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Perfluorochemicals and Endometriosis: The ENDO Study

Louis, Germaine M. Bucka; Peterson, C. Matthewb; Chen, Zhena; Hediger, Mary L.a; Croughan, Mary S.c,d; Sundaram, Rajeshwaria; Stanford, Joseph B.e; Fujimoto, Victor Y.c; Varner, Michael W.f; Giudice, Linda C.c; Kennedy, Anneg; Sun, Lipinga; Wu, Qianh,i; Kannan, Kurunthachalamh,i

doi: 10.1097/EDE.0b013e31826cc0cf
Women's Health

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.

From the aDivisions of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Health, Rockville, MD; bDivision Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT; cDepartment of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA and dDepartment of Epidemiology and Biostatistics, University of California, San Francisco, CA; eDepartment of Family and Preventive Medicine, University of Utah, Salt Lake City, UT; fDivision of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT; gDepartment of Radiology, University of Utah, Salt Lake City, UT; hDivision of Environmental Health Sciences, Wadsworth Center, New York State, NY; and iDepartment of Health and Environmental Health Sciences, The University at Albany, Albany, NY.

Submitted 29 November 2011; accepted 20 April 2012; posted 18 September 2012.

Supported by the Intramural Research Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (contracts NO1-DK-6–3428; NO1-DK-6–3427; 10001406-02; 10001406-02).

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article (www.epidem.com). This content is not peer-reviewed or copy-edited; it is the sole responsibility of the author.

Correspondence: Germaine M. Buck Louis, Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Health, 6100 Executive Blvd.; Room 7B03, Rockville, MD 20852. E-mail: louisg@mail.nih.gov.

© 2012 Lippincott Williams & Wilkins, Inc.