Hello,
Unfortunately, MS Word doesn't include options to reduce or optimize the PDF output size. In this case, the best approach would be using an external tool installed on the server, such as GhostsScript:
https://www.digitalocean.com/community/tutorials/reduce-pdf-file-size-in-linux
https://gist.github.com/ahmed-musallam/27de7d7c5ac68ecbd1ed65b6b48416f9
GhostScript is available for Windows, Linux and macOS and you can run it from PHP using shell_exec.
Please note that in most cases, a large PDF file size is due to the images. As alternative approach to using GhostScript, you could try to optimize the DOCX file with optimizeDocx (using imageFiles and imageFilesToJpegLevel options to optimize the images) before being transformed to PDF.
Regards.