(Beyond Pesticides, January 7, 2015) On Monday, the U.S. Environmental Protection Agency (EPA) released a revised human health assessment for the insecticide, chlorpyrifos, which finds risks to workers who mix, load and apply chlorpyrifos, and that the chemical has the potential to pose risks to drinking water in small watersheds. The assessment also notes that EPA will retain the 10X (10-fold) safety factor to protect children from all routes of exposures. EPA’s latest finding confirms long-standing scientific data that  has documented chlorpyrifos’ toxicity to humans and environmental contamination. However, despite these findings, EPA proposes to place additional restrictions on chlorpyrifos’ use, instead of a widespread ban. This latest assessment updates the June 2011 preliminary human health risk assessment, which was widely criticized by environmental and farmworker groups. EPA is releasing this assessment based on new information received since 2011, including public comments. The assessment is, in part, in response to a petition submitted by Natural Resources Defense Council (NRDC) and Pesticide Action Network (PAN) in 2007, which called on the agency to ban all uses of the insecticide. In 2000, EPA orchestrated a voluntary cancellation with the manufacturer Dow AgroSciences of  most residential uses of chlorpyrifos to limit children’s exposure, […]

(Beyond Pesticides, August 21, 2014) In case there wasn’t enough news about the hazards of the ubiquitous antibacterial chemical triclosan in the past week, another study published Tuesday finds additional risks associated with exposure to the pesticide. The study, Health Care Worker Exposures to the Antibacterial Agent Triclosan, led by researchers at University of California San Francisco (UCSF) finds that washing hands with antibacterial soap exposes hospital workers to significant and potentially unsafe levels of triclosan. In the study, published in the August issue of the Journal of Occupational and Environmental Medicine, researchers analyze urine samples from two groups of 38 doctors and nurses at two hospitals, identified as Hospital 1 and Hospital 2. Hospital 1 used an antibacterial soap containing 0.3 percent triclosan, while Hospital 2 used plain soap and water. Workers at Hospital 1 had significantly higher levels of triclosan in their urine than workers at Hospital 2. “Antimicrobial soaps can carry unknown risks, and triclosan is of particular concern,” said co-investigator Paul Blanc, MD, a professor of medicine at UCSF who holds the Endowed Chair in Occupational and Environmental Medicine. “Our study shows that people absorb this chemical at work and at home, depending on the products […]

(Beyond Pesticides, August 19, 2014) Newly released documents from the U.S. Food and Drug Administration (FDA) reveals that regulators expressed concerns over the safety of triclosan in Colgate Total toothpaste during the product’s registration in the mid-1990s. This information was provided to the public by FDA after a Freedom of Information Act request by the Natural Resources Defense Council (NRDC), and was posted on the agency’s website after inquiries from Bloomberg News. In addition to health effects previously identified by Beyond Pesticides, these documents raise concerns about the use of triclosan as an anti-gingivitis agent in toothpaste; a use which is not currently under scrutiny as FDA conducts its long-awaited health review of the chemical. Although FDA is requiring manufacturers of triclosan-containing soaps to prove that their products are not hazardous to humans and more effective than regular soap and water, triclosan formulated in toothpaste was not subject to a similar requirement as FDA had indicated that the chemical is effective as an anti-gingivitis agent. Colgate Total is the only brand of toothpaste on the market that still contains triclosan; GlaxoSmithKline, producer of Aquafresh and Sensodyne, removed triclosan from its toothpaste in 2009. And a focus on safer products seems […]

(Beyond Pesticides, August 8, 2014) Despite the continued documentation of weed resistance all over the United States, as well as the world, another line of herbicide-tolerant crops developed by Monsanto is currently in the pipeline awaiting likely approval by U.S. regulators. The U.S. Department of Agriculture’s (USDA) Animal and Plant Health Inspection Service (APHIS) released a draft environmental impact statement (EIS) on Tuesday, which, according to regulators, will pave the way for the approval of new  genetically modified cotton and soybean plants tolerant to a mixture of the herbicides glyphosate and dicamba. Monsanto’s new soybean and cotton crops were developed to withstand their new herbicide formulation, called Roundup Xtend, which combines the pesticides dicamba and glyphosate. The “Roundup Ready Xtend crop system” was developed to curb the proliferation of millions of acres of weeds that have grown resistant to Monsanto’s glyphosate-based Roundup, which has been used on the company’s biotech corn, soybeans, and cotton. Weed resistance due to cropping systems dependent on herbicides has been documented for years, making APHIS’ conclusions in the EIS all the more alarming. A report that Beyond Pesticides published 12 years ago, “The Environmental Risks of Transgenic Crops: An Agroecological Assessment is the failed pesticide […]

