Researchers have found a genetic correlation in endometriosis development. Women who have first-degree relatives with the disease have 10 times the risk of developing endometriosis.3 In addition, women with family histories of endometriosis are statistically more likely to experience an earlier onset and increased severity of the disease.4 Recent studies suggest oxidative stress, environmental toxin exposure, and immune dysfunction as possible factors in the onset and progression of endometriosis. Chlorinated hydrocarbons such as dioxin and polychlo-rinated biphenyls (PCBs), which have adverse clinical effects on the immune and endocrine systems, have been associated with endometriosis. For example, several studies on monkeys have demonstrated a direct correlation between dioxin exposure and endometriosis. In these studies, the amount of dioxin exposure was correlated with severity of disease. The monkeys showed immune system dysfunction similar to the immune abnormalities seen in women with endometriosis.5,6 Studies have also shown that dioxin modulates steroid receptor expression (thus changing hormonal responses) decreases natural-killer (NK) cell activity, inhibits T-lymphocytes, and stimulates macrophages in the peritoneal fluid, thus affecting angiogenesis and concentration of cytokines and growth factors.7-9 Dioxins and PCBs suppress the immune system; impair reproductive capabilities; increase the risk of multiple cancers, diabetes, and cardiovascular disease; and reduce memory function. Exposure to dioxin and dioxin-like PCBs occurs primarily via food such as animal fat and fish, and pesticides and other environmental sources.10-14 Other risk factors have been implicated in endometriosis, such as menstrual cycles that are less than 28 days, heavy flows lasting 5 or more days, menses that last more than 7 days, and increased estrogen levels. Endometriosis development is also associated with increased body fat, a high-fat diet, lack of exercise, and use of intrauterine devices.15 Inasmall study, researchers found a significant association between natural red hair color and frequency of the disease.16
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