“We have learned from previous studies that PFAS can interfere with the female reproductive system, even at low levels of exposure, in the general population,” said senior author Sofia Hammarstrand, MD, resident medical officer of the work and environment at Sahlgrenska University Hospital in Gothenburg. , Sweden. “PFAS may therefore be an underlying cause of gynecological diseases induced by reproductive hormones.”
Because the full etiology of PCOS, UF, and endometriosis is still unknown, “we saw a unique opportunity to study these diseases,” Hammarstrand said. Contemporary OB / GYN®.
In 2013, high levels of PFAS (greater than 10,000 ng / L) were found in the drinking water of 1 of the 2 water supply plants in the municipality of Ronneby, Sweden, dominated by acid perfluorooctanesulfonic acid (PFOS) and perfluorohexane sulfonic acid (PFHxS). The contamination came from fire-fighting foams used at a nearby aerodrome.
The study cohort consisted of 29,106 women of all ages who had previously resided in the municipality between 1985 and 2013.
Individual exposure was assessed using distribution data from municipal water supply networks linked to annual residential address data. Overall, 27% of the cohort had lived at an address with high levels of water contaminated with PFAS.
The gynecological health results were taken from the Swedish National Patient Register.
“No study to date has explored the association of the female reproductive system with high levels of exposure to PFAS,” Hammarstrand said.
In total, there were 161 cases of PCOS, 1,122 cases of uterine leiomyoma and 373 cases of endometriosis.
Among women aged 20 to 50 (n = 18,503), those exposed to high levels of PFAS-contaminated water were 2.18 times more likely to have a subsequent diagnosis of PCOS and 1 , 28 more likely to be diagnosed with UF than women who were not. exposed to high levels of water contaminated with PFAS.
But women exposed to high levels of PFAS-contaminated water were not at increased risk for endometriosis.
“Our results on PCOS are similar to previous studies, thus strengthening causality,” Hammarstrand said. “However, we were surprised to find that, compared to previous studies, we found no association between PFAS and endometriosis.”
The study is based on the contamination of PFAS by fire-fighting foams, “which is different from previous studies,” Hammarstrand said. “For uterine leiomyoma, there are still too few studies for comparison.”
Due to the widespread contamination of PFAS and other chemicals that are persistent in the environment, “it is important to better understand their effects on the female reproductive system,” said Hammarstrand, who is also a doctoral student in public health and community medicine. at the University of Gothenburg. .
The authors hope their study will lead to new international regulations on PFAS, such as the recent European Commission decision to ban around 200 PFAS substances, from February 2023.
“We are also encouraging more research on PFAS and the female reproductive system, both to better understand the underlying etiological mechanisms and also because these diseases can cause great harm to those affected, as well as health costs. and society, ”Hammarstrand said.
Hammarstrand does not report any relevant financial information.
Hammarstrand S, Jakobsson K, Andersson E, et al. Perfluoroalkylated substances (PFAS) in drinking water and the risk of polycystic ovary syndrome, uterine leiomyoma, and endometriosis: a Swedish cohort study. About Int. Published online August 12, 2021. doi: 10.1016 / j.envint.2021.106819