(Beyond Pesticides, August 7, 2014) Residents of St. Louis, Michigan aren’t used to seeing large excavators and dump trucks haul piles of dirt from their front yards or entire blocks of big, neighborhood trees felled. What they are used to seeing are dead birds ””sometimes even spontaneous, mid-flight deaths of the birds”” and because of a toxic series of events, disasters, and delays spanning decades, the two sights are inextricably connected. As one St. Louis resident described to the Detroit Free Press, dozens of dead robins and blackbirds had been collected from her backyard in the 18 years she has lived there, with the most recent just a couple weeks ago. This experience and other similar stories from the area prompted researchers at Michigan State University (MSU) to start figuratively and literally digging. Matt Zwiernik, Ph.D., an environmental toxicologist at MSU, and volunteers collected 29 dead birds, including 22 robins, last year from a nine-block residential area in St. Louis. The scientific sampling was only a small portion of the dead birds they could have collected, Dr. Zwiernik explained to reporters at the Detroit Free Press, as time, distance, logistics, and access to property sometimes limited collection efforts. Nevertheless, it […]

(Beyond Pesticides, July 21, 2014) According to figures released by the British Government last week, over 60% of the county’s bread supply is tainted with pesticide residues. This is a shocking increase from numbers recorded in 2001, which found 28% of bread to be tainted. According to the Department for Environment, Food and Rural Affairs (Defra) Expert Committee on Pesticides Residues in Food (PRIF), 2,951 bread samples were tested. According to a Pesticide Action Network UK report, a majority of the reoccurring pesticides were glyphosate and chlormequat. Glyphosate is an herbicide that can lead to non-Hodgkin’s Lymphoma, genetic damage, cancer, reproductive issues, liver damage, and endocrine disruption as well environmental damage such as water contamination and harmful effects to amphibians. Unfortunately, very little research has been done on what the effects can be on humans. Chlormequat, the second most-commonly found pesticide in British bread, is a plant growth regulator. A study conducted by the UN’s Food and Agriculture Organization (FAO) linked Chlormequat to developmental toxicity in animals. Very little research has been performed assessing the public health impact of this pesticide. In the U.S., it is only allowed for use on ornamental plants. Pan UK spokesman Nick Mole said, “The […]

(Beyond Pesticides, July 16, 2014) The Canadian Environmental Law Association (CELA) and Clean Production Action (CPA) released a comprehensive assessment of the hazards posed by triclosan and its chemical cousin triclocarbon Thursday, calling on the Canadian Government to create a comprehensive phase-out plan for these harmful antibacterial chemicals. The report, which finds that the chemicals are accumulating in the waters of the Great Lakes, also suggests that the U.S. and all provinces and states bordering the Great Lakes should prohibit use of the chemicals. The two antibacterial chemicals are commonly used in consumer products ranging from liquid soaps and toothpaste to kitchen cutting boards, and have come under increased scrutiny amidst human health concerns and lack of efficacy. The Canadian Medical Association (CMA) has been calling for a ban on the household use of triclosan since 2009, and in 2012, the Canadian government declared triclosan as toxic to the environment. In the U.S., Beyond Pesticides has petitioned the Food and Drug Administration (FDA) and its counterpart, the U.S. Environmental Protection Agency (EPA) (which regulates non-cosmetic products with triclosan) for years to immediately ban triclosan from consumer products, citing endocrine disruption, and other human health concerns. Last December,  FDA announced  it […]

