Abstract
Polycystic ovary syndrome (PCOS) is a major health concern for women of reproductive age and a leading cause of infertility and metabolic dysfunction. Current treatments mainly involve lifestyle modification and pharmacological therapies, such as oral contraceptives and metformin, and may also include laparoscopic ovarian drilling (LOD), acupuncture, and probiotic interventions. Although these approaches can be effective, they often produce adverse effects and show a high relapse rate after discontinuation. This review summarizes recent advances in exosome-based therapies as emerging strategies for PCOS. Exosomes derived from adipose-derived mesenchymal stem cells, menstrual blood-derived stem cells, bone marrow mesenchymal stem cells, brown adipocytes, and human umbilical cord-derived mesenchymal stem cells have demonstrated therapeutic potential. As nanosized extracellular vesicles carrying bioactive molecules, exosomes exhibit strong targeting capacity and low immunogenicity. We discuss the mechanisms by which exosomes may ameliorate PCOS, including suppression of chronic low-grade inflammation, enhancement of mitochondrial function, inhibition of apoptosis, modulation of angiogenesis, and improvement of metabolic disturbances. However, translating these promising findings into clinical practice faces significant challenges. The main obstacles include lack of standardization, high production costs, and limited clinical data to confirm safety and efficacy. Addressing these issues could pave the way for mechanism-based, personalized exosome treatments and offer new approaches for managing PCOS.