Endocrine Disrupting Chemicals and Polycystic Ovary Syndrome: A Comprehensive Narrative Review

Abstract

Background: Polycystic ovary syndrome (PCOS) affects 8-13% of reproductive-age women globally and represents a leading cause of infertility and metabolic dysfunction. While genetic factors contribute to PCOS susceptibility, the rising prevalence suggests environmental influences, particularly endocrine-disrupting chemicals (EDCs), play a significant role in disease pathogenesis.Objective: This narrative review synthesizes current evidence on the relationship between EDC exposure and PCOS, examining epidemiological associations, experimental data, and mechanistic insights to elucidate how environmental chemicals may contribute to PCOS development and progression.Materials and Method: We conducted a comprehensive literature search of PubMed, Embase, and Web of Science databases for studies published through December 2024, focusing on EDCs (bisphenol A, phthalates, persistent organic pollutants, pesticides, heavy metals) and PCOS outcomes. We included human epidemiological studies, animal models, and in vitro mechanistic investigations.Results: Epidemiological evidence demonstrates consistent associations between elevated EDC levels and PCOS prevalence, with bisphenol A and phthalates showing the strongest correlations. Women with PCOS exhibit significantly higher serum and urinary concentrations of multiple EDCs compared to controls. Animal studies reveal that prenatal EDC exposure induces PCOS-like phenotypes including hyperandrogenism, ovulatory dysfunction, and metabolic abnormalities, often persisting across generations. Mechanistic investigations identify multiple pathways through which EDCs disrupt reproductive function: interference with steroidogenesis, disruption of hypothalamic-pituitary-gonadal axis signaling, induction of insulin resistance, promotion of chronic inflammation, and epigenetic programming effects.Conclusion: Substantial evidence supports EDCs as significant environmental contributors to PCOS pathogenesis. Clinical implications include the need for exposure assessment in PCOS evaluation and patient counseling on EDC reduction strategies. Public health measures to minimize population-level EDC exposure may represent an important preventive approach for reducing PCOS burden.

J Med Coll Women Hosp.2026; 22(2): 255-263