Combined Exposure to Multiple Endocrine Disruptors and Uterine Leiomyomata and Endometriosis in US Women

Yuqing Zhang, Yingying Lu, Huiyuan Ma, Qing Xu, Xiaoli Wu
Frontiers in endocrinology · 2021 · vol. 12 , pp. 726876 · doi:10.3389/fendo.2021.726876 · PMID:34489871 · W3194741045
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This study analyzed the combined effects of multiple endocrine disruptors on uterine leiomyomata and endometriosis in US women using NHANES data, finding associations with specific chemicals and mixtures.

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

This study used NHANES 2001–2006 data from 1204 US women aged 20–54 years with measured urinary phthalate metabolites, whole-blood heavy metals, and equol, and assessed associations with self-reported uterine leiomyomata and endometriosis using multivariable logistic regression, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR). In single-chemical analyses, equol and mercury were positively associated with uterine leiomyomata, while mixture models identified a positive association between the overall exposure index and uterine leiomyomata; the mixture models also found MEHP negatively associated with uterine leiomyomata and a marginally positive WQS association with endometriosis that became significant in a premenopausal subgroup, with metabolite weights highlighted as MIBP and MBzP for endometriosis and MEHP for uterine leiomyomata. The authors note limitations including reliance on self-reported diagnoses and cross-sectional exposure assessment, which constrain causal inference. This paper is centrally about endometriosis and adenomyosis — it analyzes how combined exposure to endocrine-disrupting chemicals relates to endometriosis and uterine leiomyomata in US women.

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Abstract

Background: Uterine leiomyomata (UL) and endometriosis (EM) are common gynecological diseases damaging the reproductive health of fertile women. Among all the potential factors, environmental endocrine-disrupting chemicals are insufficiently addressed considering the multiple pollutants and mixture exposure. Methods: Women aged 20 to 54 years old in the National Health and Nutrition Examination Survey (NHANES) 2001-2006, having a complete measurement of ten commonly exposed endocrine-disrupting chemicals (including urinary phthalate metabolites, equol, and whole blood heavy metals) and answered questions about UL and EM were included (N=1204). Multivariable logistic regression model, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) models were implemented to analyze the combined effect of chemicals on the overall association with UL and EM. Results: . tertile 1. In WQS regression and BKMR models, the significant positive association between WQS index and UL (OR: 2.54, 95% CI: 1.52, 4.29) was identified and the positive relationship between equol and Hg exposure and UL were further verified. Besides, the mixture evaluation models (WQS and BKMR) also found MEHP negatively associated with UL. Although none of the single chemicals in tertile 3 were significantly associated with EM, the WQS index had a marginally positive association with EM (OR: 2.01, 95% CI: 0.98, 4.15), and a significant positive association was identified in subanalysis with participants restricted to premenopausal women (OR: 2.18, 95% CI: 1.03, 4.70). MIBP and MBzP weighted high in model of EM and MEHP weighted the lowest. Conclusion: Comparing results from these three statistical models, the associations between equol, Hg, and MEHP exposure with UL as well as the associations of MIBP, MBzP, and MEHP exposure with EM warrant further research.

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Condition tags

mesh:D004715endometriosis

MeSH descriptors

Endocrine Disruptors Endometriosis Environmental Exposure Leiomyoma Models, Statistical Nutrition Surveys Uterine Neoplasms Adult Bayes Theorem Cross-Sectional Studies Endocrine Disruptors Endometriosis Endometriosis Endometriosis Environmental Exposure Female Follow-Up Studies Humans Leiomyoma Leiomyoma

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