(Beyond Pesticides, July 15, 2014) More nutritional antioxidants, far fewer toxic pesticides; those are the results of a comprehensive meta-analysis on organic foods published yesterday in the British Journal of Nutrition.  Led by Carlo Leifort, Ph.D, at England’s Newcastle University, the analysis is a scientific rebuttal to a previous Stanford University review published in 2012, which found that there was little difference between the nutritional content of organic food over conventionally grown produce. Both studies found there to be fewer pesticides in organic products. While Stanford University’s review only looked at 200 studies, Dr. Leifert and his team of researchers expanded the scope of their meta-analysis to 343 studies, and also employed more robust analytic tools by analyzing the standardized mean differences of the data from the various studies. It shows very clearly how you grow your food has an impact,” said Dr. Leifert to The New York Times. “If you buy organic fruits and vegetables, you can be sure you have, on average, a higher amount of antioxidants at the same calorie level.” Antioxidants, compounds such as phenolic acids, flavanones, stilbenes, flavones, flavonols and anthocyanin, have been linked to lower risks of cancer and other diseases. For many, news […]

(Beyond Pesticides, July 2, 2014) According to a new study, few obstetricians offer their pregnant  patients advice on how to avoid environmental toxins that might harm their babies, even though doctors recognize that exposure to chemicals like pesticides, bisphenol-A (BPA), and metals can affect  a pregnancy. The study recommends that the medical community improve medical education and training, develop recommendations for prevention and less toxic alternatives, as well as lend support to policy change. The first of its kind study of prenatal counselling, published in the journal  PLOS ONE, Counseling Patients on Preventing Prenatal Environmental Exposures – A Mixed-Methods Study of Obstetricians, found that U.S. obstetricians and gynaecologists feel they lack the medical education and training, and evidence-based guidelines and tools for communicating potential environmental risks to patients. Exposure to environmental toxins, the researchers from the University of California, San Francisco (UCSF) found, is rarely discussed with pregnant patients, even though a national survey shows that 80 percent of physicians agree they should play a part in reducing patients’ exposure to toxins. But, of the 2,500 respondents, only one in five routinely asked  their  patients about these exposures, and just one in 15 said they received training on the harmful […]

(Beyond Pesticides, June 24, 2014) Research from the University of California, Davis CHARGE (Childhood Autism Risks from Genetics and the Environment) study finds that pregnant women who lived within a mile of agricultural fields treated with insecticides are more likely to have their child develop autism. The results of the CHARGE study, published in Environmental Health Perspectives, strengthens calls from public health and environmental groups urging regulators take a precautionary approach to agricultural chemicals and institute increased protections for those who live, work, or go to school near pesticide-treated fields. The CHARGE study looked at pregnant women’s addresses to determine their location relative to fields treated with pesticides. For women who lived less than one mile from crops sprayed with organophosphate insecticides during their pregnancy, researchers found the likelihood of their child being diagnosed with autism increased 60%. Women in the second trimester living near fields treated with chlorpyrifos, a widely used organophosphate insecticide banned for household use in 2001, are 3.3 times more likely to have their children diagnosed with autism. In response to a legal petition, the U.S. Environmental Protection Agency (EPA) in 2012 instituted risk mitigation measures for chlorpyrifos, including reduced application rates and no-spray buffer zones […]

(Beyond Pesticides, June 9, 2014) Triclosan, the antibacterial pesticide found in numerous hand soaps, toothpastes, and other cosmetics, has had a ubiquitous presence on the consumer market for over 30 years. But due to public pressure led by Beyond Pesticides, our allies, and concerned supporters, many manufacturers have been washing their hands of triclosan. Now after years of inaction, the U.S. Food and Drug Administration (FDA) is going to require data to support triclosan’s claims of being “safe and effective.” The time is now to let the agency know that triclosan is NOT safe or effective for human and environmental health. Raise your voice with a unique public comment to FDA! Use the sample letter below for guidance. Rising Evidence Against Safety Beyond Pesticides has generated extensive documentation  of the potential human and environmental health effects of triclosan and its cousin triclocarban. Studies show that triclosan can interfere with thyroid and estrogen hormones, and may promote the progression of cancer cells. This is alarming given that the CDC has found that 75% of the U.S. population contain triclosan in their bodies, even in breast milk, and at levels that are rising. Triclosan is an endocrine disruptor and has been shown […]

