Per- and Polyfluoroalkyl Substances and Endometriosis: A Systematic Review and Meta-Analysis
Sarah Pilling1, Kerry Mitchell1, Prakash V A K Ramdass1
1Department of Public Health and Preventive Medicine, St. George's University School of Medicine, St. George FZ818, Grenada.
Toxics
|April 27, 2026
Summary
Exposure to per- and polyfluoroalkyl substances (PFASs), particularly PFOS and PFOA, is linked to a higher likelihood of endometriosis. This systematic review and meta-analysis confirms a significant association between PFASs and increased endometriosis risk.
Area of Science:
- Environmental Health
- Reproductive Epidemiology
- Toxicology
Background:
- Per- and polyfluoroalkyl substances (PFASs) are persistent endocrine-disrupting chemicals.
- PFASs have been linked to reproductive dysfunction, but their association with endometriosis is unclear.
- Epidemiologic evidence on PFASs and endometriosis is inconsistent.
Purpose of the Study:
- To systematically review and meta-analyze existing epidemiologic evidence on the association between PFAS exposure and endometriosis.
- To quantify the odds of endometriosis associated with PFAS exposure.
- To assess PFAS levels in endometriosis patients versus controls.
Main Methods:
- A PRISMA-compliant systematic review and meta-analysis was conducted.
- Searches were performed in PubMed, Embase, EBSCO Host, and Google Scholar.
- Random-effects or fixed-effects models were used to estimate pooled odds ratios (ORs) and standardized mean differences (SMD).
- Heterogeneity and publication bias were assessed using established statistical methods.
Main Results:
- Twelve studies were included in the systematic review, and eleven in the meta-analysis.
- Perfluoroalkyl substances (PFASs), specifically perfluorosulfonic acids (PFSAs) (OR: 1.50) and perfluorocarboxylic acids (PFCAs) (OR: 1.46), were significantly associated with increased odds of endometriosis.
- The association was particularly notable for perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA).
- Pooled analyses of SMD did not consistently show concentration differences between cases and controls.
- Moderate to high heterogeneity was observed for most compounds, with no significant publication bias detected.
Conclusions:
- Exposure to PFASs, especially PFOS and PFOA, may be associated with an increased risk of endometriosis.
- Further prospective studies are needed to investigate the complex interactions of PFAS mixtures and emerging compounds.
- The findings highlight the potential reproductive health impact of persistent environmental contaminants.
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