Environmental exposures to endocrine disrupting chemicals (EDCs) and their role in endometriosis: a systematic literature review

Rev Environ Health. 2020 Sep 9;36(1):101-115. doi: 10.1515/reveh-2020-0046. Print 2021 Mar 26.


Purpose: Endocrine-related diseases and disorders are on the rise globally. Synthetically produced environmental chemicals (endocrine-disrupting chemicals (EDCs)) mimic hormones like oestrogen and alter signalling pathways. Endometriosis is an oestrogen-dependent condition, affecting 10-15% of women of the reproductive age, and has substantial impacts on the quality of life. The aetiology of endometriosis is believed to be multifactorial, ranging from genetic causes to immunologic dysfunction due to environmental exposure to EDCs. Hence, we undertook a systematic review and investigated the epidemiological evidence for an association between EDCs and the development of endometriosis. We also aimed to assess studies on the relationship between body concentration of EDCs and the severity of endometriosis.

Method: Following PRISMA guidelines, a structured search of PubMed, Embase and Scopus was conducted (to July 2018). The included studies analysed the association between one or more EDCs and the prevalence of endometriosis. The types of EDCs, association and outcome, participant characteristics and confounding variables were extracted and analysed. Quality assessment was performed using standard criteria.

Results: In total, 29 studies were included. Phthalate esters were positively associated with the prevalence of endometriosis. The majority (71%) of studies revealed a significant association between bisphenol A, organochlorinated environmental pollutants (dioxins, dioxin-like compounds, organochlorinated pesticides, polychlorinated biphenyls) and the prevalence of endometriosis. A positive association between copper, chromium and prevalence of endometriosis was demonstrated in one study only. Cadmium, lead and mercury were not associated with the prevalence of endometriosis. There were conflicting results for the association between nickel and endometriosis. The relationship of EDCs and severity of endometriosis was not established in the studies.

Conclusion: We found some evidence to suggest an association between phthalate esters, bisphenol A, organochlorinated environmental pollutants and the prevalence of endometriosis. Disentangling these exposures from various other factors that affect endometriosis is complex, but an important topic for further research.

Keywords: PCB; bisphenol A; dioxins; endocrine disrupting chemicals; endometriosis; gynaecology; organochlorinated environmental pollutants; phthalates.

Publication types

  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Endocrine Disruptors / adverse effects*
  • Endometriosis / chemically induced
  • Endometriosis / epidemiology*
  • Endometriosis / pathology
  • Environmental Exposure / adverse effects*
  • Environmental Pollutants / adverse effects*
  • Female
  • Humans
  • Middle Aged
  • Prevalence
  • Young Adult


  • Endocrine Disruptors
  • Environmental Pollutants