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Reproductive Health Consequences of Per- and Polyfluoroalkyl Substances and Microplastics in Mid-life Women: A Systematic Review of Emerging Evidence
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A systematic review of 18 human studies found that PFAS exposure is consistently linked to earlier menopause, reduced fertility, and elevated endometriosis risk in mid-life women, while limited studies confirmed microplastics are present in ovarian follicular fluid and placental tissue with preliminary evidence of reproductive harm. This is critical for microplastic pollution research as it establishes human reproductive tissue as a target for microplastic accumulation and identifies mid-life women as a vulnerable population requiring focused study.
A BSTRACT 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.
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