Abstract
Objective: The association between phthalates and endometriosis risk is inconclusive. This meta-analysis aims to evaluate the association between five different phthalate metabolites and endometriosis, based on current evidence. Methods: The literature included PubMed, WOS (web of science), and EMBASE, published until 3 March 2019. We selected the related literature and evaluated the relationship between phthalates exposure and endometriosis risk. All statistical analyses were conducted with STATA version 12.0. Results: Data from eight studies were used in this review. The results of this analysis showed that mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) exposure was potentially associated with endometriosis (OR = 1.246, 95% CI = 1.003–1.549). We have not found positive results in mono(2-ethylhexyl) phthalate (MEHP), monoethyl phthalate (MEP), monobenzyl phthalate (MBzP) and mono(2-ethyl-5-oxohexyl) phthalate (MEOHP) analyses (MEHP: OR = 1.089, 95% CI = 0.858–1.383; MEP: OR = 1.073, 95% CI = 0.899–1.282; MBzP: OR = 0.976, 95% CI = 0.810–1.176; MEOHP: OR = 1.282, 95% CI = 0.874–1.881). In subgroup analyses for regions, the associations were significant between MEHHP and endometriosis in Asia (OR = 1.786, 95% CI = 1.005–3.172, I² = 0%), but not in USA (OR = 1.170, 95% CI = 0.949–1.442, I² = 45.6%). Conclusions: Our findings suggested a potential statistical association between MEHHP exposure and endometriosis, particularly, the exposure of MEHHP might be a potential risk for women with endometriosis in Asia. However, positive associations between the other four Phthalate acid esters (PAEs) and endometriosis was not found. Given the weak strength of the results, well-designed cohort studies, with large sample sizes, should be performed in future.
Highlights
Phthalate acid esters (PAEs) are mainly composed of dialkyl esters, or alkyl and aryl esters of orthophthalic acid (1,2-dicarboxylic acid) [1,2]
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
We included studies according to the following criteria: (1) Papers investigated phthalates and their metabolites; (2) one outcome was endometriosis; (3) cohort, case-control or cross-sectional studies; (4) odds ratio (OR) or relative risk (RR) were offered for the associations between phthalate exposure and endometriosis; (5) published in English
Summary
Phthalate acid esters (PAEs) are mainly composed of dialkyl esters, or alkyl and aryl esters of orthophthalic acid (1,2-dicarboxylic acid) [1,2]. They affect human health to some extent, while some of them disrupt endocrine function and alter hormone activity in animals [3,4]. A number of studies have been conducted to explore the relationship between reproductive problems in humans and PAEs [9,10]. Studies have shown that women are more likely to be exposed to PAEs through products such as perfume, cosmetics, and personal care products [11,12]. Recent studies have shown that PAEs may have a certain influence on
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