Women diagnosed with endometriosis show high serum levels of diethyl hexyl phthalate

Abstract

Background:Endometriosis is one of the common causes of infertility with very diverse etiology. In modern lifestyle, humans are exposed to several endocrine-disrupting chemicals (EDCs) which may lead to reproductive disturbances. Diethyl hexyl phthalate (DEHP) is one of the common EDCs to which women are exposed by the use of cosmetics, perfumes, food packaging, medicine, and insecticides.Aim:The aim of this study was to measure the levels of DEHP in women diagnosed with endometriosis and healthy females and to compare these levels among different stages of endometriosis.Setting and Design:This descriptive study was conducted at a tertiary care hospital.Subjects and Methods:This study comprised of fifty women diagnosed with endometriosis, aged 20–40 years, and fifty age-matched healthy, fertile women without endometriosis. Females on any medication/comorbid conditions were excluded from the study. Serum DEHP concentrations were measured by high-performance liquid chromatography (HPLC). The results were expressed as means ± standard deviation (SD) (ng/ml of DEHP).Statistical Analysis:Data were analyzed using IBM-SPSS version 20. Two-sample Student's t-test and one-way ANOVA were applied for the analysis.Results:The mean ± SD value of DEHP in cases was 65.29 ± 21.69 ng/ml; however, the mean ± SD value of DEHP in controls was undetectable. Comparison of DEHP among stages of endometriosis revealed an increasing trend with advanced stages (III and IV). The values were not different between the two age groups of women with endometriosis (20–30 and 31–40 years).Conclusion:High levels of DEHP in women diagnosed with endometriosis suggest a role of phthalates in the etiology of endometriosis and permit careful use of such compounds.

Unravelling the link between phthalate exposure and endometriosis in humans: a systematic review and meta-analysis of the literature

“…Blood phthalate concentrations were quantified in seven studies [ 40 , 51 – 53 , 56 , 60 , 61 ]. BBP (SMD 1.26, 95% CI 0.10–2.42; p <0.05), DEHP (SMD 0.90, 95% CI 0.32–1.47; p <0.05), DnBP (SMD 0.49, 95% CI 0.29–0.69; p <0.05), and MEHP (SMD 2.26, 95% CI 0.43–4.09; p <0.05) were significantly higher in the endometriosis group compared to the control group (Figure 3 ).…”

“…The largest study was cross-sectional [ 54 ]. The method by which patients were diagnosed with endometriosis was not always specified [ 61 ], or alternatively the diagnosis was self-reported [ 54 ] or a diagnosis of endometriosis was excluded based on self-reported fertility [ 60 ]. Despite the argument that population cohorts are more representative for association studies [ 41 ], the diagnosis of endometriosis relies on histology and laparoscopy as gold standards and therefore it appears difficult to overcome the risk of misclassification of controls in population cohorts.…”

Association between Phthalate Metabolites and Risk of Endometriosis: A Meta-Analysis

“…But the effects of phthalates on humans, especially reproductive development, are unproven [30,38]. However, whether the exposure to phthalates affects estrogen-related diseases, such as endometriosis, has not been addressed [14,15,16]. So our meta-analysis, which is a quantitative assessment of published data on the role of phthalates in endometriosis, was conducted to find a clear relationship between five different phthalates and endometriosis.…”

“…Because endometriosis is a common chronic gynaecological disorder associated with pelvic pain and infertility [13], it was important to explore the relationship between PAEs and endometriosis. Although, recent studies have shown that PAEs may have a certain influence on the development of endometriosis [14,15,16,17,18,19], there are also studies that disagree or suggest a lack of consistency in their results [20,21]. In addition, there are a wide variety of PAE metabolites, and their relationship with endometriosis is inconsistent [20,22,23].…”

Update about the disrupting‐effects of phthalates on the human reproductive system

“…(2018) reported higher levels of DEHP in women with endometriosis compared to the control group (Nazir et al, 2018). In the same year, Pednekar et al (2018) also evaluated the phthalate metabolites in plasma samples of both fertile and infertile women (diagnosed with endometriosis or polycystic ovary syndrome [PCOS]).…”