Bisphenol A and phthalates and endometriosis: the Endometriosis: Natural History, Diagnosis and Outcomes Study

Germaine M Buck Louis; C Matthew Peterson; Zhen Chen; Mary Croughan; Rajeshwari Sundaram; Joseph Stanford; Michael W Varner; Anne Kennedy; Linda Giudice; Victor Y Fujimoto; Liping Sun; Lei Wang; Ying Guo; Kurunthachalam Kannan

doi:10.1016/j.fertnstert.2013.03.026

Lifestyle and Environment Environmental Exposures

Bisphenol A and phthalates and endometriosis: the Endometriosis: Natural History, Diagnosis and Outcomes Study

Buck Louis GM, Peterson CM, Chen Z, Croughan M, Sundaram R, Stanford J, Varner MW, Kennedy A, Giudice L, Fujimoto VY, Sun L, Wang L, Guo Y, Kannan K

Published July 2013 Fertility and sterility, 100(1), 162-169.e2

DOI 10.1016/j.fertnstert.2013.03.026 PMID 23579005 PMC PMC3700684

RRM Academy Synopsis

Six urinary phthalates were associated with endometriosis on MRI

In a matched cohort, six phthalate breakdown products in urine were linked to about double the odds of endometriosis on MRI in community women. The study compared 131 community women with 495 women having surgery. The surgery group showed no matching link in the main analysis.

Study at a glance, matched cohort of 131 community women: Six urinary phthalates were linked to endometriosis on MRI. Source: Buck Louis GM et al., 2013, PMID 23579005.

Key Findings

Among the 127 women analyzed in the community group, six phthalate metabolites (mBP, mCMHP, mECPP, mEHP, mEHHP, mEOHP) were linked to roughly double the odds of endometriosis.
In the population cohort, the highest adjusted odds ratio (AOR, adjusted for age, body mass index and creatinine) was for mECPP: 2.92; 95% CI 1.46, 5.84, per standard deviation increase.
In the operative cohort, the main models adjusted for age, body mass index and creatinine found no phthalate or bisphenol A with a significantly increased odds ratio.
Two restricted operative analyses found links. mOP: AOR 1.38; 95% CI 1.10, 1.72 (visualized and histologic disease). mEHP: AOR 1.35; 95% CI 1.03, 1.78 (normal-pelvis comparison women).
Bisphenol A showed no significant association in the main adjusted models in the population cohort (AOR 1.68; 95% CI 0.96, 2.92).

Interpretation

The ENDO Study is a cohort study. Researchers enrolled women aged 18 to 44 near Salt Lake City or San Francisco. They compared a community group to women having pelvic surgery. Women gave urine samples when they joined the study. Doctors checked for endometriosis with MRI or surgery. The authors say urine tests may track phthalate exposure better than blood tests used in earlier studies. The findings support larger studies of chemical exposure and endometriosis.

RRM Context

Restorative reproductive medicine looks for the cause of disease. Chemical exposure is one possible cause. Researchers study it. The ENDO Study asked this question. Researchers included women with a surgical diagnosis and women from the community.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To explore the relation between bisphenol A and 14 phthalate metabolites and endometriosis.

Design

Matched cohort design.

Setting

Fourteen clinical centers.

Patients

The operative cohort comprised 495 women undergoing laparoscopy/laparotomy, whereas the population cohort comprised 131 women matched on age and residence.

Interventions

None.

Main Outcome Measures

Surgically visualized or pelvic magnetic resonance imaging diagnosed endometriosis in the two cohorts, respectively.

Results

Odds ratios (OR) and 95% confidence intervals (CIs) were estimated using logistic regression adjusting for age, body mass index, and creatinine. In the population cohort, six phthalate metabolites-mono-n-butyl phthalate, mono-[(2-carboxymethyl) hexyl] phthalate, mono (2-ethyl-5-carboxyphentyl) phthalate, mono (2-ethylhexyl) phthalate, mono (2-ethyl-5-hydroxyhexyl) phthalate, and mono (2-ethyl-5-oxohexyl) phthalate-were significantly associated with an approximately twofold increase in the odds of an endometriosis diagnosis. Two phthalates were associated with endometriosis in the operative cohort when restricting to visualized and histologic endometriosis (monooctyl phthalate; OR 1.38; 95% CI 1.10-1.72) or when restricting comparison women to those with a postoperative diagnosis of a normal pelvis [mono (2-ethylhexyl) phthalate; OR 1.35; 95% CI 1.03-1.78].

Conclusions

Select phthalates were associated with higher odds of an endometriosis diagnosis for women with magnetic resonance imaging-diagnosed endometriosis. The lack of consistency of findings across cohorts underscores the impact of methodology on findings.

Topics

Lifestyle and Environment Environmental Exposures Endocrine Disrupting Chemicals

Lifestyle and Environment › Environmental Exposures › Endocrine Disrupting Chemicals

Germaine M Buck Louis, C Matthew Peterson, Zhen Chen, Mary Croughan, Rajeshwari Sundaram, Joseph Stanford, Michael W Varner, Anne Kennedy, Linda Giudice, Victor Y Fujimoto, Liping Sun, Lei Wang, Ying Guo, Kurunthachalam Kannan

G Louis, Z Chen, M Croughan, R Sundaram, Joe Stanford, Joey Stanford, J Stanford, Mike Varner, M Varner, A Kennedy, L Giudice, V Fujimoto, L Sun, L Wang, Y Guo, K Kannan

PMID 23579005 23579005 DOI 10.1016/j.fertnstert.2013.03.026 10.1016/j.fertnstert.2013.03.026 Buck Louis et al. 2013, Buck Louis 2013

Bisphenol A and phthalates and endometriosis: the Endometriosis: Natural History, Diagnosis and Outcomes Study

Six urinary phthalates were associated with endometriosis on MRI

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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