{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T06:47:38Z","timestamp":1785739658024,"version":"3.56.0"},"reference-count":105,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Endometriosis is a chronic estrogen-dependent disease with a complex and incompletely understood etiology. Environmental exposure to toxic elements, including cadmium, lead, mercury, and arsenic, may contribute to its development and progression. Proposed mechanisms include endocrine disruption, oxidative stress, chronic inflammation, and epigenetic alterations. Methods: This narrative review was based on a structured literature search of the PubMed, Scopus, and Web of Science databases for studies published up to 15 June 2026. The search included the following keywords: endometriosis, cadmium, lead, mercury, arsenic, toxic elements, heavy metals, environmental exposure, diet, nutrition, and biomonitoring. Results: This review summarizes current evidence on the relationship between toxic element exposure and endometriosis, including sources of exposure, biomonitoring findings, proposed biological mechanisms, and human studies. The influence of nutritional status on metal bioavailability is also considered. Among the toxic elements reviewed, cadmium has been studied most extensively and shows the most consistent association with endometriosis. Evidence for lead is less consistent, whereas data on mercury and arsenic remain limited. Although the available epidemiological evidence does not establish a causal relationship, biomonitoring and experimental studies support a possible role of toxic elements in the development and progression of endometriosis. Conclusions: Current evidence supports a possible role of toxic elements in endometriosis, although a causal relationship has not been established. Cadmium has been investigated most extensively, while evidence for other toxic elements remains limited. Nutritional status should be considered when evaluating biomonitoring findings, particularly in relation to cadmium exposure.<\/jats:p>","DOI":"10.3390\/nu18152489","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T06:17:40Z","timestamp":1785737860000},"page":"2489","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dietary and Environmental Exposure to Toxic Elements in Endometriosis: A Missing Piece of the Etiological Puzzle?"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4835-8517","authenticated-orcid":false,"given":"Kamila","family":"Pokorska-Niewiada","sequence":"first","affiliation":[{"name":"Department of Toxicology, Dairy Technology and Food Storage, West Pomeranian University of Technology, 71-454 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Izabela","family":"Gutowska","sequence":"additional","affiliation":[{"name":"Department of Medical Chemistry, Pomeranian Medical University, 70-204 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9808-0624","authenticated-orcid":false,"given":"Ma\u0142gorzata","family":"Szczuko","sequence":"additional","affiliation":[{"name":"Department of Bromatology and Diagnostic Nutrition, Pomeranian Medical University, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"102418","DOI":"10.1016\/j.jogoh.2022.102418","article-title":"Endometriosis and Environmental Factors: A Critical Review","volume":"51","author":"Coiplet","year":"2022","journal-title":"J. Gynecol. Obstet. Hum. Reprod."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"62067","DOI":"10.1007\/s11356-021-16581-9","article-title":"Environmental and Occupational Exposure of Metals and Female Reproductive Health","volume":"29","author":"Dutta","year":"2022","journal-title":"Environ. Sci. Pollut. