In a cross-sectional study analyzing data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2006, Hall and colleagues at Michigan State University uncovered a potential association between cadmium exposure and endometriosis. Cadmium exhibits estrogenic properties, which means it can act similarly to estrogen, the hormone that is involved in the development of endometriosis. These findings could hold important implications because although theories have been posited, the exact cause of endometriosis remains unknown.

In the retrospective study, Hall and colleagues filtered NHANES survey respondents to include only individuals aged 20–54 years with an endometriosis diagnosis, available data on urinary cadmium, and a glomerular filtration rate of ≥60ml/min/1.73 m^2. They categorised participants into quartiles based on their cadmium concentration, with the first quartile being the lowest cadmium concentration and the fourth being the highest. The researchers observed that there was twice the prevalence of endometriosis among respondents in the second and third quartiles as compared to the first quartile. They also noted a 60% increased prevalence of endometriosis for respondents in the fourth quartile as compared to those in the first quartile. Thus, they concluded that cadmium is associated with an increased endometriosis prevalence. Cadmium exposure primarily occurs when individuals ingest certain foods grown in contaminated soil or inhale cigarette smoke.

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Endometriosis is a disease in which endometrial-like tissue is found outside of the uterus. Menstruation occurs when endometrium, or the inner lining of the uterus, thickens and sheds during each month that conception does not take place. When endometrial-like tissue is stuck inside the body, local inflammatory reactions occur, leading to scar tissue formation and adhesions. Symptoms include chronic pelvic pain (CPP), severe and frequent cramps during menstruation (dysmenorrhea), genital pain during sexual intercourse (dyspareunia), and in severe cases, infertility. Symptoms can be variable between cases, with some women experiencing no symptoms at all. This heterogeneity and non-specificity of symptoms can lead to misdiagnosis. Potential causes of endometriosis include genetics and malfunctions of the immune system.

The majority of current endometriosis treatments are generic, with the exception of AbbVie’s Orilissa (elagolix), Myovant Sciences/Pfizer’s Myfembree (estradiol + norethindrone acetate + relugolix), and Kissei Pharmaceutical’s Yselty (linzagolix). Examples of drug classes that are used for the treatment of endometriosis include gonadotropin-releasing hormone (GnRH) agonists, progestins, estrogen antagonists, and oral contraceptives. According to GlobalData’s Endometriosis: Seven-Market Drug Forecast and Market Analysis Update, GlobalData forecasts the endometriosis market to grow to a value of $2.bn by 2030. Dopamine receptor antagonist Quinagolide is the only late-stage pipeline therapy included in the report and forecast that has not yet come to market.

Endometriosis is a complicated and poorly understood condition. Additional research is needed in order to better understand its aetiology. However, the findings from Hall and colleagues provide interesting insight regarding potential contributing factors that could lead to the onset of the disease.

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