Vaginal drug delivery for precision therapy in polyendocrine metabolic ovarian syndrome: emerging technologies, translational challenges and future perspectives.

INTRODUCTION: Polyendocrine Metabolic Ovarian Syndrome (PMOS) is an endocrine disorder characterized by metabolic dysfunction, hormonal imbalance, inflammation, and clinical manifestations. Current treatments, systemic drugs, may provide limited benefits because of adverse effects, variable efficacy, and poor adherence, highlighting the need for personalized therapeutic strategies. Vaginal administration offers an underexplored approach that may enable localized delivery, reduce systemic exposure, and support dosing. Furthermore, the vaginal microenvironment can influence drug stability, absorption, retention, and therapeutic outcomes. AREAS COVERED: This review examines the pathophysiological basis of PMOS and recent advances in vaginal drug delivery (VDD) systems for precision therapy. It highlights the transition from conventional approaches to nanoscale carriers, bioresponsive formulations, genetic and microbiome-informed strategies, and 3D-printed devices. The roles of artificial intelligence, machine learning, point-of-care diagnostics, and theranostic platforms in personalized therapy are discussed, together with translational and regulatory considerations. Relevant literature was identified through searches of PubMed, Scopus, Web of Science, and Google Scholar. EXPERT OPINION: VDD represents a promising precision medicine approach for PMOS; however, clinical translation remains challenged by vaginal microenvironment variability, limited safety evidence, formulation scalability, patient acceptance, and insufficient clinical validation. Future progress will require interdisciplinary integration of biomaterial engineering, biology, drug delivery, microbiome science, and digital health.