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1111\/1471-0528.17687","article-title":"Pollution and Endometriosis: A Deep Dive into the Environmental Impacts on Women\u2019s Health","volume":"131","author":"Ceccaldi","year":"2024","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Czubak, P., Herda, K., Niewiadomska, I., Putowski, L., \u0141a\u0144cut, M., and Mas\u0142yk, M. (2025). Understanding Endometriosis: A Broad Review of Its Causes, Management, and Impact. Int. J. Mol. Sci., 26.","DOI":"10.20944\/preprints202505.0315.v1"},{"key":"ref_5","first-page":"806","article-title":"Canonical Analysis of Concentrations of Toxic Metals in Endometrium of Women with Gynecological Disorders","volume":"93","author":"Tomczyk","year":"2022","journal-title":"Ginekol. Pol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"6435","DOI":"10.1158\/0008-5472.CAN-08-0329","article-title":"Long-Term Dietary Cadmium Intake and Postmenopausal Endometrial Cancer Incidence: A Population-Based Prospective Cohort Study","volume":"68","author":"Julin","year":"2008","journal-title":"Cancer Res."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Guyot, E., Solovyova, Y., Tomkiewicz, C., Leblanc, A., Pierre, S., El Balkhi, S., Le Fr\u00e8re-Belda, M.-A., Lecuru, F., Poupon, J., and Barouki, R. (2015). Determination of Heavy Metal Concentrations in Normal and Pathological Human Endometrial Biopsies and In Vitro Regulation of Gene Expression by Metals in the Ishikawa and Hec-1b Endometrial Cell Line. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0142590"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.1093\/humrep\/dead117","article-title":"Urinary Cadmium and Endometriosis Prevalence in a US Nationally Representative Sample: Results from NHANES 1999\u20132006","volume":"38","author":"Hall","year":"2023","journal-title":"Hum. Reprod."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s12958-026-01530-3","article-title":"Association of Metal Exposure in Follicular Fluid with Assisted Reproductive Technology Outcomes in East Chinese Women","volume":"24","author":"Han","year":"2026","journal-title":"Reprod. Biol. Endocrinol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/S0048-9697(97)00155-1","article-title":"Toxic Trace Element Reference Levels in Blood and Urine: Influence of Gender and Lifestyle Factors","volume":"204","author":"Kristiansen","year":"1997","journal-title":"Sci. Total Environ."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"56","DOI":"10.2478\/fv-2022-0038","article-title":"Toxic Effects of Cadmium on the Female Reproductive Organs a Review","volume":"66","author":"Maretta","year":"2022","journal-title":"Folia Vet."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Mass\u00e1nyi, P., Mass\u00e1nyi, M., Madeddu, R., Stawarz, R., and Luk\u00e1\u010d, N. (2020). Effects of Cadmium, Lead, and Mercury on the Structure and Function of Reproductive Organs. Toxics, 8.","DOI":"10.3390\/toxics8040094"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.reprotox.2013.05.009","article-title":"Trace Elements and Endometriosis: The ENDO Study","volume":"42","author":"Pollack","year":"2013","journal-title":"Reprod. Toxicol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"259","DOI":"10.5604\/12321966.1152077","article-title":"Impact of Heavy Metals on the Female Reproductive System","volume":"22","author":"Rzymski","year":"2015","journal-title":"Ann. Agric. Environ. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"158882","DOI":"10.1016\/j.scitotenv.2022.158882","article-title":"The Association between Exposure to Multiple Toxic Metals and the Risk of Endometriosis: Evidence from the Results of Blood and Follicular Fluid","volume":"855","author":"Shen","year":"2023","journal-title":"Sci. Total Environ."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"L\u00f3pez-Botella, A., G\u00f3mez-Torres, M.J., S\u00e1nchez, R., Todol\u00ed-Torr\u00f3, J.-L., Velasco, I., and Aci\u00e9n, M. (2023). Elevated Lead, Nickel, and Bismuth Levels in the Peritoneal Fluid of a Peritoneal Endometriosis Patient without Toxic Habits or Occupational Exposure Following a Vegetarian Diet. Toxics, 11.","DOI":"10.3390\/toxics11121009"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"161028","DOI":"10.1016\/j.scitotenv.2022.161028","article-title":"Detention and Mapping of Iron and Toxic Environmental Elements in Human Ovarian Endometriosis: A Suggested Combined Role","volume":"864","author":"Pascolo","year":"2023","journal-title":"Sci. Total Environ."