Subscribe to RSS
DOI: 10.1055/s-0045-1802986
Examining the Impact of Environmental Non-Persistent Compounds: Phthalates, BPA, and Benzophenone on Endometriosis

Abstract
Endometriosis is a debilitating condition characterized by the growth of endometrial-like tissue outside the uterus, leading to chronic pain and inflammation. While its etiology remains complex, emerging evidence implicates environmental contaminants as potential contributors. This review explores the roles of endocrine-disrupting chemicals such as phthalates, bisphenol A (BPA), and benzophenone-like ultraviolet (UV) filters in the development and progression of endometriosis. These chemicals, commonly found in everyday products such as plastics, personal care items, and sunscreen, can mimic or interfere with hormonal functions, disrupting the hormonal balance essential for reproductive health. This review included 18 peer-reviewed studies on phthalates, BPA, and UV filters from 2003 to 2023. Evidence for UV filters was inconclusive, with only two studies available. BPA was positively associated with endometriosis in four out of seven studies. Phthalates were associated with a greater odds of endometriosis in five studies, and with a reduced odds in one study, while three studies found no association with endometriosis. This underscores the need for further research with improved timing of exposure measurement. Understanding the role of phthalates, BPA, and UV filters on endometriosis is crucial for developing effective prevention strategies, potentially reducing the burden of endometriosis.
Keywords
endometriosis - environmental contaminants - bisphenol A - benzophenones - endocrine-disrupting chemicalsPublication History
Article published online:
10 March 2025
© 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Kennedy S, Bergqvist A, Chapron C. et al; ESHRE Special Interest Group for Endometriosis and Endometrium Guideline Development Group. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 2005; 20 (10) 2698-2704
- 2 Buck Louis GM, Peterson CM, Chen Z. et al. Bisphenol A and phthalates and endometriosis: the Endometriosis: Natural History, Diagnosis and Outcomes Study. Fertil Steril 2013; 100 (01) 162-9.e1 , 2
- 3 Culley L, Law C, Hudson N, Mitchell H, Denny E, Raine-Fenning N. A qualitative study of the impact of endometriosis on male partners. Hum Reprod 2017; 32 (08) 1667-1673
- 4 Bulletti C, Coccia ME, Battistoni S, Borini A. Endometriosis and infertility. J Assist Reprod Genet 2010; 27 (08) 441-447
- 5 Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet 2021; 397 (10276): 839-852
- 6 Nnoaham KE, Hummelshoj L, Webster P. et al; World Endometriosis Research Foundation Global Study of Women's Health Consortium. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril 2011; 96 (02) 366-373.e8
- 7 De Graaff AA, D'Hooghe TM, Dunselman GA, Dirksen CD, Hummelshoj L, Simoens S. WERF EndoCost Consortium. The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey. Hum Reprod 2013; 28 (10) 2677-2685
- 8 Lamceva J, Uljanovs R, Strumfa I. The main theories on the pathogenesis of endometriosis. Int J Mol Sci 2023; 24 (05) 4254
- 9 Wolff EF, Sun L, Hediger ML. et al. In utero exposures and endometriosis: the Endometriosis, Natural History, Disease, Outcome (ENDO) Study. Fertil Steril 2013; 99 (03) 790-795
- 10 Konieczna A, Rutkowska A, Rachoń D. Health risk of exposure to Bisphenol A (BPA). Rocz Panstw Zakl Hig 2015; 66 (01) 5-11
- 11 Ahn C, Jeung EB. Endocrine-disrupting chemicals and disease endpoints. Int J Mol Sci 2023; 24 (06) 5342
- 12 Vandenberg LN, Colborn T, Hayes TB. et al. Hormones and endocrine-disrupting chemicals: low-dose effects and nonmonotonic dose responses. Endocr Rev 2012; 33 (03) 378-455
- 13 Healy BF, English KR, Jagals P, Sly PD. Bisphenol A exposure pathways in early childhood: reviewing the need for improved risk assessment models. J Expo Sci Environ Epidemiol 2015; 25 (06) 544-556
- 14 Vandenberg LN, Hauser R, Marcus M, Olea N, Welshons WV. Human exposure to bisphenol A (BPA). Reprod Toxicol 2007; 24 (02) 139-177
- 15 Takeuchi T, Tsutsumi O, Ikezuki Y. et al. Elevated serum bisphenol A levels under hyperandrogenic conditions may be caused by decreased UDP-glucuronosyltransferase activity. Endocr J 2006; 53 (04) 485-491
- 16 Yovich JL, Rowlands PK, Lingham S, Sillender M, Srinivasan S. Pathogenesis of endometriosis: look no further than John Sampson. Reprod Biomed Online 2020; 40 (01) 7-11
- 17 Koninckx PR, Ussia A, Adamyan L, Wattiez A, Gomel V, Martin DC. Pathogenesis of endometriosis: the genetic/epigenetic theory. Fertil Steril 2019; 111 (02) 327-340
