Environmental Risk Factors for Endometriosis: a Critical Evaluation of Studies and Recommendations from the Epidemiologi
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REPRODUCTIVE AND PERINATAL EPIDEMIOLOGY (K FERGUSON, SECTION EDITOR)
Environmental Risk Factors for Endometriosis: a Critical Evaluation of Studies and Recommendations from the Epidemiologic Perspective Kristen Upson 1 Published online: 18 August 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review Recent studies of environmental chemicals and endometriosis were critically evaluated from the epidemiologic perspective to identify aspects of study design and analyses that may contribute to discrepant results across studies. Recent Findings Of the 29 studies reviewed, 12 studies used new approaches to population-based sampling. The remaining studies were conducted primarily among patients undergoing pelvic surgery; controls may not represent the exposure experience of the underlying study base, resulting in biased estimates of associations. Most studies used biologic specimens collected near diagnosis and varied in analytic approaches to minimize bias. Few studies investigated ovarian, deep-infiltrating, and peritoneal endometriosis presentations separately. Summary Recommendations to move the field forward include (1) control selection from a defined study base, (2) exposure characterization during the etiologically relevant window, (3) employment of best practices to minimize bias in analyses, and (4) separate consideration of endometriosis presentations that may be etiologically distinct entities. Keywords Endometriosis . Environment . Persistent organic pollutants . Phthalates . Bisphenol A . Metals
Introduction Endometriosis is characterized by the presence of endometrial glands and stroma outside the uterus, usually in the peritoneal cavity. Endometriosis is associated with substantial morbidity; women with endometriosis frequently report pain symptoms, including dysmenorrhea, chronic pelvic pain, and dyspareunia [1]. For many women, these symptoms can be chronic and debilitating, substantially interfering with all aspects of life— daily activities, work productivity, school performance, and personal relationships [2–5]. This serious condition is estimated to affect approximately 10% of reproductive-age women globally, although reported prevalence estimates vary widely
This article is part of the Topical Collection on Reproductive and Perinatal Epidemiology * Kristen Upson [email protected] 1
Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 Wilson Road, Room 601, East Lansing, MI, USA
[6]. This is due to surgical visualization being required to definitively diagnose the disease. The etiology of endometriosis is not well understood. Several theories have been hypothesized for disease pathogenesis which fall into two categories—in situ-based and transplantation-based theories (as reviewed by Lagana et al. [7••]). In situ-based theories hypothesize that endometrial-like stroma and glands originate from local tissues that undergo metaplasia or from cells of primitive endometrial tissue misplaced in utero, outside the expected area of Mülleria
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