Keywords: PCOS, Hesperidin, Oxidative Stress, Insulin Resistance, Inflammation, Apoptosis, gut-biota
Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine–metabolic disorder driven by complex interactions between ovarian dysfunction, insulin resistance, chronic inflammation, oxidative stress, and gut microbial dysbiosis. Current therapies address isolated symptoms and are often associated with adverse effects, prompting interest in bioactive natural compounds with multi-target potential. Hesperidin (HSP), a citrus flavanone widely investigated for its antioxidant, anti-inflammatory, metabolic, and immunomodulatory properties, has gained attention as a candidate for PCOS management. This review synthesizes experimental evidence demonstrating that HSP improves ovarian morphology, supports follicular development, modulates sex-steroid and gonadotropin profiles, and enhances oocyte developmental competence. HSP additionally attenuates oxidative injury, inflammatory cascades, and apoptosis in ovarian and metabolic tissues through regulation of Nrf2, NF-κB, Bax/Bcl-2, and caspase pathways. Metabolically, HSP improves insulin signaling, glucose tolerance, and lipid profiles while suppressing hepatic lipogenesis and promoting fatty acid oxidation. Recent studies further highlight its capacity to modify gut microbial composition, strengthen mucosal barrier function, increase short-chain fatty acid production, and reduce endotoxin-driven inflammation. Together, the findings indicate that HSP engages multiple mechanistic axes relevant to PCOS pathophysiology. However, clinical validation remains limited, underscoring the need for human trials to establish therapeutic applicability.