Trace elements and endometriosis: the ENDO study

Anna Z Pollack; Germaine M Buck Louis; Zhen Chen; C Matthew Peterson; Rajeshwari Sundaram; Mary S Croughan; Liping Sun; Mary L Hediger; Joseph B Stanford; Michael W Varner; Christopher D Palmer; Amy J Steuerwald; Patrick J Parsons

doi:10.1016/j.reprotox.2013.05.009

Lifestyle and Environment Environmental Exposures

Trace elements and endometriosis: the ENDO study

Pollack AZ, Louis GMB, Chen Z, Peterson CM, Sundaram R, Croughan MS, Sun L, Hediger ML, Stanford JB, Varner MW, Palmer CD, Steuerwald AJ, Parsons PJ

Published December 2013 Reproductive toxicology (Elmsford, N.Y.), 42, 41-48

DOI 10.1016/j.reprotox.2013.05.009 PMID 23892002 PMC PMC3836840

RRM Academy Synopsis

Only 3 of 20 trace elements linked to endometriosis in surgical women

Three of 20 trace elements were linked to endometriosis in women having surgery. The study matched 473 women aged 18 to 44. No element was linked to endometriosis in women from the general population.

Study at a glance, matched cohort design: Only 3 of 20 trace elements were linked to endometriosis in surgical women — Study at a glance, matched cohort design of 473 women: Only 3 of 20 trace elements were linked to endometriosis in surgical women. Source: Pollack AZ et al., 2013, PMID 23892002.

Key Findings

In the operative cohort, 190 of 473 women had surgically visualized endometriosis. In the population cohort, 14 of 127 women had endometriosis diagnosed by magnetic resonance imaging.
Blood cadmium in the highest third of levels, compared with the lowest third, was associated with reduced odds of diagnosis in the operative cohort (aOR=0.55; 95% CI: 0.31, 0.98).
In the operative cohort, urinary chromium (second versus lowest third; aOR=1.97; 95% CI: 1.21, 3.19) and copper (highest versus lowest third; aOR=2.66; 95% CI: 1.26, 5.64) were associated with increased odds.
Grouped in thirds and modeled together, cadmium (aOR=0.52; 95% CI: 0.29, 0.93) stayed associated with lower odds and chromium (aOR=2.32; 95% CI: 1.42, 3.79) with higher odds.
Modeled as continuous measures, no element was associated with endometriosis in either cohort. Population cohort results showed no significant associations.

Interpretation

This study followed women aged 18 to 44 in Utah and California. Some women came from surgery clinics. Others came from the general population. Three of 20 trace elements were linked to endometriosis in the surgery group. The links showed up only after levels were split into thirds. In the combined model, chromium odds were higher in the middle third, but not in the highest third. The authors note that MRI scans can miss mild endometriosis. The MRI limit may explain why the general population group showed no links. The findings support larger studies on how these trace elements relate to endometriosis.

RRM Context

Restorative reproductive medicine looks for the causes of endometriosis. Endometriosis risk factors are still largely unknown. Earlier studies on pesticides and other long-lasting chemicals gave mixed results. This study adds metals, measured in blood and urine, to that search. In the surgery group, doctors confirmed endometriosis by direct view during surgery.

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

Abstract

There has been limited study of trace elements and endometriosis. Using a matched cohort design, 473 women aged 18-44 years were recruited into an operative cohort, along with 131 similarly aged women recruited into a population cohort. Endometriosis was defined as surgically visualized disease in the operative cohort, and magnetic resonance imaging diagnosed disease in the population cohort. Twenty trace elements in urine and three in blood were quantified using inductively coupled plasma mass spectrometry. Logistic regression estimated the adjusted odds (aOR) of endometriosis diagnosis for each element by cohort. No association was observed between any element and endometriosis in the population cohort. In the operative cohort, blood cadmium was associated with a reduced odds of diagnosis (aOR=0.55; 95% CI: 0.31, 0.98), while urinary chromium and copper reflected an increased odds (aOR=1.97; 95% CI: 1.21, 3.19; aOR=2.66; 95% CI: 1.26, 5.64, respectively). The varied associations underscore the need for continued research.

Topics

Lifestyle and Environment

Environmental Exposures Heavy Metals

Lifestyle and Environment › Environmental Exposures › Heavy Metals

Anna Z Pollack, Germaine M Buck Louis, Zhen Chen, C Matthew Peterson, Rajeshwari Sundaram, Mary S Croughan, Liping Sun, Mary L Hediger, Joseph B Stanford, Michael W Varner, Christopher D Palmer, Amy J Steuerwald, Patrick J Parsons

A Pollack, G Louis, Z Chen, R Sundaram, M Croughan, L Sun, M Hediger, Joe Stanford, Joey Stanford, J Stanford, Mike Varner, M Varner, Chris Palmer, C Palmer, A Steuerwald, Pat Parsons, P Parsons

PMID 23892002 23892002 DOI 10.1016/j.reprotox.2013.05.009 10.1016/j.reprotox.2013.05.009 Pollack et al. 2013, Pollack 2013

Trace elements and endometriosis: the ENDO study

Only 3 of 20 trace elements linked to endometriosis in surgical women

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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