(Beyond Pesticides, June 5, 2014) Environmental advocacy groups filed an Administration Objection and a court appeal last week in order to challenge the Environmental Protection Agency’s (EPA) refusal to quickly correct errors in pesticide registrations and immediately implement measures to protect children from exposure to dangerous pesticides that drift from fields during and after application. EPA’s continued refusal to protect children’s health from pesticide drift is being criticized by numerous environmental, health, and farmworker advocacy groups. The groups, which include  United Farmworkers, Pineros y Campesinos Unidos del Noroeste, Pesticide Action Network of North America, Sea Mar Community Health Centers, California Rural Legal Assistance Foundation, Physicians for Social Responsibility, and Farm Labor Organizing Committee, originally filed a petition back in 2009 titled “Pesticides in the Air””Kids at Risk: Petition to EPA to Protect Children from Pesticide Drift (2009).” The petition asked that the agency properly comply with an existing law that requires EPA to protect children’s health from exposure to pesticides that drift from fields and orchards. After a more than four-year wait and a court appeal, EPA finally provided a response last March. These groups object to EPA’s recent response to their 2009 petition on the basis of two issues, […]

(Beyond Pesticides, March 21, 2014) Banned pesticides and flame retardants may be the cause of higher autistic behaviors for children who were exposed in utero, according to new research published last week in the journal Environmental Health Perspectives. Previous research has demonstrated that organochlorine chemicals are linked to learning problems, such as attention-deficit hyperactivity disorder (ADHD), especially in boys. This research is one of the first studies to evaluate their contribution to autistic behaviors. According to the study, Gestational Exposure to Endocrine-Disrupting Chemicals and Reciprocal Social, Repetitive, and Stereotypic Behaviors in 4- and 5-Year Old Children, children who were exposed to higher levels of brominated flame retardant PBDE-28 and trans-nonachlor, a component of the banned pesticide chlordane, scored higher in terms of autistic behavioral patterns as ranked by their mothers. In the study, researchers conducted a case-cohort study recruiting 175 pregnant women from seven prenatal clinics within the greater Cincinnati, Ohio region who provided urine and blood samples during pregnancy to measure the concentration of endocrine disrupting chemicals. On average, pregnant women had 44 suspected hormone disrupting chemicals. Five years later, when children had turned four or five, mothers were asked to rank their children’s behavior based on a series […]

(Beyond Pesticides, March 13, 2014) Part deux of a 2012 study finding that sperm counts in French men had decreased 30% over the past 16 years came to a second startling conclusion in a 2014 analysis: the cause for those dramatic decreases may be pesticides. 2012 Sperm-Count Study Published in the scientific journal Human Reproduction, the landmark 2012 study showed an alarming 30 percent decrease in sperm counts across France between 1989 and 2005. Because the data for the 2012 study were drawn from Fivnat ””a French assisted reproduction technology database”” researches made sure to limit analysis to 26,600 sperm samples from otherwise virile 35-year-old men whose partners’ fallopian tubes were either blocked or missing. This control was added to ensure that the each couple’s infertility was due to these latter problems and not a problem with the man’s sperm. Broken down, the 2012 studies identified a 1.9 percent continued annual dip in sperm concentration and also found that there was a significant 33.4% decrease in the percentage of normally formed sperm over the entire 16-year period. At the time of release, the 2012 study’s authors wrote: “To our knowledge, it is the first study concluding a severe and general […]

(Beyond Pesticides, December 20, 2013) The European Food Safety Authority (EFSA) announced on Tuesday that pesticides linked to honey bee deaths worldwide may also damage human nervous systems ””in particular the brain, and recommended that the European Commission lower the guidance levels of acceptable exposure until more research is conducted. This new determination heightens the call to ban the use of these toxic chemicals in the U.S., following the lead of the European Union (EU). EFSA found that two commonly used chemicals “may adversely affect the development of neurons and brain structure associated with functions such as learning and memory” particularly of children. The recommendation focuses on two chemicals ””acetamiprid and imidacloprid”” in a relatively new class of insecticide called neonicotinoids. Three chemicals in this class were recently placed under a two-year ban in the European Union (EU) for uses on flowering crops known to attract honey bees. The move stems from a recent review of research on rats which found, “Neonicotinoids may adversely affect human health, especially the developing brain.” Researchers who exposed newborn rats to one of these chemicals ””imidacloprid”” found they suffered brain shrinkage, fewer nerve signals controlling movement, and weight loss. Another study on rats found […]