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"European Food Safety Authority (2012). Cadmium Dietary Exposure in the European Population. EFSA J., 10, 2551.","DOI":"10.2903\/j.efsa.2012.2551"},{"key":"ref_19","unstructured":"European Food Safety Authority (EFSA), Gergelov\u00e1, P., Martino, L., and Rovesti, E. (2025). EFSA Scientific Report on Dietary Exposure to Lead in the European Population. EFSA J., 23, e9577."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"European Food Safety Authority (EFSA), Bearth, A., Jansen, T., Mazzocchi, M., Verbeke, W., Alaveras, G., Kanellakopoulou, A., Koffas, N., Naska, A., and Niforou, K. (2026). Frequency of Consumption of Different Fish, Crustacean and Mollusc Species Contributing to Methylmercury Exposure and Consumer Awareness of National Advice on Their Consumption. EFSA J., 24, e9865.","DOI":"10.2903\/j.efsa.2026.9865"},{"key":"ref_21","unstructured":"WHO (2007). Health Risks of Heavy Metals from Long-Range Transboundary Air Pollution, World Health Organization Regional Office Europe."},{"key":"ref_22","unstructured":"WHO (2021). WHO Guideline for the Clinical Management of Exposure to Lead, World Health Organization. [1st ed.]."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Charkiewicz, A.E., Omeljaniuk, W.J., Nowak, K., Garley, M., and Nikli\u0144ski, J. (2023). Cadmium Toxicity and Health Effects\u2014A Brief Summary. Molecules, 28.","DOI":"10.3390\/molecules28186620"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e70241","DOI":"10.1002\/mco2.70241","article-title":"Heavy Metals Toxicity: Mechanism, Health Effects, and Therapeutic Interventions","volume":"6","author":"Cheng","year":"2025","journal-title":"MedComm"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"118966","DOI":"10.1016\/j.envres.2024.118966","article-title":"Plastic-Related Endocrine Disrupting Chemicals Significantly Related to the Increased Risk of Estrogen-Dependent Diseases in Women","volume":"252","author":"Chitakwa","year":"2024","journal-title":"Environ. Res."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Chronchol, Z., Witczak, A., and Pokorska-Niewiada, K. (2026). Trace Element Intake from Dairy-Free Infant Porridges and Its Nutritional and Safety Implications for Infants Aged Six Months and Older. Nutrients, 18.","DOI":"10.3390\/nu18020333"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1093\/humrep\/dey014","article-title":"Fruit and Vegetable Consumption and Risk of Endometriosis","volume":"33","author":"Harris","year":"2018","journal-title":"Hum. Reprod."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"249","DOI":"10.12911\/22998993\/162955","article-title":"Heavy Metals\u2014Definition, Natural and Anthropogenic Sources of Releasing into Ecosystems, Toxicity, and Removal Methods\u2014An Overview Study","volume":"24","author":"Jadaa","year":"2023","journal-title":"J. Ecol. Eng."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Lehel, J., Pleva, D., Nagy, A.L., S\u00fcth, M., and Kocsner, T. (2025). Potential Metal Contamination in Foods of Animal Origin\u2014Food Safety Aspects. Appl. Sci., 15.","DOI":"10.3390\/app15158468"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"141148","DOI":"10.1016\/j.jhazmat.2026.141148","article-title":"Cadmium Exposure Is Associated with Impaired Ovarian Function: Potential Role of Cadmium-Induced Ferroptosis in Granulosa Cells","volume":"503","author":"Li","year":"2026","journal-title":"J. Hazard. Mater."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"353","DOI":"10.32394\/rpzh.2021.0188","article-title":"The Content of Lead, Cadmium, Arsenic, Mercury and Tin in Fruit and Their Products Based on Monitoring Studies\u2014Exposure Assessment","volume":"72","author":"Mania","year":"2021","journal-title":"Rocz. Pa\u0144stw. Zak\u0142adu Hig."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Michalczyk, K., Kapczuk, P., Kupnicka, P., Witczak, G., Michalczyk, B., Bosiacki, M., Chlubek, D., and Cymbaluk-P\u0142oska, A. (2023). Assessment of Serum Zn, Cu, Mn, and Fe Concentration in Women with Endometrial Cancer and Different Endometrial Pathologies. Nutrients, 15.","DOI":"10.3390\/nu15163605"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"100428","DOI":"10.1016\/j.cjac.2024.100428","article-title":"Heavy Metals Concentration and Human Health Risk Assessment in Tobacco Cigarette Products from Tanzania","volume":"52","author":"Ntarisa","year":"2024","journal-title":"Chin. J. Anal. Chem."