Perfluoroalkyl substances and endometriosis in US women in NHANES 2003-2006

Exposure to endocrine-active perfluoroalkyl substances (PFASs), is nearly ubiquitous, but data on the association between PFASs and endometriosis diagnosis are limited. We aimed to examine the relationship between PFASs and endometriosis. Women aged 20-50 years from the National Health and Nutrition Examination Survey (2003-2006) were selected (n=753). Serum PFAS levels were measured and endometriosis status was determined by self-report of doctor diagnosis. Weighted survey sampling logistic regression was used. Women reporting endometriosis were older (39.4 vs. 33.7 years), and more likely to be non-Hispanic white. Geometric mean levels of perfluorononanoic acid (PFNA), perfluorooctanoic acid (PFOA), and perfluorooctane sulfonate (PFOS) were significantly higher among women reporting endometriosis. Endometriosis was associated with select quartiles of PFOA, PFNA, and PFOS. Sensitivity analyses had similar results but wider confidence intervals. These findings suggest that PFOA, PFNA, and PFOS may be of interest in future studies with improved endometriosis diagnostic criteria and prospectively measured exposure.