Trace elements and endometriosis: The ENDO Study

•473 women were recruited into an operative cohort and 131 in a population cohort.•Twenty trace elements in urine and three in blood were quantified.•Diagnosis by surgical visualization in operative and MRI in population cohort.•Blood cadmium was associated with a reduced odds of endometriosis diagnosis.•Urinary chromium and copper reflected an increased odds of endometriosis diagnosis. There has been limited study of trace elements and endometriosis. Using a matched cohort design, 473 women aged 18–44 years were recruited into an operative cohort, along with 131 similarly aged women recruited into a population cohort. Endometriosis was defined as surgically visualized disease in the operative cohort, and magnetic resonance imaging diagnosed disease in the population cohort. Twenty trace elements in urine and three in blood were quantified using inductively coupled plasma mass spectrometry. Logistic regression estimated the adjusted odds (aOR) of endometriosis diagnosis for each element by cohort. No association was observed between any element and endometriosis in the population cohort. In the operative cohort, blood cadmium was associated with a reduced odds of diagnosis (aOR=0.55; 95% CI: 0.31, 0.98), while urinary chromium and copper reflected an increased odds (aOR=1.97; 95% CI: 1.21, 3.19; aOR=2.66; 95% CI: 1.26, 5.64, respectively). The varied associations underscore the need for continued research.