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"114029","DOI":"10.1016\/j.ecoenv.2022.114029","article-title":"The Environment and Female Reproduction: Potential Mechanism of Cadmium Poisoning to the Growth and Development of Ovarian Follicle","volume":"244","author":"Qu","year":"2022","journal-title":"Ecotoxicol. Environ. Saf."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Rashid, A., Schutte, B.J., Ulery, A., Deyholos, M.K., Sanogo, S., Lehnhoff, E.A., and Beck, L. (2023). Heavy Metal Contamination in Agricultural Soil: Environmental Pollutants Affecting Crop Health. Agronomy, 13.","DOI":"10.20944\/preprints202305.0398.v1"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Rashidian, P., Amini-Salehi, E., Karami, S., Nezhat, C., and Nezhat, F. (2025). Exploring the Association Between Dietary Fruit Intake and Endometriosis: A Systematic Review and Meta-Analysis. J. Clin. Med., 14.","DOI":"10.3390\/jcm14041246"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Riaz, R.M.Y., Murtaza, G., Farooqi, Z.U.R., Ali, S., Aziz, H., Mahboob, S., Al-Ghanim, K.A., Owens, G., Ahmad, H.R., and Riaz, U. (2022). Assessment of Arsenic Contamination in Groundwater and Associated Human Health Risk. Sustainability, 14.","DOI":"10.3390\/su141912460"},{"key":"ref_38","first-page":"340","article-title":"Dietary Intake, Carcinogenic and Non-Carcinogenic Risk Potentials of Lead, Cadmium, Mercury and Arsenic Exposure via Consumption of Dried Crayfish in Calabar, Nigeria","volume":"10","author":"Udiba","year":"2022","journal-title":"J. Geosci. Environ. Prot."},{"key":"ref_39","unstructured":"ATSDR (2012). Toxicological Profile for Cadmium."},{"key":"ref_40","unstructured":"ATSDR (2024). Toxicological Profile for Mercury."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Boente, C., Sierra, C., Mart\u00ednez, J., Rodr\u00edguez-Vald\u00e9s, E., Afif, E., Rey, J., Antunes, I.M.H.R., and Gallego, J.L.R. (2022). Impact of Old Pb Mining and Metallurgical Production in Soils from the Linares Mining District (Spain). Environments, 9.","DOI":"10.3390\/environments9020024"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e04691","DOI":"10.1016\/j.heliyon.2020.e04691","article-title":"Heavy Metal Pollution in the Environment and Their Toxicological Effects on Humans","volume":"6","author":"Briffa","year":"2020","journal-title":"Heliyon"},{"key":"ref_43","first-page":"3","article-title":"An Overview of Heavy Metal Pollution and Control","volume":"Volume 1456","author":"Dagdag","year":"2023","journal-title":"Heavy Metals in the Environment: Management Strategies for Global Pollution"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e14228","DOI":"10.1111\/jfbc.14228","article-title":"Therapeutic Potentials of Genistein: New Insights and Perspectives","volume":"46","author":"Rasheed","year":"2022","journal-title":"J. Food Biochem."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1038\/s43017-020-00110-2","article-title":"Groundwater Arsenic","volume":"1","author":"Zinke","year":"2020","journal-title":"Nat. Rev. Earth Environ."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1186\/s12982-025-00650-2","article-title":"Cigarettes as a Source of Heavy Metal Toxicity: Evaluating Human Health Risks","volume":"22","author":"Sandal","year":"2025","journal-title":"Discov. Public Health"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e40370","DOI":"10.1016\/j.heliyon.2024.e40370","article-title":"Review on the Impact of Heavy Metals from Industrial Wastewater Effluent and Removal Technologies","volume":"10","author":"Oladimeji","year":"2024","journal-title":"Heliyon"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Balali-Mood, M., Naseri, K., Tahergorabi, Z., Khazdair, M.R., and Sadeghi, M. (2021). Toxic Mechanisms of Five Heavy Metals: Mercury, Lead, Chromium, Cadmium, and Arsenic. Front. Pharmacol., 12.","DOI":"10.3389\/fphar.2021.643972"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"127263","DOI":"10.1016\/j.jtemb.2023.127263","article-title":"The Role of Cadmium in the Pathogenesis of Myeloid Leukemia in Individuals with Anemia, Deficiencies in Vitamin