Reproductive Health Consequences of Per- and Polyfluoroalkyl Substances and Microplastics in Mid-life Women: A Systematic Review of Emerging Evidence.
Level 3 - non-randomized controlled study
Systematic review of observational studies without randomized trials.
PubMed 42124818 · doi:10.4103/jmh.jmh_93_25
What was done
Authors systematically reviewed human studies indexed in PubMed, Scopus, Web of Science, and EMBASE through April 2025 following PRISMA guidelines (PROSPERO CRD42025446217). Eligible studies evaluated chronic exposure to per- and polyfluoroalkyl substances (PFAS) or microplastics in relation to reproductive health outcomes (menopause timing, hormone levels, fertility metrics, gynecologic conditions) in mid-life women. Study quality was appraised with the Newcastle-Ottawa Scale.
What was found
Eighteen human studies met inclusion criteria (16 on PFAS, 2 on microplastics). The abstract reports no numerical effect sizes or pooled risk estimates. Qualitatively, PFAS exposure was consistently associated with earlier menopause, elevated follicle-stimulating hormone, reduced fertility, and higher odds of endometriosis and polycystic ovarian syndrome. Microplastics were detected in ovarian follicular fluid and placental tissue with preliminary evidence of altered ovarian reserve, but large-scale epidemiological outcome data were unavailable.
Why it matters
This review collates human evidence linking chronic PFAS exposure to accelerated reproductive aging and gynecologic disease in mid-life women, while highlighting that evidence on microplastics remains largely restricted to tissue detection rather than clinical outcome studies.
Limits
The abstract provides no quantitative effect sizes, confidence intervals, or meta-analytic results. The underlying evidence base is entirely observational and subject to residual confounding. Only two studies evaluated microplastics, precluding firm conclusions regarding clinical health endpoints.