Perfluorochemicals and endometriosis: the ENDO study
Germaine M Buck Louis, C Matthew Peterson, Zhian Chen
Rajeshwari Sundaram, Joseph B Stanford, Michael W Varner, Linda C Giudice, Anne Kennedy, Lei Sun, Qing Wu, Kurunthachalam Kannan, Louis GM , Mary S Croughan , Victor Y Fujimoto , Mary L Hediger
Author affiliations (7)
Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentROR
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.
PMID 22992575 22992575 DOI 10.1097/EDE.0b013e31826cc0cf 10.1097/EDE.0b013e31826cc0cf Louis et al. 2012, Louis 2012
Cite this article
Louis, G. M. B., Peterson, C. M., Chen, Z., Hediger, M. L., Croughan, M. S., Sundaram, R., Stanford, J. B., Fujimoto, V. Y., Varner, M. W., Giudice, L. C., Kennedy, A., Sun, L., Wu, Q., & Kannan, K. (2012). Perfluorochemicals and endometriosis: the ENDO study. Epidemiology (Cambridge, Mass.), 23(6), 799-805. https://doi.org/10.1097/EDE.0b013e31826cc0cf
Louis GMB, Peterson CM, Chen Z, Hediger ML, Croughan MS, Sundaram R, et al. Perfluorochemicals and endometriosis: the ENDO study. Epidemiology. 2012;23(6):799-805. doi:10.1097/EDE.0b013e31826cc0cf
Louis, G. M. B., et al. "Perfluorochemicals and endometriosis: the ENDO study." Epidemiology (Cambridge, Mass.), vol. 23, no. 6, 2012, pp. 799-805.
Buck Louis GM et al., 2012·Environ Health Perspect·
Open Access
An equivocal literature exists regarding the relation between persistent organochlorine pollutants (POPs) and endometriosis in women, with differences attributed to methodologies. We assessed the association between POPs and the odds of an endometriosis diagnosis and the consistency of findings by biological medium and study cohort. Using a matched cohort design, we assembled an operative cohort of women 18-44 years of age undergoing laparoscopy or laparotomy at 14 participating clinical centers from 2007 to 2009 and a population-based cohort matched on age and residence within a 50-mile catchment area of the clinical centers. Endometriosis was defined as visualized disease in the operative cohort and as diagnosed by magnetic resonance imaging in the population cohort. Logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for each POP in relation to an endometriosis diagnosis, with separate models run for each medium (omental fat in the operative cohort, serum in both cohorts) and cohort. Adjusted models included age, body mass index, breast-feeding conditional on parity, cotinine, and lipids. Concentrations were higher in omental fat than in serum for all POPs. In the operative cohort, γ-hexachlorocyclohexane (γ-HCH) was the only POP with a significant positive association with endometriosis [per 1-SD increase in log-transformed γ-HCH: adjusted OR (AOR) = 1.27; 95% CI: 1.01, 1.59]; β-HCH was the only significant predictor in the population cohort (per 1-SD increase in log-transformed β-HCH: AOR = 1.72; 95% CI: 1.09, 2.72). Using a matched cohort design, we found that cohort-specific and biological-medium-specific POPs were associated with endometriosis, underscoring the importance of methodological considerations when interpreting findings.
Rovira J et al., 2025·Journal of Environmental Science and Health. Part A, Toxic/hazardous Substances & Environmental Engineering·
Global textile production, driven by consumer demand, raises significant concerns about exposure to chemicals in clothing and related products. This review synthesizes evidence (2019-2025) on hazardous substances in textiles, including dyes, plasticizers, per- and polyfluoroalkyl substances (PFAS), and metals, and identifies and categorizes their associated human health risks. Emerging evidence highlights microfibers as critical vectors for chemical exposure via inhalation and dermal routes, necessitating updated risk assessments. Focusing on dermal absorption as the primary exposure route, risks to vulnerable populations (e.g., infants, pregnant women) and gaps in regulatory frameworks are highlighted. The current analysis reveals that chronic exposure to chemical mixtures in textiles remains poorly understood, with current safety assessments often neglecting synergistic effects. Key findings include elevated risks from phthalates in infant clothing, PFAS in water-repellent fabrics, and carcinogenic aromatic amines (AAs) from azo dyes. We underscore the urgency of harmonized global regulations, advanced biomonitoring, and sustainable alternatives (e.g., enzymatic dyes, biodegradable finishes). Public awareness initiatives and stricter enforcement of certifications like OEKO-TEX(®) or GOTS are critical to mitigating risks. Interdisciplinary collaboration among textile technologists, toxicologists, and public health experts is essential to develop safer textile alternatives and integrate health-centric approaches into sustainability agendas, safeguarding consumers, workers, and ecosystems.
