**Author details**

*Endometriosis*

been addressed yet.

**4. Conclusions**

**Acknowledgements**

**Conflict of interest**

granted to N. Olea (INT18/00060).

The authors declare no conflict of interest.

Other EDCs found in cosmetics and PCPs are phthalates. Several studies have explored the existing associations between exposure to these chemicals and endometriosis, showing conflicting results. One of the very first investigations reported higher concentrations of phthalates in women with a confirmed diagnosis of endometriosis [118]. Similarly, two studies evidenced an increased risk of endometriosis in women with higher levels of mono (2-ethylhexyl) phthalate [111, 119]. Conversely, few studies did not found any association between levels of urinary levels of any phthalate congener and enhanced risk for endometriosis [112, 120–122]. Currently, there are no studies that have explored the possible contribution of other EDCs released from cosmetics and PCPs (such as parabens, oxycinnamates, camphenes, and dimethicones) and the risk of endometriosis. Moreover, the combined effect of EDCs released from these products on endometriosis has not

To date, there is still very limited evidence on the potential role of EDCs released

from cosmetics and PCPs on the origin and development of endometriosis. In general terms, *in vitro*, *in vivo,* and epidemiological evidence is consistent with the endocrine-disrupting hypothesis set out in this chapter, indicating that EDCs might be in the causal pathway that leads to endometriosis. Nevertheless, in all published studies, the particular effect of specific EDCs was measured, without taking into account the possible synergistic or antagonistic effect that these chemicals can exert when they are present in a mixture. Thus, because its diagnosis is difficult and its treatment is mainly symptomatic, it is vitally necessary to establish preventive measures to avoid as far as possible the origin of this disease. Therefore, it is necessary to carry out well-conducted studies, with appropriate sample size and in which the "gold-standard" diagnosis serves to distinguish between cases and controls. Moreover, the combined effect of multiple EDCs on endometriosis should be addressed. These studies are needed to fully elucidate the potential disrupting properties of these PCP-released EDCs in the gynecological tissues. In this way, preventive measures could be established, the chemical composition of PCPs could be modified by other substances that are not endocrine disruptors, or the use of

This work was supported by a grant from the Spanish Ministry of Health-FEDER (FIS PI17/01743) and the Research Chair "Antonio Chamorro/Alejandro Otero." It was also partly supported by the European Union Commission (the European Human Biomonitoring Initiative H2020-EJP-HBM4EU) and the Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP). The authors are also grateful to the Carlos III Institute of Health (ISCIII) for the predoctoral research contracts (IFI18/00052 and FI17/00316) granted to F.M. Peinado and L.M. Iribarne-Durán, respectively, and the José María Segovia de Arana contract

these cosmetics could be reduced as far as possible.

**36**

Francisco M. Peinado1†, Luz M. Iribarne-Durán1†, Olga Ocón-Hernández1,2, Nicolás Olea1,3,4,5 and Francisco Artacho-Cordón1,3,4\*

1 Biohealth Research Institute in Granada (ibs.GRANADA), Granada, Spain

2 Obstetrics and Gynecology Service, San Cecilio University Hospital, Granada, Spain

3 Radiology and Physical Medicine Department, University of Granada, Granada, Spain

4 CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain

5 Nuclear Medicine Unit, "San Cecilio" University Hospital, Granada, Spain

\*Address all correspondence to: fartacho@ugr.es

† These authors equally contributed to this work.

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
