title: Phthalates and risk of endometriosis.
abstract: BACKGROUND
  Phthalates are ubiquitous environmental chemicals with endocrine disruptive properties. The impact of these chemicals on endocrine-related disease in reproductive-age women is not well understood.
  
  
  OBJECTIVE
  To investigate the relationship between urinary phthalate metabolite concentrations and the risk of a hormonally-driven disease, endometriosis, in reproductive-age women.
  
  
  METHODS
  We used data from a population-based case-control study of endometriosis, conducted among female enrollees of a large healthcare system in the U.S. Pacific Northwest. We measured urinary phthalate metabolite concentrations on incident, surgically-confirmed cases (n=92) diagnosed between 1996 and 2001 and population-based controls (n=195). Odds ratios (OR), and 95% confidence intervals (CI) were estimated using unconditional logistic regression, adjusting for urinary creatinine concentrations, age, and reference year.
  
  
  RESULTS
  The majority of women in our study had detectable concentrations of phthalate metabolites. We observed a strong inverse association between urinary mono-(2-ethyl-5-hexyl) phthalate (MEHP) concentration and endometriosis risk, particularly when comparing the fourth and first MEHP quartiles (aOR 0.3, 95% CI: 0.1-0.7). Our data suggested an inverse association between endometriosis and urinary concentrations of other di-2-ethylhexyl phthalate (DEHP) metabolites (mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP)) and ∑DEHP, however, the confidence intervals include the null. Our data also suggested increased endometriosis risk with greater urinary concentrations of mono-benzyl phthalate (MBzP) and mono-ethyl phthalate (MEP), although the associations were not statistically significant.
  
  
  CONCLUSIONS
  Exposure to select phthalates is ubiquitous among female enrollees of a large healthcare system in the U.S. Pacific Northwest. The findings from our study suggest that phthalates may alter the risk of a hormonally-mediated disease among reproductive-age women.
authors.affiliation: Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. Electronic address: kupson@u.washington.edu.
authors.forename: Kristen
authors.initials: K
authors.lastname: Upson
authors.forename: Sheela
authors.initials: S
authors.lastname: Sathyanarayana
authors.forename: Anneclaire J
authors.initials: AJ
authors.lastname: De Roos
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Thompson
authors.forename: Delia
authors.initials: D
authors.lastname: Scholes
authors.forename: Russell
authors.initials: R
authors.lastname: Dills
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Holt
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D052244:Endocrine Disruptors / Q000009:adverse effects* / Q000652:urine; D004715:Endometriosis / Q000139:chemically induced*; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D015205:Northwestern United States; D010795:Phthalic Acids / Q000009:adverse effects* / Q000652:urine; D055815:Young Adult
chemical_list: D052244:Endocrine Disruptors; D010795:Phthalic Acids; C032279:phthalic acid
keywords: BMI; BzBP; CI; DAG; DBP; DEHP; DEP; Endometriosis; Environmental health; Epidemiology; GH; GM; Group Health; LOQ; MBzP; MECPP; MEHHP; MEHP; MEOHP; MEP; MiBP; MnBP; NHANES; National Health and Nutrition and Evaluation Survey; OR; POPs; Persistent Organic Pollutants and endometriosis risk study; Phthalate; Population-based case-control study; WREN; Women's Risk of Endometriosis study; benzyl butyl phthalate; body mass index; confidence interval; di-(2-ethylhexyl) phthalate; dibutyl phthalate; diethyl phthalate; directed acyclic graph; geometric mean; limit of quantitation; mono-(2-ethyl-5-carboxypentyl) phthalate; mono-(2-ethyl-5-hexyl) phthalate; mono-(2-ethyl-5-hydroxyhexyl) phthalate; mono-(2-ethyl-5-oxohexyl) phthalate; mono-benzyl phthalate; mono-ethyl phthalate; mono-iso-butyl phthalate; mono-n-butyl phthalate; odds ratio
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