Perfluorochemicals and endometriosis: the ENDO study

Louis GMB; Peterson CM; Chen Z; Hediger ML; Croughan MS; Sundaram R; Stanford JB; Fujimoto VY; Varner MW; Giudice LC; Kennedy A; Sun L; Wu Q; Kannan K; Louis GM

doi:10.1097/EDE.0b013e31826cc0cf

Lifestyle and Environment Environmental Exposures

Perfluorochemicals and endometriosis: the ENDO study

Louis GMB, Peterson CM, Chen Z, Hediger ML, Croughan MS, Sundaram R, Stanford JB, Fujimoto VY, Varner MW, Giudice LC, Kennedy A, Sun L, Wu Q, Kannan K, Louis GM

Published November 2012 Epidemiology (Cambridge, Mass.), 23(6), 799-805

DOI 10.1097/EDE.0b013e31826cc0cf PMID 22992575 PMC PMC4122261

RRM Academy Synopsis

Blood PFOA and PFNA were linked to endometriosis in surgery patients

Blood PFOA and PFNA were linked to endometriosis in women having surgery. The ENDO study compared women with and without the disease. It measured nine chemicals in 495 surgical patients and 131 women from the general population.

Sought infertility treatment: With endometriosis, 34 in 100; Without endometriosis, 17 in 100. Source: Louis GMB et al., 2012, PMID 22992575.

Study at a glance, case-control study: Blood PFOA and PFNA were linked to endometriosis in surgery patients — Study at a glance, case-control study of 495 surgical patients: Blood PFOA and PFNA were linked to endometriosis in surgery patients. Source: Louis GMB et al., 2012, PMID 22992575.

Key Findings

Among 495 surgical patients, higher PFOA was linked to higher odds of endometriosis (adjusted OR 1.89, 95% CI 1.17–3.06). In the same group, PFNA showed 2.20 (1.02–4.75).
After adjusting for parity as well, the surgical-patient estimates fell to 1.62 (0.99–2.66) for PFOA and 1.99 (0.91–4.33) for PFNA. Both intervals include 1.
For stage 3 or 4 disease, PFOS (1.86 [1.05–3.30]) and PFOA (2.58 [1.18–5.64]) were linked to higher odds. With parity added: 1.50 (0.82–2.74) and 1.86 (0.81–4.24).
In the population sample, 14 of 127 women had endometriosis on MRI. The Table 3 intervals span 1 for all five chemicals analyzed, in every model.
An infertility history was the only consistent difference by disease status. Among surgical patients, 64 of 190 (34%) with endometriosis had sought infertility treatment, against 48 of 283 (17%) without.

Interpretation

This case-control study compared blood levels of nine perfluorochemicals between women with and without endometriosis, recruited from Salt Lake City and San Francisco in 2007-2009. The authors report it as the first study to link PFOA and PFNA levels to the disease. The authors note that adjusting for parity may itself affect the strength of these associations. The findings support larger studies of PFOA and PFNA in endometriosis risk.

RRM Context

Restorative reproductive medicine looks for the cause of disease. Chemical exposures belong among the questions physicians ask. Endometriosis affects couples. In both samples, a larger share of women with endometriosis had sought infertility treatment.

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

Abstract

Background

Environmental chemicals may be associated with endometriosis. No published research has focused on the possible role of perfluorochemicals (PFCs) despite their widespread presence in human tissues.

Methods

We formulated two samples. The first was an operative sample comprising 495 women aged 18-44 years scheduled for laparoscopy/laparotomy at one of 14 participating clinical sites in the Salt Lake City or San Francisco area, 2007-2009. The second was a population-based sample comprising 131 women matched to the operative sample on age and residence within a 50-mile radius of participating clinics. Interviews and anthropometric assessments were conducted at enrollment, along with blood collection for the analysis of nine PFCs, which were quantified using liquid chromatography-tandem mass spectrometry. Endometriosis was defined based on surgical visualization (in the operative sample) or magnetic resonance imaging (in the population sample). Using logistic regression, we estimated odds ratios (ORs) and 95% confidence intervals (CIs) for each PFC (log-transformed), adjusting for age and body mass index, and then parity.

Results

Serum perfluorooctanoic acid (PFOA; OR = 1.89 [95% CI = 1.17-3.06]) and perfluorononanoic acid (2.20 [1.02-4.75]) were associated with endometriosis in the operative sample; findings were moderately attenuated with parity adjustment (1.62 [0.99-2.66] and 1.99 [0.91-4.33], respectively). Perfluorooctane sulfonic acid (1.86 [1.05-3.30]) and PFOA (2.58 [1.18-5.64]) increased the odds for moderate/severe endometriosis, although the odds were similarly attenuated with parity adjustment (OR = 1.50 and 1.86, respectively).

Conclusions

Select PFCs were associated with an endometriosis diagnosis. These associations await corroboration.

Topics

Lifestyle and Environment Environmental Exposures Persistent Organic Pollutants

Lifestyle and Environment › Environmental Exposures › Persistent Organic Pollutants

Germaine M Buck Louis, C Matthew Peterson, Zhen Chen, Rajeshwari Sundaram, Joseph B Stanford, Michael W Varner, Linda C Giudice, Anne Kennedy, Lei Sun, Qian Wu, Kurunthachalam Kannan, Mary S Croughan, Victor Y Fujimoto, Mary L Hediger

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

PMID 22992575 22992575 DOI 10.1097/EDE.0b013e31826cc0cf 10.1097/EDE.0b013e31826cc0cf Louis et al. 2012, Louis 2012

Perfluorochemicals and endometriosis: the ENDO study

Blood PFOA and PFNA were linked to endometriosis in surgery patients

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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