D, Zinc, and Low Calcium Dietary Intake","volume":"79","author":"Djulejic","year":"2023","journal-title":"J. Trace Elem. Med. Biol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.taap.2007.04.009","article-title":"Influence of Iron and Zinc Status on Cadmium Accumulation in Bangladeshi Women","volume":"222","author":"Kippler","year":"2007","journal-title":"Toxicol. Appl. Pharmacol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.whi.2024.03.004","article-title":"Risk of Iron Deficiency in Women with Endometriosis: A Population-Based Prospective Cohort Study","volume":"34","author":"Gete","year":"2024","journal-title":"Women\u2019s Health Issues"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"725","DOI":"10.22141\/2224-0586.21.7.2025.1965","article-title":"The Effectiveness of Iron Deficiency Nutritional Correction in Patients with Genital Endometriosis Accompanied by Mild Anemia","volume":"21","author":"Gladchuk","year":"2025","journal-title":"Emerg. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.envint.2017.08.023","article-title":"Blood Levels of Toxic Metals and Rare Earth Elements Commonly Found in E-Waste May Exert Subtle Effects on Hemoglobin Concentration in Sub-Saharan Immigrants","volume":"109","author":"Boada","year":"2017","journal-title":"Environ. Int."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1038\/s41370-024-00724-4","article-title":"Human Biomonitoring of Essential and Toxic Trace Elements (Heavy Metals and Metalloids) in Urine of Children, Teenagers, and Young Adults from a Central European Cohort in the Czech Republic","volume":"35","author":"Sharma","year":"2025","journal-title":"J. Expo. Sci. Environ. Epidemiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1093\/biolre\/ioac016","article-title":"Mercury Impairs Human Primary Endometrial Stromal Cell Function","volume":"106","author":"Palomar","year":"2022","journal-title":"Biol. Reprod."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Wang, J., Zhao, C., Feng, J., Sun, P., Zhang, Y., Han, A., Zhang, Y., and Ma, H. (2024). Advances in Understanding the Reproductive Toxicity of Endocrine-Disrupting Chemicals in Women. Front. Cell Dev. Biol., 12.","DOI":"10.3389\/fcell.2024.1390247"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2","DOI":"10.55810\/2313-0083.1128","article-title":"Health Effects of Cadmium and Manganese Exposure on Luteinizing Hormone Levels: A Pilot Study of Female Infertility","volume":"8","author":"Alhous","year":"2026","journal-title":"Al-Bahir"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.ejogrb.2014.05.039","article-title":"Role of Endometrial Concentrations of Heavy Metals (Cadmium, Lead, Mercury and Arsenic) in the Aetiology of Unexplained Infertility","volume":"179","author":"Karaer","year":"2014","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Miglietta, S., Cristiano, L., Battaglione, E., Macchiarelli, G., Nottola, S.A., De Marco, M.P., Costanzi, F., Schimberni, M., Colacurci, N., and Caserta, D. (2023). Heavy Metals in Follicular Fluid Affect the Ultrastructure of the Human Mature Cumulus-Oocyte Complex. Cells, 12.","DOI":"10.20944\/preprints202310.0843.v1"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Cavallini, A., Lippolis, C., Vacca, M., Nardelli, C., Castegna, A., Arnesano, F., Carella, N., and Depalo, R. (2016). The Effects of Chronic Lifelong Activation of the AHR Pathway by Industrial Chemical Pollutants on Female Human Reproduction. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0152181"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"L\u00f3pez-Botella, A., S\u00e1nchez, R., Todol\u00ed-Torr\u00f3, J.-L., G\u00f3mez-Torres, M.J., Velasco, I., and Aci\u00e9n, M. (2023). A New Advanced and Validated Method for the Determination of Potentially Toxic Metals and Trace and Ultra-Trace Elements in Peritoneal Fluid to Assess the Health Risks of Women with Gynecological Pathologies. Toxics, 11.","DOI":"10.3390\/toxics11050399"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Osuchowska-Grochowska, I., Blicharska, E., Gogacz, M., Nogalska, A., Winkler, I., Szopa, A., Ekiert, H., Tymczyna-Borowicz, B., Rahnama-Hezavah, M., and Grochowski, C. (2021). Brief Review of Endometriosis and the Role of Trace Elements. