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STUDY OBJECTIVE: To broadly review the recent literature linking environmental factors and adult female reproductive health for the UCSF–CHE Summit on Environmental Challenges to Reproductive Health and Fertility. DESIGN: Reviewed articles indexed in PubMed from 1999–2007 addressing environment and puberty, menstrual and ovarian function, fertility, and menopause. RESULT(S): The strongest evidence of environmental contaminant exposures interfering with healthy reproductive function in adult females is for heavy metals, particularly lead. Compounds that can influence hormone function, including pesticides and persistent pollutants, are also associated with risk. The pattern of effects for these endocrine-active compounds is often complex, with no clear dose response, but alterations in function and poor reproductive health outcomes are observed. From a clinical perspective, most modifiable risk …