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This low-grade systemic inflammation: Impairs insulin receptor signalling, directly worsening insulin resistance Damages ovarian granulosa cells, impairing egg development and ovarian function Disrupts gut barrier integrity, contributing to what some researchers call a "leaky gut" pattern associated with systemic inflammation Amplifies HPA axis dysregulation, raising cortisol and further disrupting sex hormone balance Chronic inflammation is both a consequence of PMOS and a driver that perpetuates it

J Transl Med (2020) 18:387

If a source treats all routes as equivalent, read it with caution