Environmental exposures to endocrine disrupting chemicals (EDCs) and their role in endometriosis: a systematic literature review

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Environmental exposures to endocrine disrupting chemicals (EDCs) and their role in endometriosis: a systematic literature review

Sirohi et al., 2021 | Rev Environ Health | Systematic Review

Citation

Sirohi Diksha, Al Ramadhani Ruqaiya, Knibbs Luke D. Environmental exposures to endocrine disrupting chemicals (EDCs) and their role in endometriosis: a systematic literature review. Rev Environ Health. 2021-Mar-26;36(1):101-115. doi:10.1515/reveh-2020-0046

Abstract

PURPOSE: Endocrine-related diseases and disorders are on the rise globally. Synthetically produced environmental chemicals (endocrine-disrupting chemicals (EDCs)) mimic hormones like oestrogen and alter signalling pathways. Endometriosis is an oestrogen-dependent condition, affecting 10-15% of women of the reproductive age, and has substantial impacts on the quality of life. The aetiology of endometriosis is believed to be multifactorial, ranging from genetic causes to immunologic dysfunction due to environmental exposure to EDCs. Hence, we undertook a systematic review and investigated the epidemiological evidence for an association between EDCs and the development of endometriosis. We also aimed to assess studies on the relationship between body concentration of EDCs and the severity of endometriosis. METHOD: Following PRISMA guidelines, a structured search of PubMed, Embase and Scopus was conducted (to July 2018). The included studies analysed the association between one or more EDCs and the prevalence of endometriosis. The types of EDCs, association and outcome, participant characteristics and confounding variables were extracted and analysed. Quality assessment was performed using standard criteria. RESULTS: In total, 29 studies were included. Phthalate esters were positively associated with the prevalence of endometriosis. The majority (71%) of studies revealed a significant association between bisphenol A, organochlorinated environmental pollutants (dioxins, dioxin-like compounds, organochlorinated pesticides, polychlorinated biphenyls) and the prevalence of endometriosis. A positive association between copper, chromium and prevalence of endometriosis was demonstrated in one study only. Cadmium, lead and mercury were not associated with the prevalence of endometriosis. There were conflicting results for the association between nickel and endometriosis. The relationship of EDCs and severity of endometriosis was not established in the studies. CONCLUSION: We found some evidence to suggest an association between phthalate esters, bisphenol A, organochlorinated environmental pollutants and the prevalence of endometriosis. Disentangling these exposures from various other factors that affect endometriosis is complex, but an important topic for further research.

Key Findings

In total, 29 studies were included. Phthalate esters were positively associated with the prevalence of endometriosis. The majority (71%) of studies revealed a significant association between bisphenol A, organochlorinated environmental pollutants (dioxins, dioxin-like compounds, organochlorinated pesticides, polychlorinated biphenyls) and the prevalence of endometriosis. A positive association between copper, chromium and prevalence of endometriosis was demonstrated in one study only. Cadmium, l

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 29
Age Range See abstract
Condition See abstract

MeSH Terms

  • Adult
  • Aged
  • Endocrine Disruptors
  • Endometriosis
  • Environmental Exposure
  • Environmental Pollutants
  • Female
  • Humans
  • Middle Aged
  • Prevalence
  • Young Adult

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Journal Article, Systematic Review
  • Vertical: chromium

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09