Peripheral miRNA profiling identifies therapy-specific biological trajectories in the treatment of cognitive dysfunction in depression: an exploratory mechanistic study.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-aged women, affecting 6–13% of this population globally. Women with PCOS may face several challenges, including menstrual irregularities, hirsutism, acne, skin-related complications, androgenic alopecia, reproductive impairments including infertility and pregnancy complications, metabolic disturbances such as insulin resistance (IR) (present in 65–70% of patients) and metabolic syndrome (MetS) (occurring in approximately 30% of cases), as well as psychological effects including depression. IR is characterized by higher-than-normal insulin concentrations required to elicit normal physiological responses, leading to hyperinsulinemia and impaired insulin function. MetS encompasses a cluster of interrelated metabolic derangements, including central adiposity, dyslipidemia, hypertension and hyperglycemia, collectively predisposing individuals to heightened cardiometabolic risk. Current therapeutic approaches face significant limitations, with oral contraceptives carrying increased thrombosis risk, metformin causing gastrointestinal side effects leading to 20–30% discontinuation rates, and thiazolidinediones inducing problematic weight gain. Growing evidence supports the potential of phytotherapeutic interventions for PCOS management. Cinnamon supplementation has demonstrated 0.7–1.2 point reductions in Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) values, berberine has shown efficacy comparable to metformin in randomized controlled trials, and spearmint tea consumption has been associated with an approximate 30% decrease in free testosterone levels, as measured in serum concentrations in relevant studies. Apple cider vinegar (ACV), a fermented product containing 4–6% acetic acid along with active polyphenolic compounds and essential micronutrients, exhibits multiple potentially beneficial mechanisms including antihyperglycemic effects through Peroxisome Proliferator-Activated Receptor Gamma (PPARγ) activation, lipid metabolism regulation via the Adenosine Monophosphate-Activated Protein Kinase (AMPK) pathway, and possible anti-androgenic activity. ACV is generally well tolerated at commonly studied doses, with only mild gastrointestinal discomfort or intolerance reported in some individuals; excessive intake may increase the risk of dental enamel erosion.