Reproductive Health Consequences of Per- and Polyfluoroalkyl Substances and Microplastics in Mid-life Women: A Systematic Review of Emerging Evidence.

BACKGROUND

Mid-life women are increasingly recognized as a vulnerable population for endocrine disruption due to chronic environmental exposures. Among emerging contaminants, per- and polyfluoroalkyl substances (PFAS) and microplastics have been implicated in reproductive health risks, yet focused evaluations in mid-life populations remain limited.

OBJECTIVE

The to systematically review human studies assessing the association between chronic exposure to PFAS and microplastics with reproductive health outcomes in mid-life women.

METHODS

We conducted a systematic review adhering to PRISMA 2020 guidelines. Databases searched included PubMed, Scopus, Web of Science, and EMBASE up to April 2025. Inclusion criteria were original human studies evaluating PFAS or microplastics in association with at least one reproductive health outcome (e.g., menopause, hormone levels, fertility metrics, and gynecologic conditions) in mid-life women. Study quality was appraised using the Newcastle-Ottawa Scale. Publication bias was qualitatively assessed. PROSPERO Registration ID: CRD42025446217.

RESULTS

Eighteen human studies were included (16 PFAS-related, 2 microplastic-related). PFAS exposure was consistently linked with earlier menopause, elevated FSH, reduced fertility, and higher odds of endometriosis and polycystic ovarian syndrome. Limited studies on microplastics demonstrated their presence in human ovarian follicular fluid and placental tissues, with preliminary evidence of altered ovarian reserve. However, no large-scale epidemiological outcomes for microplastics were available.

CONCLUSION

PFAS are significantly associated with adverse reproductive outcomes in mid-life women. Although microplastics have been detected in reproductive tissues, outcome-based evidence is insufficient. Further longitudinal studies are warranted to clarify these emerging environmental risks.