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OD Research - Reproductive Epidemiology

Endometriosis: Natural History, Diagnosis, and Outcomes (ENDO) Study

The ENDO Study utilizes a matched exposure cohort design for purposes of assessing environmental chemicals, lifestyle and medical history in relation to the development of endometriosis. An operative cohort comprising 625 women undergoing laparoscopy or laparotomy was recruited for participation. Baseline interviews and anthropometric assessments were performed with all women followed by the collection of blood and urine samples. Surgeons obtained peritoneal fluid, omentum fat and endometrial biopsies, and also completed standardized operative forms to capture postoperative diagnoses and findings. The operative cohort was matched to the population residing within a 50-mile catchment area of participating clinical sites to obtain a cohort of women of reproductive age without a known history of endometriosis. Participating women complete the baseline interview, anthropometric assessment and provide blood and urine samples. They also underwent a pelvic MRI to identify endometriosis or other gynecologic pathology. Several classes of environmental chemicals have been associated with a surgically visualized diagnosis of endometriosis.

Principal Investigator

Germaine Louis, Ph.D., M.S.

DIPHR Collaborator

Zhen Chen, Ph.D.

Selected Publications

  • Buck Louis GM, Hediger ML, Peterson CM, Croughan M, Sundaram R, Stanford J, Chen Z, Fujimoto V, Varner M, Giudice L. Estimated incidence of endometriosis by diagnostic method and study population: The ENDO Study. Fertility and Sterility 2011; 96(2):360-365.
  • Buck Louis GM, Schisterman EF, Sweeney AM, Wilcosky TC, Gore-Langton R, Lynch CD, Barr DD, Schrader SM, Kim S, Chen Z, Sundaram R. Designing prospective cohort studies for assessing reproductive and developmental toxicity during sensitive windows of human reproduction and development: The LIFE Study. Paediatric and Perinatal Epidemiology 2011; 25:413-424.
  • Buck Louis GM, Chen Z, Peterson CM, Hediger ML, Croughan MS, Sundaram R, Stanford JB, Varner MW, Fujimoto VY, Giudice LC, Trumble A, Parsons PJ, Kannan K. Persistent lipophilic environmental chemicals and endometriosis: The ENDO Study, 2007-2009. Environmental Health Perspectives 2012; 120(6):811-816.
  • Kunisue T, Chen Z, Buck Louis GM, Sundaram R, Hediger ML, Sun L, Kannan K. Urinary concentrations ofbenzophenone-type UV filters and endometriosis, the ENDO Study. Environmental Science and Technology 2012; 46:4624-4632.
  • Schliep KC, Stanford JB, Zhang B, Chen Z, Dorais JK, Johnstone EB, Hammoud AO, Varner MW, Buck Louis GM. Inter- and intra-reliability in the diagnosis and staging of endometriosis: The ENDO Study. Obstetrics and Gynecology 2012; 120:104-112.
  • Buck Louis GM, Peterson MC, Chen Z, Hediger ML, Croughan MS, Sundaram R, Stanford JB, Fujimoto V, Varner MB, Giudice, LC, Kennedy A, Sun L, Parsons P, Kannan K. Perflurochemicals and Endometriosis: The ENDO Study. Epidemiology 2012; 23:799-805.
  • Wolff EF, Hediger ML, Sundaram R, Peterson CM, Chen Z, Buck Louis GM. In utero exposures and endometriosis, the ENDO Study. Fertility and Sterility 2013;99(3):790-795.
  • Peterson CM, Boiman Johnstone E, Hammoud AO, Stanford JB, Varner MW, Kennedy A, Chen Z, Buck Louis GM. Risk factors associated with endometriosis: Importance of study population for characterizing disease: The ENDO Study. American Journal of Obstetrics and Gynecology 2013;451:e1-11.
  • Steuerwald AJ, Parsons PJ, Amason JG, Chen Z, Peterson CM, Buck Louis GM. Trace element analysis of human urine collected after administration ofGd-based MRI contrast agents: Characterizing spectral interferences using inorganic mass spectrometry. Journal of Analytical Atomic Spectrometry 2013;28:821-830.
  • Buck Louis GM, Peterson CM, Chen Z, Croughan M, Sundaram R, Stanford J, Varner J, Kennedy A, Giudice L, Fujimoto V, Sun L, Wang L, Guo Y, Kannan K. Bisphenol A and phthalates and endometriosis, The ENDO Study. Fertility and Sterility 2013;100(1):162-169.
  • Pollack AZ, Buck Louis GM, Chen Z, Peterson CM, Sundaram R, Croughan MS, Sun L, Hediger ML, Stanford JB, Varner MW, Palmer CD, Steuerwald AJ, Parsons PJ. Trace element and endometriosis: The ENDO Study. Reproductive Toxicology 2013;42:41-48.
  • Williams KE, Miroshnychenko O, Johansen EB, Niles RK, Sundaram R, Kannan K, Albertolle M, Drake P, Giudice LC, Hall SC, Witkowska HE, Buck Louis GM, Fisher SJ.  Urine, peritoneal fluid and omental fat proteomes of reproductive age women:  endometriosis-related changes and associations with endocrine disrupting chemicals.  Journal of Proteomics 2014; 113:194-205. PMCID: PMC4467531
  • Johnstone EB, Buck Louis GM, Parsons PJ, Steuerwald AJ, Palmer CD, Chen Z, Hammoud AO, Dorais J, Peterson CM.  Increased whole blood concentrations of cadmium and mercury in women with uterine leiomyomata:  Findings from the ENDO Study.  Reproductive Toxicology 2014 Jun 30;49C:27-32. doi: 10.1016/j.reprotox.2014.06.007.
  • Pollack AZ, Buck Louis GM, Chen Z, Sun L, Trabert B, Guo Y, Kannan K.  Bisphenol A, benzophenonetype ultraviolet filters, and phthalates in relation to uterine leiomyoma.  Environmental Research 2015 February;137:101-107. PMCID: PMC4355097
  • Schliep KC, Mumford SL, Peterson CM, Chen Z, Sharp HT, Johnstone EB, Hammoud AO, Stanford JB, Sun L, Buck Louis GM.  Pain typology and incident endometriosis. Pain characterization among women with and without endometriosis using operative and non-operative diagnostic methodologies.  Human Reproduction 2015; Aug 1. Pii: dev147. PMID: 26269527
  • Trabert B, Chen Z, Kannan K, Peterson CM, Pollack A, Sun L, Buck Louis GM.  Persistent organic pollutants (POPs) and fibroids: Results from the ENDO study.  Journal of Exposure Science and Environmental Epidemiology 2015;25:278-285.
  • Schliep K, Chen Z, Stanford JB, Xie Y, Hammoud AO, Johnstone E, Mumford SL, Dorais JK, Varner MW, Buck Louis GM, Peterson CM.  Endometriosis diagnosis and staging:  are surgeons’ diagnoses consistent?  British Journal of Obstetrics and Gynecology (In Press). PMID:26435386.
Last Reviewed: 01/11/2016

Contact Information

Name: Dr Germaine M Louis
Director and Senior Investigator
Phone: 301-496-6155
Fax: 301-402-2084
E-mail: louisg@mail.nih.gov

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