FIGO committee opinion: Environmental drivers of gynecologic and reproductive health

This FIGO committee opinion paper addresses the growing body of evidence linking environmental exposures to common gynecologic and reproductive conditions across the life course. From adolescence through menopause, women are exposed to a wide range of environmental toxicants, including endocrine-disrupting chemicals, air pollutants, heavy metals, pesticides, and industrial compounds, which influence hormonal function, ovarian reserve, and disease risk. This article synthesizes high-quality systematic and authoritative reviews along with high-quality literature on exposures that can increase the risk of infertility, polycystic ovary syndrome, endometriosis, uterine fibroids, hormonally mediated cancers, and menopause. It highlights underlying mechanisms, such as endocrine disruption, oxidative stress, inflammation, and epigenetic modification. Importantly, the article emphasizes disparities in exposure and outcomes, particularly among historically marginalized populations with heightened vulnerability to environmental injustice. Practical guidance is offered to help clinicians incorporate environmental health into routine care, through patient counseling, exposure screening, and advocacy. The article calls for obstetrician/gynecologists to take leadership roles in recognizing environmental risk as a determinant of reproductive health and equity-both within the clinic and through systems-level policy change.