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms222011098"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Chantalat, E., Valera, M.-C., Vaysse, C., Noirrit, E., Rusidze, M., Weyl, A., Vergriete, K., Buscail, E., Lluel, P., and Fontaine, C. (2020). Estrogen Receptors and Endometriosis. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21082815"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"12135","DOI":"10.1038\/s41598-019-46912-3","article-title":"Chronic Cadmium Exposure Decreases the Dependency of MCF7 Breast Cancer Cells on ER\u03b1","volume":"9","author":"Bloomfield","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1093\/toxsci\/kfw064","article-title":"Arsenite and Cadmium Activate MAPK\/ERK via Membrane Estrogen Receptors and G-Protein Coupled Estrogen Receptor Signaling in Human Lung Adenocarcinoma Cells","volume":"152","author":"Huff","year":"2016","journal-title":"Toxicol. Sci."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Collins, S.P., and Barton-Maclaren, T.S. (2022). Novel Machine Learning Models to Predict Endocrine Disruption Activity for High-Throughput Chemical Screening. Front. Toxicol., 4.","DOI":"10.3389\/ftox.2022.981928"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/B978-0-12-386485-7.00006-5","article-title":"Recent Advances in the Molecular Modeling of Estrogen Receptor-Mediated Toxicity","volume":"Volume 85","author":"Tsakovska","year":"2011","journal-title":"Advances in Protein Chemistry and Structural Biology"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1039\/C3MT00344B","article-title":"A Proteomic Approach to Investigate the Effects of Cadmium and Lead on Human Primary Renal Cells","volume":"6","author":"Galano","year":"2014","journal-title":"Metallomics"},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Doligalska-Dolina, A., Dolina, M., Zo\u0144, A., G\u0142\u00f3wczewska-Siedlecka, E., Osi\u0144ska, K., Margossian, G.A., Margossian, C.L., and Napi\u00f3rkowska-Baran, K. (2026). Effects of Micronutrients and Heavy Metals on Endothelial Function and Cardiovascular Risk in the Face of Environmental Changes. Curr. Issues Mol. Biol., 48.","DOI":"10.3390\/cimb48010041"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Kumar, P., and Gogia, N. (2025). Chapter 1\u2014Biological Pathways of Heavy Metal Toxicity. Heavy Metal Toxicity and Neurodegeneration, Academic Press.","DOI":"10.1016\/B978-0-443-36575-1.00031-5"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"127648","DOI":"10.1016\/j.jtemb.2025.127648","article-title":"Heavy Metals and Cardiovascular Health: Uncovering Links and Health Challenges","volume":"89","author":"Ozarde","year":"2025","journal-title":"J. Trace Elem. Med. Biol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"116480","DOI":"10.1016\/j.envpol.2021.116480","article-title":"Associations between Metabolic Syndrome and Four Heavy Metals: A Systematic Review and Meta-Analysis","volume":"273","author":"Xu","year":"2021","journal-title":"Environ. Pollut."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1039\/c1mt00050k","article-title":"Zinc, Cadmium and Nickel Increase the Activation of NF-\u03baB and the Release of Cytokines from THP-1 Monocytic Cells","volume":"3","author":"Freitas","year":"2011","journal-title":"Metallomics"},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Parchwani, D.N., Sharma, P., and Singh, R. (2025). Oxidative-Inflammo Mechanism of Heavy Metal Toxicity. Indian J. Clin. Biochem.","DOI":"10.1007\/s12291-025-01354-9"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1093\/humrep\/dem394","article-title":"The Association between Heavy Metals, Endometriosis and Uterine Myomas among Premenopausal Women: National Health and Nutrition Examination Survey 1999\u20132002","volume":"23","author":"Jackson","year":"2008","journal-title":"Hum. Reprod."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"4357","DOI":"10.1038\/s41598-024-85017-4","article-title":"Correlation of Ferritin and Glutathione Peroxidase 4 (GPX4) Level as a Marker of Ferroptosis Process in Endometrioma","volume":"15","author":"Nulianti","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1002\/rmb2.12047","article-title":"Epigenetic Regulation of the Pathological Process in Endometriosis","volume":"16","author":"Hsiao","year":"2017","journal-title":"Reprod. Med. Biol."