FIGO Committee Opinion: Environmental Drivers of Gynecologic and Reproductive Health

Throughout their reproductive years, women are exposed to a variety of factors that can impact hormone signaling, reproductive organ function, and systemic metabolic regulation, such as industrial chemicals, heavy metals, air pollutants, and endocrine-disrupting compounds. Recent years have seen an acceleration in exposure to these factors, especially microplastics, which have been shown to be present in utero and beyond. This article is a FIGO opinion aimed to link a wide range of environmental drivers of maternal and child health with familiar health outcomes in women’s health. It focuses on chemicals and pollutants with the most evidence of exposure, but there are many factors that have no data surrounding their exposure and effects. Common mechanisms for environmental exposures include disrupting endocrine signaling, contributing to oxidative stress, inflammation, and epigenetic modifications. Certain chemicals can also contribute to the production of reactive oxygen species, which can cause cellular damage resulting in mutation or cell death; air pollutants in particular can induce oxidative stress and inflammation that can impair fertility. During the creation of this article, evidence was reviewed for environmental influences on infertility, PCOS, endometriosis, uterine fibroids, menopause, and gynecologic cancer. More evidence for the role of environmental factors in fertility continues to emerge over time, showing that air pollution, endocrine-disrupting chemicals, plastics, heavy metals, and pesticides can have effects on female fertility, male fertility, or both. This presents an opportunity to address patient counseling and education for those pursuing fertility treatment, indicating that some environmental changes can be made to improve outcomes. Endocrine-disrupting chemicals may also play a role in the development and severity of PCOS, with most evidence to date focusing on BPA, showing an association with BPA exposure and an increased likelihood of PCOS. Other endocrine-disrupting chemicals such as organochlorine chemicals have been shown to be associated with endometriosis, and both these chemicals and heavy metals have been associated with uterine fibroids. Environmental influences may also affect the timing and progression of menopause. In addition, evidence is mounting for the role of exposure to endocrine-disrupting chemicals, air pollutants, heavy metals, pesticides, and industrial particulates in the development of gynecologic cancer. This is true for ovarian, uterine, and breast cancers. Clinicians can play an important role in incorporating considerations of environmental factors in gynecology and reproductive medicine by addressing their role in women’s health. Clinicians should remain aware of regional health alerts, as well as collaborate with public health agencies and referring patients to reputable sources. (Abstracted from Int J Gynaecol Obstet. 2025 Dec;171(3):1008-1021. doi: 10.1002/ijgo.70547)