Marroquin JM et al., 2025·Environ Health Perspect·
Open Access
Perand polyfluoroalkyl substances (PFAS) exposure is widespread and has been linked with gynecologic disease. To our knowledge, no study has measured PFAS in endometrial tissue. Eutopic endometrial tissue specimens (n=434) were collected from Investigating Mixtures of Pollutants and Endometriosis in Tissue (IMPLANT) study participants undergoing laparoscopy or laparotomy for any indication (2007-2009). Nine PFAS were measured by high-performance liquid chromatography-tandem mass spectrometry [perfluorodecanoic acid (PFDA), perfluorohexane sulfonic acid (PFHxS), perfluorononanoic acid (PFNA), perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorododecanoic acid (PFDoDA), perfluoroheptanoic acid (PFHpA), perfluorooctanesulfonamide (PFOSA), and perfluoroundecanoic acid (PFUnDA)]. Surgeons diagnosed endometriosis by gold-standard visualization and evaluated the endometriosis staging as moderate and severe (stages 3 and 4) compared to minimal and mild (stages 1 and 2) using American Society of Reproductive Medicine (ASRM) classification. We used modified Poisson regression models adjusted for age (continuous), race (white, all other race/ethnicities), smoking status (serum cotinine >10 ng/mL), study site (Utah, California), and body mass index (continuous) to obtain relative risks (RR) of endometriosis diagnosis and 95% confidence intervals (CIs) for each PFAS. PFAS mixtures were evaluated using Bayesian kernel machine regression. Participants were, on average, 33±7 years old, and 75% of participants were non-Hispanic white. Of the 181 participants with an incident endometriosis diagnosis, 73% had ASRM stage 1 or 2, while 27% had stage 3 or 4. Median [interquartile range (IQR)] eutopic endometrium tissue levels, in nanograms per gram, were 6.58 (6.44) for PFOS, 1.93 (1.71) for PFOA, 0.65 (0.75) for PFHxS, 0.58 (0.52) for PFNA, and 0.12 (0.18) for PFOSA. PFAS in the endometrial tissue was not associated with endometriosis. However, select PFAS in the eutopic tissue were associated with a risk of more advanced (stage 3 or 4 vs. 1 or 2) endometriosis [PFOSA RR=1.25 (95% CI: 1.10, 1.43), PFHxS RR=1.37 (95% CI: 1.12, 1.68), PFOS RR=1.36 (95% CI: 1.02, 1.81)]. PFAS were widely detected in eutopic endometrial tissue. There was no evidence that PFAS in endometrial tissue were associated with a higher risk of endometriosis diagnosis. However, PFOS, PFOSA, and PFHxS in the endometrial tissue were associated with risk of more severe stage of endometriosis. https://doi.org/10.1289/EHP15852.
Abstract Per- and polyfluoroalkyl substances (PFAS), previously known as perfluorinated compounds (PFC), are a group of synthetic chemicals widely used over the past decades. Their extensive application, combined with their environmental persistence, has contributed to their ubiquitous presence in the environment and the associated toxicological risks. Regarding humans, blood serum testing remains the primary method for biomonitoring PFAS exposure, while breast milk has also been used due to the transfer of these substances from mothers to infants during lactation. This paper aims to review the scientific literature (using PubMed and Scopus databases) on PFAS concentrations in the breast milk of non-occupationally exposed women. Where available, the estimated daily intake of these compounds by breastfeeding infants is also examined. The reviewed studies are categorized by continent and country/region, revealing a significant lack of data for many countries, including both developed and developing nations. The findings indicate substantial variability in PFAS concentrations, influenced by factors such as geographic location, sampling year, and the specific PFAS analyzed. Among the identified compounds, perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) are most commonly detected, along with perfluorohexanesulfonic acid (PFHxS) and perfluorononanoic acid (PFNA), being the only PFAS with regulated maximum levels in certain foodstuffs. Most studies were conducted before the implementation of the current (updated) tolerable weekly intake (TWI) values for these substances. Consequently, the majority reported a low health risk for breastfeeding infants, even in high-intake scenarios. Nevertheless, biomonitoring studies are urgently needed in countries with limited or no data, and new investigations should assess whether current estimated intakes exceed the updated TWI. Special focus should be given to rural and industrial areas where exposure levels remain poorly understood.