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

Alessandro Conforti,Carlo Alviggi,Federica Cariati,Vincenzo Marrone,Vittorio Simeon,Ida Strina,Paolo Chiodini,Francesca Bagnulo,Luigi Carbone

doi:10.1007/s10815-021-02265-3

Abstract

PurposeEndometriosis is a chronic debilitating inflammatory pathology which interests females in their reproductive age. Its pathogenesis has not yet been clearly defined. Recent evidence linked chemical agents as endocrine-disrupting chemicals to endometriosis. Phthalates are a widely used class of such compounds. This study aimed to summarize the current literature evaluating the link between exposure to phthalates and occurrence of endometriosis.MethodsA systematic review of literature and meta-analysis has been carried out following PRISMA guidelines to assess such link. Fourteen studies have been included in the review. Risk of bias has been assessed through the Newcastle Ottawa Scale.ResultsWe observed association between endometriosis and increased urinary levels of MBP/MnBP, MEOHP, and MEHHP, but not for others. Blood-derived analysis showed statistically significant link between endometriosis and BBP, DEHP, DnBP, and MEHP.ConclusionGiven the wide heterogeneity of included studies, results should be taken with caution. Further studies with more rigorous methodology are encouraged to unravel the true link between this class of toxic compounds and manifestation of endometriosis.

Highlights

Endometriosis is one of the most frequent gynecological diseases, affecting 6–10% of women of reproductive age [1]
In a recent multicenter study, we demonstrated that phthalates accumulated in the serum and follicular fluid of women who underwent assisted reproductive techniques [23]
Study conduct adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [42] and the corresponding checklist is provided in the Supplementary Material

Summary

Introduction

Endometriosis is one of the most frequent gynecological diseases, affecting 6–10% of women of reproductive age [1]. Endometriosis is characterized by the presence of endometrial-like tissue outside the uterus that in turn provokes chronic pelvic inflammation [2,3,4,5]. Endometriosis involves extra-pelvic organs such as the gastrointestinal or urinary tracts [6]. Clinical manifestations are widely variable among patients and can include dysmenorrhea, chronic pelvic pain, dyspareunia, infertility, and bowel and/or urinary disorders when these organs are involved [7, 8]. In a recent multicenter study, we demonstrated that phthalates accumulated in the serum and follicular fluid of women who underwent assisted reproductive techniques [23]

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