(Beyond Pesticides, November 7, 2013) A study released this week established a strong connection between endometriosis and exposure to two dangerous pesticides: lindane and mirex. While the results are not surprising given past connections between these pesticides and their endocrine-disrupting effects, this new study, Organochlorine Pesticides and Risk of Endometriosis: Findings from a Population-Based Case-Control Study, is one of the first to examine the association between organochlorine pesticides (OCPs) and endometriosis, one of the most common gynecological diseases, in women in the general population. The study’s authors, Kristen Upson, Ph.D. et al,  explained to Environmental Health Perspectives, “Our study suggests that exposure from extensive past use of environmentally persistent OCPs in the United States, or present use in other countries may impact the health of the current generation of reproductive-age women with regard to a hormonally-mediated disease.” In conducting the study, researchers selected a group of women with surgically-confirmed cases of endometriosis from the greater Pacific Northwest area. This group of women was then divided into four groups, based on the level of pesticide in each woman’s blood. Women in the second-highest exposure group for beta-hexacyclochlorohexane (beta-HCH), a byproduct of lindane, had a 70 percent greater risk of endometriosis than […]

(Beyond Pesticides, November 1, 2013) Insecticides commonly used in homes and schools are associated with behavioral problems in children, according to a recent study by Canadian researchers. The study investigates exposure to pyrethroid pesticides, used in more than 3,500 products, including flea and tick controls, cockroach sprays, and head lice controls. The study, Urinary metabolites of organophosphates and pyrethroid pesticides and behavioral problems in Canadian children, published in the journal Environmental Health Perspectives, raises serious concerns about the impact of pyrethroids, which are increasingly used as a replacement for organophosphates. This study uses data from the Canadian Health Measures Survey (2007-2009), a nationally representative survey, so researchers are able to apply these findings to the entire population of Canadian children. In a previous study among U.S. children, researchers at the National Health and Nutrition Examination Survey (NHANES) examined the metabolites of pyrethroids in children below the age of six. Similarly, they found pyrethroid insecticides in more than 70 percent of the samples, concluding that children had significantly higher metabolite concentrations than those of adolescents. Together these studies demonstrate that exposure is widespread, with real impacts to human health. In the recent study, researchers analyzed organophosphate and pyrethroid metabolites in the […]

(Beyond Pesticides, May 9, 2013) A review of the scientific literature of the toxic effects of glyphosate, one of the most popular weed killers in the U.S. and the active ingredient in Roundup, links the herbicide  to a wide range of diseases and suggests  that more research is needed. The review, conducted by a scientist at Massachusetts Institute of Technology (MIT), looks at the mechanisms through which the adverse effects may be happening and points to  the chemical’s inhibition of cytochrome P450 (CYP) enzymes, which plays the crucial role of detoxifying xenobiotics. Thus, glyphosate can enhance the negative effects of other environmental toxicants on the body. Authors argue that this has been a critically overlooked component in research on glyphosates’ toxicity to mammals. We “have hit upon something very important that needs to be taken seriously and further investigated,” Stephanie Seneff, PhD, lead author and research scientist at MIT, told Reuters. Not surprisingly, Monsanto, the developer of Roundup, the leading product containing glyphosate, has attempted to discredit the study, claiming that its product has a long track record of being safe – read Another Bogus “Study.” However, Beyond Pesticides has assembled  extensive documentation on the human health and environmental risks […]

(Beyond Pesticides, April 26, 2013) Female agricultural workers experience the same hardships as their male counterparts, but have additional responsibilities and danger at home and in the field, according to a report released by the Association of Farmworker Opportunity Programs (AFOP). While women make up only 22 percent of agricultural labor in the U.S., AFOP makes a strong argument that women face disproportionate burdens, while at the same time earning less for their labor: On average they earn  just over $11,000 per year compared to male agricultural workers who earn $16,000. Through hundreds of interviews and focus groups of female farmworkers in California and Florida, AFOP revealed some of the most dangerous  conditions associated with farm work, among the worst being pesticide exposure. Carmela, a farmworker from Florida, indicated in the AFOP report that, “More than anything else, we have problems with pesticides. Sometimes they put us to work right after they’ve sprayed the pesticides. And this is bad for us because when we go in the field and start working with the plants, it gets in our eyes. It makes your head hurt too.” According to the EPA’s “Pesticide Industry Sales and Usage: 2000 and 2001 Market Estimates,” female […]

