From Plastic to Pelvis: Two Decades of Evidence on Bisphenol A and Endometriosis in Indonesia’s Online Food Delivery Era

Abstract: Endometriosis is an estrogen-dependent inflammatory disorder that may be influenced by bisphenol A (BPA), an endocrine-disrupting chemical commonly found in food-contact plastics. BPA has been implicated in altered steroidogenesis, immune dysregulation, oxidative stress, and epigenetic modifications associated with ectopic endometrial growth. In Indonesia, the rapid expansion of app-based online food delivery (OFD), which heavily relies on single-use plastic packaging, has raised concerns regarding dietary BPA exposure. This narrative review synthesizes evidence linking BPA to endometriosis and explores OFD-related plastic exposure in Indonesia within the broader Asian context over the past two decades. A narrative search of PubMed, Google Scholar, and manual sources identified English-language peer-reviewed studies published between 2005 and 2025 addressing BPA, endometriosis, food-contact plastics, dietary exposure, and OFD practices in Indonesia and Asia. Of 57 screened articles, 47 full texts were reviewed, including 18 primary studies focusing on clinical outcomes, biomarker assessment, and BPA migration from packaging materials. Mechanistic evidence demonstrates that BPA interacts with estrogen receptors and promotes pathways associated with ectopic endometrial proliferation. Epidemiological studies frequently report higher urinary or serum BPA levels among women with endometriosis, although findings remain heterogeneous. Dietary intake represents a major exposure route, particularly when plastics are exposed to heat, fat, and prolonged contact time. Indonesia’s OFD practices, including excessive plastic packaging and sealing methods, may further increase unnecessary exposure. Limitations include the narrative design, language restriction, and reliance on animal-based evidence. Overall, current evidence supports the need for safer food-packaging practices, public education, and region-specific biomonitoring studies to better define BPA-related risks and inform public health policy. Keywords: bisphenol A, endometriosis, online food delivery