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.
Highlights
Endometriosis is a gynecological disorder characterized by the growth of endometrial-like tissue outside the uterine cavity, e.g., on fallopian tubes, ovaries, peritoneal wall, and/or intestine [1]
This study in women of childbearing age reveals a relationship between inadvertent exposure to bisphenols and the risk of endometriosis, which was greater in the women with higher urinary concentrations of bisphenols A (BPA) and Σbisphenols
The hypothesis that exposure to bisphenols may enhance the risk of endometriosis risk is biologically plausible, as mentioned above
Summary
Endometriosis is a gynecological disorder characterized by the growth of endometrial-like tissue outside the uterine cavity, e.g., on fallopian tubes, ovaries, peritoneal wall, and/or intestine [1]. This ectopic endometrium is sensitive to hormonal signaling, usually undergoing histological changes along the menstrual cycle, which leads to such symptoms as dysmenorrhea, dyspareunia, chronic pelvic pain, and menstrual irregularities [2]. Endometriosis is considered to be one of the most frequent pathologic conditions in women, despite the absence of national registries and the numerous women with this disease who are free of symptoms. There is a scarcity of information regarding prevalence or incidence of endometriosis in Spain
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