(Beyond Pesticides, April 24, 2013) Using the aquatic species Daphnia, commonly referred to as “water fleas,” scientists at North Carolina State University (NC State) determined that exposure to the pesticide pyriproxyfen impacted multiple generations, ultimately resulting in more male offspring, and causing reproductive problems in female offspring. Lead author Gerald LeBlanc, PhD, notes, “This work supports the hypothesis that exposure to some environmental chemicals during sensitive periods of development can cause significant health problems for those organisms later in life —and affect their offspring and, possibly, their offspring’s offspring.” The study, published in the journal PLoS One, provides the scientific community with new information on how organisms respond to the environmental signals resulting from pesticide exposure. Environmental cues normally determine whether the Daphina offspring will be male or female, according to the researchers. This study is part of an investigation to understand the mechanisms involved with these environmental cues. The NC State team had previously identified the hormone methyl farnesoate (Mf) as an important factor in determining the sex of the organisms at the embryotic stage. The scientists exposed Daphnia to varying levels of the pesticide pyriproxyfen, an insecticide that mimics the Mf hormone. The exposure resulted in Daphnia producing […]

(Beyond Pesticides, December 10, 2012) Long-term low-level exposure to organophosphate pesticides produces lasting damage to neurological and cognitive functions, according to researchers at University College London (UCL). This research pulls data from 14 studies over the past 20 years, including more than 1,600 participants, in order to provide a quantitative analysis of the current literature on these dangerous chemicals. Lead author of the study, Sarah Mackenzie Ross, Ph.D., notes, “This is the first time anyone has analyzed the literature concerning the neurotoxicity of organophosphate pesticides, using the statistical technique of meta-analysis.” UCL’s systematic review, published in the journal Critical Reviews in Toxicology, comes to an unsettling conclusion about the hazards of constant low-level occupational exposure to organophosphates. The study notes, “The majority of well designed studies found a significant association between low-level exposure to [organophosphates] and impaired neurobehavioral function which is consistent, small to moderate in magnitude and concerned primarily with cognitive functions such as psychomotor speed, executive function, visuospatial ability, working and visual memory.” In other words, low-level exposure had significant detrimental effect on working memory and information processing. The researchers are hopeful that the results of their analysis will be used to inform governments performing reviews on the […]

(Beyond Pesticides, August 10, 2012) A new study is the first to find a difference between how boys and girls respond to prenatal exposure to the insecticide chlorpyrifos. Researchers at the Columbia Center for Children’s Environmental Health (CCCEH) at the Mailman School of Public Health found that, at age 7, boys had greater difficulty with working memory, a key component of IQ, than girls with similar exposures. On the plus side, having nurturing parents improved working memory, especially in boys, although it did not lessen the negative cognitive effects of exposure to the chemical. Results are published online in the journal Neurotoxicology and Teratology. In 2011, research led by Virginia Rauh, ScD, Co-Deputy Director of CCCEH, established a connection between prenatal exposure to chlorpyrifos and deficits in working memory and IQ at age 7. Earlier this year, a follow-up study showed evidence in MRI scans that even low to moderate levels of exposure during pregnancy may lead to long-term, potentially irreversible changes in the brain. The latest study, led by Megan Horton, PhD, explored the impact of sex differences and the home environment on these health outcomes. Dr. Horton and colleagues looked at a subset of 335 mother-child pairs enrolled […]

(Beyond Pesticides, August 1, 2012) New research is adding to the evidence that some pesticides and industrial chemicals may increase women’s risk of uterine and ovarian diseases, such as endometriosis. The research supports the decades old theory that hormone-mimicking chemicals impact human reproductive systems. Scientists have long suspected a link between estrogen-mimicking pollutants and gynecological diseases. According to Environmental Health News, research investigating a link between hormone-disrupting chemicals in the environment and gynecological diseases has had mixed results. But a new study, “Persistent Lipophilic Environmental Chemicals and Endometriosis: The ENDO Study,” from researchers at the National Institutes of Health and others, found that two groups of women in the Salt Lake City and San Francisco areas — one group with pelvic pain and the other with no symptoms — were more likely to be diagnosed with endometriosis if they had high blood levels of the estrogen-like pesticide hexachlorocyclohexane (HCH) than women with low levels. HCH, a persistent organic pollutant (POP), and a byproduct of the production of the insecticide lindane (head lice treatments), has been banned as a crop pesticide in the United States but it persists in the environment and remains in some food supplies. Endometriosis is a female […]