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The clinical presentation typically includes hyperandrogenism (HA), ovulatory dysfunction, and polycystic ovarian morphology ( Ferroptosis is a recently identified form of programmed cell death driven primarily by iron-dependent lipid peroxidation and compromised cellular antioxidant defenses ( The gut microbiota, meanwhile, exerts a profound influence on both PCOS development and ferroptosis through microbial metabolites and immune-inflammatory signaling pathways ( 2 Ferroptosis 2.1 The key role of iron metabolism and iron overload in triggering ferroptosis Iron is an essential trace element that participates in fundamental physiological processes such as oxygen transport, energy metabolism, immune defense, and DNA synthesis