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"de Ara\u00fajo, M.L., Gomes, B.C., Dev\u00f3z, P.P., de Assis Aguilar Duarte, N., Ribeiro, D.L., de Ara\u00fajo, A.L., Batista, B.L., Antunes, L.M.G., Barbosa, F., and Rodrigues, A.S. (2021). Association Between miR-148a and DNA Methylation Profile in Individuals Exposed to Lead (Pb). Front. Genet., 12.","DOI":"10.3389\/fgene.2021.620744"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1186\/s13148-024-01705-y","article-title":"Exposure-Associated DNA Methylation among People Exposed to Multiple Industrial Pollutants","volume":"16","author":"Chen","year":"2024","journal-title":"Clin. Epigenet."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1289\/ehp.1104600","article-title":"Low-Level Environmental Cadmium Exposure Is Associated with DNA Hypomethylation in Argentinean Women","volume":"120","author":"Hossain","year":"2012","journal-title":"Environ. Health Perspect."},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Hwang, S., Kang, H.B., Kim, D.H., and Park, M.H. (2026). Epigenetic Mechanisms of Reproductive Dysfunction Induced by Endocrine-Disrupting Chemicals: Evidence from Molecular Studies. Front. Biosci. (Landmark Ed), 31.","DOI":"10.31083\/FBL42777"},{"key":"ref_82","first-page":"47","article-title":"Plasma and Urinary Levels of Lead and Cadmium in Patients with Endometriosis","volume":"30","author":"Schiattarella","year":"2018","journal-title":"Ital. J. Gynaecol. Obstet."},{"key":"ref_83","first-page":"210","article-title":"Heavy metal toxicity versus trace element protection in women\u2019s reproductive health\u2014A systematic review","volume":"369","author":"Amanzholkyzy","year":"2025","journal-title":"Georgian Med. News"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1002\/ijgo.70547","article-title":"FIGO Committee Opinion: Environmental Drivers of Gynecologic and Reproductive Health","volume":"171","author":"DeNicola","year":"2025","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.scitotenv.2008.05.006","article-title":"A Case\u2013Control Study of the Association between Urinary Cadmium Concentration and Endometriosis in Infertile Japanese Women","volume":"402","author":"Itoh","year":"2008","journal-title":"Sci. Total Environ."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/s00420-006-0114-7","article-title":"Cadmium, Lead and Endometriosis","volume":"80","author":"Heilier","year":"2006","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Kim, M.-G., Min, Y.-S., and Ahn, Y.-S. (2021). Does Exposure of Lead and Cadmium Affect the Endometriosis?. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18179077"},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Iavarone, I., Mele, D., Caprio, F., Coroleu, B., De Franciscis, P., Cobellis, L., and Ronsini, C. (2026). Lead Concentration in Follicular Fluid of Infertile Patients with and without Endometriosis: A Propensity Score Matching Exploratory Study. Front. Endocrinol., 17.","DOI":"10.3389\/fendo.2026.1814365"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1007\/s00210-024-03452-6","article-title":"Impact of Arsenic on Male and Female Reproductive Function: A Review of the Pathophysiology and Potential Therapeutic Strategies","volume":"398","author":"Adeogun","year":"2025","journal-title":"Naunyn-Schmiedeberg\u2019s Arch. Pharmacol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/s40471-020-00236-3","article-title":"Environmental Risk Factors for Endometriosis: A Critical Evaluation of Studies and Recommendations from the Epidemiologic Perspective","volume":"7","author":"Upson","year":"2020","journal-title":"Curr. Epidemiol. Rep."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1038\/s41431-025-01977-9","article-title":"Endometriosis\u2014On the Intersection of Modern Environmental Pollutants and Ancient Genetic Regulatory Variants","volume":"34","author":"Warren","year":"2026","journal-title":"Eur. J. Hum. Genet."