## 3 Results and Discussion
### Urinary Concentrations of Phthalate and Alternative Plasticizer Metabolites  
Twenty phthalate metabolites and seven alternative plasticizer metabolites (i.e., 4 DEHTP and 3 DINCH) are shown in Table 2. A total of 12 phthalate metabolites (di-2-ethylhexyl phthalate (DEHP) (i.e., MEHP, MEOHP, MEHHP, 2 cx-MMHP, and 5 cx-MEPP); di-n-octyl phthalate (DnOP), and others (i.e., MBzP, MiBP, MEP, MnBP, MMP, MCP, and OH-MiNP)) were detected \(>\)73%, while MiNP, MnOP, MCHP, MiDP, MnPP, MiPrP, MhxP, and cx-MiDP were rarely detected. Urinary concentrations of 4 DEHTP and 3 DINCH \begin{table}
\begin{tabular}{c c c} \hline \hline
**Variable** & \
\begin{tabular}{c} **Number (\%)** \\ **(\(n=30\))** \\ \end{tabular} &
\begin{tabular}{c} **Mean \(\pm\) SD** \\ **(Range)** \\ \end{tabular} \\ \hline Age (years) & & 44.67 \(\pm\) 4.99 (29–54) \\ BMI (kg/m\({}^{2}\)) & & 24.25 \(\pm\) 4.43 (17.7–35.9) \\ Waist circumference (cm) & & 73.95 \(\pm\) 6.54 (61–86.4) \\ Diameter of the largest & & 6.79 \(\pm\) 2.42 (12–108) \\ leiomyoma (mm) & & 3.93 \(\pm\) 3.16 (1–12) \\ Number of leiomyoma & & \\ Operation status & & \\ Myomectomy & 12 (40) & \\ Hysterectomy & 18 (60) & \\ Disease status & & \\ Leiomyoma only & 14 (46.7) & \\ Leiomyoma + Endometriosis & 3 (10) & \\ (E) & & \\ Leiomyoma + Adenomyosis & 9 (30) & \\ (A) & & \\ Leiomyoma + E + A & 4 (13.3) & \\ Parity & & \\ Primipara & 13 (43.7) & \\ Multipara & 17 (56.7) & \\ Menstrual phase & & \\ Proliferative & 14 (46.7) & \\ Secretory phase & 13 (43.3) & \\ Atrophy & 3 (10) & \\ Menstrual cycle & & \\ Regular & 22 (73.3) & \\ Irregular & 8 (26.7) & \\ Dysmenorrhea & & \\ No & 13 (43.3) & \\ Yes & 17 (56.7) & \\ Smoking status & & \\ No & 21 (75) & \\ Yes & 7 (25) & \\ Alcohol drinking status & & \\ No & 1 (3.6) & \\ Yes & 27 (96.4) & \\ \hline \hline \end{tabular} If \(n<30\), missing values are present.  
\end{table} 
Table 1: Demographic and clinical characteristics of the study population. metabolites were measured, while their monoesters such as MEHTP and MINCH were rarely detected. Three DEHTP metabolites (i.e., 5 cx-MEHTP, 5 OH-MEHTP, and 5 OXO-MEHTP) and two MINCH metabolites (i.e., OH MINCH and cx MINCH) were detected >75%, showing that alternative plasticizers are widespread and frequently exposed. In phthalates, the creatinine-adjusted levels of 5 cx-MEPP (35.47\(\pm\) 33.24 \(\upmu\)g/g creatinine) were the highest, followed by MnBP, MEHHP, 2 cx-MMHP, MiBP, MEOHP, MEHP, MEP, MBzP, MMP, OH-MiNP, and MCPP. Among alternative plasticizers, creatinine-adjusted levels of 5 cx-MEHTP (28.78 \(\pm\)16.31\(\upmu\)g/g creatinine) were the highest, followed by 5 OH-MEHTP, 5 OXO-MEHTP, cx-MINCH and OH-MINCH. Both 5 cx-MEPP and 5 cx-MEPP are carboxylated monoester metabolites and major oxidized metabolites excreted in urine. Metabolites of DEHP (i.e., MEOHP, MEHHP, 2 cx-MMHP), DEHTP, (i.e., 5 cx-MEHTP, 5 OH-MEHTP, 5 OXO-MEHTP), and MINCH (i.e., OH-MINCH, and cx-MINCH) were significantly correlated within each group as shown in Figure S1. In particular, the most widely and frequently used phthalates, including di-ethyl phthalate (DEP), DEHP, and di-n-butyl phthalate (DnBP), showed significant correlations among their metabolites (Spearman's rho = 0.55 for MEP vs. MEHP, 0.39 for MEP vs. MCPP, rho = 0.53 for MiBP vs. MnBP, rho = 0.83 for MnBP and MCPP). This could be attributable to various phthalates that are mixed and used in products. Therefore, factor analyses were further performed to consider the possible mixing effects; however, there were no significant associations, as demonstrated by the single phthalate-leiomyoma association (data not shown). There has recently been a shift from the use of traditional phthalates to alternative plasticizers due to environmental and health concerns [31]. One of the well-known al