Based on preliminary data, environmental pollutants such as bisphenols, perfluorochemicals, particulate matter and benzophenone derivatives have been suspected to play a role in the etiopathogenesis of endometriosis. Ho- wever, data from recent epidemiological studies are still mixed and the real impact of environmental pollutants on endometriosis is still a matter of de- bate. Consequently, this important issue, which has wide-ranging implica- tions, remains to be solved. In the attempt to clarify this issue, we carried out a systematic review of studies related to the aforementioned pollutants and endometriosis with no time restriction. Only articles regarding the asso- ciation between endometriosis and environmental pollutants published on peer reviewed articles were included. Exclusion criteria were: in vitro studies; case report or case series; unpublished data; study involving animals; the use of a not conservative statistical method (Bayesian analysis). The following studies were included in our analysis; 4 papers bisphenols; 1 paper about perfluorochemicals and particulate matter; 2 papers about benzophenone derivatives. Regarding bisphenol A, results are mixed despite an increased risk was observed in women with non-ovarian pelvic endometriosis. A signi- ficantly associations between perfluorochemicals [perfluorooctanoic acid (PFOA) and perfluorononanoic (PFNA)] and two benzophenone metaboli- tes [2,4-dihydroxybenzophenone (2OH-BP)] with endometriosis. No associa- tion with particulate matter was reported. Relevant differences were found among studies regarding the diagnostic method, type of pollutant analyzed, selection of controls and method adopted for the assessment of contami- nants. Due to the relevant heterogeneity among studies no definitive con- clusion could be still drawn. According to the current data, the possible as- sociation between endometriosis and environmental pollution could not be excluded. More prospective well-designed and less heterogeneous trials are demanded.

Keywords: endometriosis; environmental pollution; perfluorochemicals; bisphenols, air pollution.