Exposure to Phthalate Esters and the Risk of Endometriosis

Ju Hee Kim, Sung Hoon Kim
Development & reproduction · 2020 · vol. 24(2) , pp. 71–78 · doi:10.12717/dr.2020.24.2.71 · PMID:32734124 · PMC7375982 · W3044798003
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This review synthesizes cell culture, animal model, and human data to examine the potential role of phthalate ester exposure in the pathogenesis and risk of endometriosis.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This review evaluates evidence that exposure to phthalate esters, especially DEHP and its metabolite MEHP, may contribute to endometriosis development by combining in vitro, animal, and human studies. Across cell culture experiments, DEHP was reported to increase endometrial/uterine stromal cell viability, oxidative stress (ROS and antioxidant enzyme downregulation), MAPK/NF-κB signaling, and pro-endometriotic markers including MMP activity and invasiveness, with an acknowledged need for further mechanistic clarification. In animal models, DEHP exposure increased human endometrial lesion volume in ovariectomized mice and altered uterine/endometrial cell proliferation and steroid receptor localization in additional studies, though some models were not directly focused on endometriosis. In human data from plasma and peritoneal fluid studies, DEHP and/or MEHP were higher in women with endometriosis compared with controls, but limitations include exclusion of minimal/mild disease and exclusion of patients with minimal or mild endometriosis and adenomyosis in the prospective case-control study. This paper is centrally about endometriosis — specifically, it synthesizes evidence linking phthalate (DEHP/MEHP) exposure to endometriosis risk and mechanisms across experimental models.

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Abstract

Endometriosis is a common gynecologic disease, worldwide, whose true prevalence is uncertain because it is a difficult disease to diagnose. Endometriosis is a common cause of chronic pelvic pain, dysmenorrhea, and infertility, and is also associated with ovarian cancer. Although the risk factors for endometriosis are unclear, there is increasing evidence that exposure to environmental contaminants, especially phthalates, could affect the pathogenesis of endometriosis. Phthalates are industrial chemicals, used to make flexible plastics, and are present in numerous common plastic products, including medical devices and materials. Several in vitro studies have suggested a positive association between exposure to phthalate, or phthalate metabolites, and the risk of endometriosis. Since the 2000s, studies based on human plasma and urinary concentrations of various phthalate metabolites have been published, but there are still limitations to our understanding of the pathophysiology of phthalates and endometriosis. This report aims to review the current state of knowledge about a possible role of phthalates in the pathogenesis of endometriosis based on cell culture, animal models, and human data.

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Condition tags

endometriosischronic_pelvic_paindysmenorrheainfertility

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