kapha - Meda dushti, and Artavavaha Srotodushti. Disturbance of Grahani initiates metabolic dysfunction, leading to Ama formation and Srotorodha, which ultimately affect Artava and reproductive health. These concepts exhibit remarkable similarities to the modern understanding of gut dysbiosis and metabolic inflammation. This narrative review explores the current evidence on the gut-ovary axis in PMOD and critically correlates it with classical Ayurvedic principles to provide an integrative understanding of disease pathogenesis. The review also highlights the potential role of gut microbiota modulation, lifestyle modification, and Ayurvedic interventions in improving metabolic and reproductive outcomes, thereby offering a holistic framework for future research and personalized management of PMOD.