Send to

Choose Destination
Environ Res. 2013 Oct;126:91-7. doi: 10.1016/j.envres.2013.07.003. Epub 2013 Jul 25.

Phthalates and risk of endometriosis.

Author information

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:



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.


To investigate the relationship between urinary phthalate metabolite concentrations and the risk of a hormonally-driven disease, endometriosis, in reproductive-age women.


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.


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.


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.


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

[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center