Women’s Health
A case-control study of environmental chemical exposure and adenomyosis risk Kristen Upson* Kristen Upson Mandy Hall Kwalton Holly R. Harris Sawsan As-Sanie Victoria L. Holt
Adenomyosis, marked by endometrial glands and stroma within the myometrium, can confer debilitating symptoms. As estrogen is central to disease pathogenesis, environmental chemicals that are endocrine disruptive may alter adenomyosis risk. We investigated this hypothesis among female enrollees ages 18-59 of an integrated healthcare system in Washington State. Cases had incident, pathology-confirmed adenomyosis diagnosed 2001-2006 (n=386). We employed two control groups: randomly selected age-matched enrollees with intact uteri (“population controls”, n=323) and hysterectomy controls (n=233). Data on occupational and non-occupational exposure to chemical groups were collected by in-person interview. We conducted logistic regression to estimate adjusted ORs and 95% CIs, comparing cases to population and hysterectomy controls. Our data suggested increased adenomyosis risk with ever exposure to epoxy resins (cases vs. population controls: OR 1.8, 95%CI: 0.9-3.6; hysterectomy controls: OR 1.4, 95%CI: 0.7-2.9) and heavy metals (population controls: OR 1.5, 95%CI: 0.8-2.7; hysterectomy controls: OR 2.0, 95%CI: 1.0-4.1). Our data also suggested twice the risk of adenomyosis with lead exposure (population controls: OR 2.2, 95%CI: 0.8-6.3; hysterectomy controls: OR 2.0, 95%CI: 0.6-6.1); lead exposure mostly occurred from non-occupational sources (paint, home renovation, soldering, and stain glass work). The association with mercury exposure was inconsistent (cases vs. population controls: OR 1.1, 95%CI: 0.5-2.3; hysterectomy controls: OR 1.7, 95%CI: 0.7- 4.5). No association was observed with solvent exposure; results were inconclusive for exposure to herbicides, insecticides, fungicides, and rodenticides given few exposed participants. Results from our case-control study suggest that exposure to epoxy resins and heavy metals, particularly lead, are associated with increased adenomyosis risk. Given the exploratory nature of our analysis, further research is warranted.