An Epidemiologic Review of Endocrine-disrupting Chemicals and Understudied Gynecologic Health Conditions Affecting Quality of Life.

PURPOSE OF REVIEW: Endocrine-disrupting chemicals (EDCs) are exogenous compounds that can deleteriously affect gynecologic health through interference with hormonal systems. Research on EDC exposure and gynecologic health has generally focused on outcomes important for reproduction, particularly fertility. Less attention has been given to gynecologic conditions that substantially affect morbidity and quality of life. In this narrative review, we describe the current epidemiologic literature on EDCs and understudied gynecologic conditions that can be life-altering – adenomyosis, dysmenorrhea, heavy menstrual bleeding (HMB), sexual function, persistent vulvar pain, bacterial vaginosis (BV), and pelvic inflammatory disease (PID). RECENT FINDINGS: We identified only a handful of studies on EDCs and adenomyosis (n = 2), dysmenorrhea (n = 5), HMB (n = 4), sexual function (n = 5), persistent vulvar pain (n = 2), BV (n = 2), and PID (n = 2). The EDCs investigated varied by condition and included phthalates, per- and polyfluoroalkyl substances, polychlorinated biphenyls, polybrominated diphenyl ethers, pesticides, and heavy metals. For each condition, discrepant results were observed across studies, likely due to limitations in study design, small sample size, lack of adjustment for important confounders, and issues with EDC exposure and outcome assessment. Studies of EDCs and several gynecologic conditions affecting morbidity and quality of life are scarce. We provide recommendations for improving methodological rigor in future studies, focusing on epidemiological study design principles, exposure timing, exposure to chemical mixtures, and leveraging interdisciplinary expertise. Expanding environmental epidemiologic research on these understudied gynecologic conditions is vital for supporting the gynecologic health and well-being of women.