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1056\/NEJMra1810764","article-title":"Endometriosis","volume":"382","author":"Zondervan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.envint.2008.09.003","article-title":"Non-Invasive Matrices in Human Biomonitoring: A Review","volume":"35","author":"Esteban","year":"2009","journal-title":"Environ. Int."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/1476-069X-8-8","article-title":"Applicability of Non-Invasively Collected Matrices for Human Biomonitoring","volume":"8","author":"Smolders","year":"2009","journal-title":"Environ. Health"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1080\/10937404.2024.2428206","article-title":"Review of Non\u2013Invasive Biomarkers as a Tool for Exposure Characterization in Human Health Risk Assessments","volume":"28","author":"Shilnikova","year":"2025","journal-title":"J. Toxicol. Environ. Health Part B"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"2143","DOI":"10.1016\/j.cgh.2024.03.005","article-title":"Endometriosis Is Associated with Higher Healthcare Utilization and Upper Gastrointestinal Symptoms","volume":"22","author":"Simons","year":"2024","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_97","first-page":"182","article-title":"Endometriosis: Can Diet Help and If so, What Kind?","volume":"68","author":"Heinze","year":"2021","journal-title":"Ernahr. Umsch."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"96","DOI":"10.5603\/GP.a2017.0017","article-title":"Influence of Diet on the Risk of Developing Endometriosis","volume":"88","author":"Lemm","year":"2017","journal-title":"Ginekol. Pol."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s13668-024-00518-y","article-title":"Diet in Prevention and Treatment of Endometriosis: Current State of Knowledge","volume":"13","author":"Oszajca","year":"2024","journal-title":"Curr. Nutr. Rep."},{"key":"ref_100","doi-asserted-by":"crossref","unstructured":"Cirovic, A., Milovanovic, P., and Satarug, S. (2026). Cadmium, Iron Deficiency Anemia and Hypophosphatemic Osteomalacia Due to Intravenous Iron Supplementation. Biomedicines, 14.","DOI":"10.20944\/preprints202601.0338.v1"},{"key":"ref_101","doi-asserted-by":"crossref","unstructured":"Zheng, S., Guo, X., and Ying, X. (2026). The Association Between Cadmium Exposure and Endometrial Cancer Risk: Evidence from a Comprehensive Updated Meta-Analysis. J. Clin. Med., 15.","DOI":"10.3390\/jcm15041479"},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Flieger, W., Niedzielski, P., Flieger, M., Wojciechowska, Z., Proch, A., Proch, J., Forma, A., Torbicz, A., Majerek, D., and Teresi\u0144ski, G. (2026). Distribution of Toxic and Essential Elements in Autopsy Organs of Subjects Living in South-Eastern Poland. Int. J. Mol. Sci., 27.","DOI":"10.3390\/ijms27062585"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"34630","DOI":"10.1007\/s11356-021-13099-y","article-title":"Occupational Exposure to Potentially Toxic Elements in the Foundry Industry: An Integrated Environmental and Biological Monitoring","volume":"28","author":"Freire","year":"2021","journal-title":"Environ. Sci. Pollut. Res."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/j.envres.2011.03.007","article-title":"The Relationship between Body Iron Stores and Blood and Urine Cadmium Concentrations in US Never-Smoking, Non-Pregnant Women Aged 20\u201349 Years","volume":"111","author":"Gallagher","year":"2011","journal-title":"Environ. Res."},{"key":"ref_105","doi-asserted-by":"crossref","unstructured":"Gaia-Oltean, A.I., Boitor, D., Pop, L.-A., Galea, G., Telecan, T., and Micu, R. (2025). Non-Invasive Methods for Early Diagnosis of Endometriosis\u2014A Comprehensive Narrative Literature Review. Healthcare, 13.","DOI":"10.3390\/healthcare13243276"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/15\/2489\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T06:28:23Z","timestamp":1785738503000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/15\/2489"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,2]]},"references-count":105,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["nu18152489"],"URL":"https:\/\/doi.org\/10.3390\/nu18152489","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,2]]}}}