Association of Urinary Levels of Bisphenols A, F, and S with Endometriosis Risk: Preliminary Results of the EndEA Study

Abstract

Aim: The aim of this study was to explore associations of urinary concentrations of bisphenols A (BPA), S (BPS), and F (BPF) and of thiobarbituric acid reactive substances (TBARS) with the risk of endometriosis in women of childbearing age. Methods: This case–control study enrolled 124 women between January 2018 and July 2019: 35 women with endometriosis (cases) and 89 women without endometriosis undergoing abdominal surgery for other reasons (controls). Endometriosis was diagnosed (cases) or ruled out (controls) by laparoscopic inspection of the pelvis and the biopsy of suspected lesions (histological diagnosis). Fasting urine samples were collected before surgery to determine concentrations of BPA, BPS, BPF, and TBARS. Associations of bisphenol and TBARS concentrations with endometriosis risk were explored with multivariate logistic and linear regression analyses. Results: After adjustment for urinary creatinine, age, BMI, parity, and residence, endometriosis risk was increased with each 1 log unit of BPA [OR 1.5; 95%CI 1.0–2.3] and Σbisphenols [OR 1.5; 95%CI 0.9–2.3] but was not associated with the presence of BPS and BPF. Classification of the women by tertiles of exposure revealed statistically significant associations between endometriosis risk and the second tertile of exposure to BPA [OR 3.7; 95%CI 1.3–10.3] and Σbisphenols [OR 5.4; 95%CI 1.9–15.6]. In addition, TBARS concentrations showed a close-to-significant relationship with increased endometriosis risk [OR 1.6; 95%CI 1.0–2.8], and classification by TBARS concentration tertile revealed that the association between endometriosis risk and concentrations of BPA [OR 2.0; 95%CI 1.0–4.1] and Σbisphenols [OR 2.2; 95%CI 1.0–4.6] was only statistically significant for women in the highest TBARS tertile (>4.23 μM). Conclusion: Exposure to bisphenols may increase the risk of endometriosis, and oxidative stress may play a crucial role in this association. Further studies are warranted to verify these findings.

From Environmental to Possible Occupational Exposure to Risk Factors: What Role Do They Play in the Etiology of Endometriosis?

“…In the class of alkylphenols, octylphenol and nonylphenol are also represented. Bisphenol F and S have recently been used as substitutes for BPA, whose deleterious effects on health are starting to be known [ 23 ].…”

“… Bias assessment within articles [ 10 , 11 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. …”

Endocrine Disrupting Chemicals in Cosmetics and Personal Care Products and Risk of Endometriosis

“…Due to the suspected increase in the number of cases in the last decades [107], it is suspected that, in addition to the increased awareness among doctors and patients, environmental risk factors are suspected to also contribute to the onset and progression of this disease. This environmental hypothesis of the origin of the disease is also reinforced due to the estrogen-dependent nature of this pathology [53,108].…”

“…Although the underlying mechanisms are still poorly understood, it has been suggested that, at least in part, EDCs might induce oxidative stress via estrogen receptor-α signaling pathways [52]. Moreover, EDC exposure has also been evidenced to trigger an inflammatory microenvironment [50,53]. With an intimate relationship, both oxidative and inflammatory responses have also been suggested as crucial mechanisms beyond a variety of chronic diseases, as well as some gynecological conditions such as endometriosis [54,55].…”

Is There a Link between Bisphenol A (BPA), a Key Endocrine Disruptor, and the Risk for SARS-CoV-2 Infection and Severe COVID-19?

“…Furthermore, increasing evidence from both in vitro and animal studies suggest that BPA exposure, even at low doses, may have carcinogenic effects on breast cancer [ 48 ]. Moreover, BPA appears to increase the risk of endometriosis which, in turn, increases the risk of both coronary heart disease and ovarian cancer [ 49 , 50 ]. Finally, BPA exposure may induce endometrial stromal cell invasion and has a positive association with peritoneal endometriosis [ 51 ].…”