- 18 Bulun SE. Endometriosis. N Engl J Med 2009; 360 (03) 268-279
- 19 Hayashi K, Nakayama M, Iwatani C. et al. The natural history of spontaneously occurred endometriosis in cynomolgus monkeys by monthly follow-up laparoscopy for two years. Tohoku J Exp Med 2020; 251 (04) 241-253
- 20 Chantalat E, Valera MC, Vaysse C. et al. Estrogen receptors and endometriosis. Int J Mol Sci 2020; 21 (08) 2815
- 21 Missmer SA, Tu FF, Agarwal SK. et al. Impact of endometriosis on life-course potential: a narrative review. Int J Gen Med 2021; 14: 9-25
- 22 Weiss JM, Gustafsson Å, Gerde P, Bergman Å, Lindh CH, Krais AM. Daily intake of phthalates, MEHP, and DINCH by ingestion and inhalation. Chemosphere 2018; 208: 40-49
- 23 Dutta S, Haggerty DK, Rappolee DA, Ruden DM. Phthalate exposure and long-term epigenomic consequences: a review. Front Genet 2020; 11: 405
- 24 Guo Y, Wu Q, Kannan K. Phthalate metabolites in urine from China, and implications for human exposures. Environ Int 2011; 37 (05) 893-898
- 25 Meeker JD, Sathyanarayana S, Swan SH. Phthalates and other additives in plastics: human exposure and associated health outcomes. Philos Trans R Soc Lond B Biol Sci 2009; 364 (1526): 2097-2113
- 26 Cobellis L, Colacurci N, Trabucco E, Carpentiero C, Grumetto L. Measurement of bisphenol A and bisphenol B levels in human blood sera from healthy and endometriotic women. Biomed Chromatogr 2009; 23 (11) 1186-1190
- 27 Kunisue T, Chen Z, Buck Louis GM. et al. Urinary concentrations of benzophenone-type UV filters in U.S. women and their association with endometriosis. Environ Sci Technol 2012; 46 (08) 4624-4632
- 28 Smarr MM, Kannan K, Buck Louis GM. Endocrine disrupting chemicals and endometriosis. Fertil Steril 2016; 106 (04) 959-966
- 29 Wen X, Xiong Y, Qu X. et al. The risk of endometriosis after exposure to endocrine-disrupting chemicals: a meta-analysis of 30 epidemiology studies. Gynecol Endocrinol 2019; 35 (08) 645-650
- 30 Kim SH, Chun S, Jang JY, Chae HD, Kim CH, Kang BM. Increased plasma levels of phthalate esters in women with advanced-stage endometriosis: a prospective case-control study. Fertil Steril 2011; 95 (01) 357-359
- 31 Ghazipura M, McGowan R, Arslan A, Hossain T. Exposure to benzophenone-3 and reproductive toxicity: a systematic review of human and animal studies. Reprod Toxicol 2017; 73: 175-183
- 32 Cobellis L, Latini G, De Felice C. et al. High plasma concentrations of di-(2-ethylhexyl)-phthalate in women with endometriosis. Hum Reprod 2003; 18 (07) 1512-1515
- 33 Weuve J, Hauser R, Calafat AM, Missmer SA, Wise LA. Association of exposure to phthalates with endometriosis and uterine leiomyomata: findings from NHANES, 1999-2004. Environ Health Perspect 2010; 118 (06) 825-832
- 34 Upson K, Sathyanarayana S, De Roos AJ. et al. Phthalates and risk of endometriosis. Environ Res 2013; 126: 91-97
- 35 Reddy BS, Rozati R, Reddy BVR, Raman NVVSS. Association of phthalate esters with endometriosis in Indian women. BJOG 2006; 113 (05) 515-520
- 36 Itoh H, Iwasaki M, Hanaoka T, Sasaki H, Tanaka T, Tsugane S. Urinary phthalate monoesters and endometriosis in infertile Japanese women. Sci Total Environ 2009; 408 (01) 37-42
- 37 Reddy BS, Rozati R, Reddy S, Kodampur S, Reddy P, Reddy R. High plasma concentrations of polychlorinated biphenyls and phthalate esters in women with endometriosis: a prospective case control study. Fertil Steril 2006; 85 (03) 775-779
- 38 Kim SH, Cho S, Ihm HJ. et al. Possible role of phthalate in the pathogenesis of endometriosis: in vitro, animal, and human data. J Clin Endocrinol Metab 2015; 100 (12) E1502-E1511
- 39 Lee AW, Eata V. Association of environmental phenols with endometriosis and uterine leiomyoma: an analysis of NHANES, 2003-2006. Reprod Toxicol 2022; 113: 30-34
- 40 Rashidi BH, Amanlou M, Lak TB, Ghazizadeh M, Eslami B. A case-control study of bisphenol A and endometrioma among subgroup of Iranian women. J Res Med Sci 2017; 22: 7
- 41 Upson K, Sathyanarayana S, De Roos AJ, Koch HM, Scholes D, Holt VL. A population-based case-control study of urinary bisphenol A concentrations and risk of endometriosis. Hum Reprod 2014; 29 (11) 2457-2464
- 42 Peinado FM, Lendínez I, Sotelo R. et al. Association of urinary levels of bisphenols A, F, and S with endometriosis risk: preliminary results of the EndEA study. Int J Environ Res Public Health 2020; 17 (04) 1194
- 43 Requadt E, Nahlik AJ, Jacobsen A, Ross WT. Patient experiences of endometriosis diagnosis: a mixed methods approach. BJOG 2024; 131 (07) 941-951
- 44 Gore AC, Chappell VA, Fenton SE. et al. EDC-2: the Endocrine Society's second scientific statement on endocrine-disrupting chemicals. Endocr Rev 2015; 36 (06) E1-E150