Gut Microbiota and Probiotics in Obesity-Associated Female Reproductive Dysfunction: Underlying Mechanisms and Therapeutic Potential

Obesity adversely affects female reproductive health via metabolic dysregulation, chronic inflammation, and hormonal imbalances, leading to conditions such as ovulatory dysfunction, polycystic ovary syndrome (PCOS), and pregnancy complications. Emerging evidence identifies gut microbiota dysbiosis as a key mediator that transmits obesity-related metabolic and inflammatory signals to the reproductive system. Characteristic alterations in obesity—including an elevated Firmicutes/Bacteroidetes (F/B) ratio, reduced short-chain fatty acid (SCFA) production, and endotoxemia—promote reproductive dysfunction by activating inflammatory pathways and disrupting hormonal balance. Targeting the gut microbiota with probiotics offers a promising therapeutic approach through structural and functional remodeling of the microbiota, enhanced barrier integrity, and immunomodulation. Nevertheless, challenges such as insufficient understanding of strain-specific mechanisms, scarce clinical evidence, and the absence of personalized protocols persist. This review synthesizes the impact of obesity on female reproduction, outlines the gut microbiota's regulatory role, and explores the dual mechanisms of probiotic action. Future research should leverage multi-omics technologies, stratified population studies, and functional strain analysis to facilitate the translational application of probiotics in reproductive medicine.