Endometriosis and ovarian aging: a pilot study exploring oxidative stress and DNA damage markers

To assess whether specific markers of oxidative stress and DNA damage are expressed at higher levels in primordial follicles of patients with endometriomas compared to age-matched controls.

A retrospective pilot cohort study was conducted using ovarian tissue from patients who underwent unilateral or bilateral salpingo-oophorectomy for symptomatic endometriomas, with controls undergoing an identical procedure for other benign gynecologic conditions. Immunohistochemistry (IHC) was used to assess percent positivity in primordial follicles for 4-hydroxy-2-nonenal (4-HNE) as a marker of oxidative stress; 8-Oxoguanine (8-Oxo) and phosphorylated H2AX (γH2AX) for DNA damage. Chi-square tests were used for categorical variables and Student t-tests for continuous variables, with p < 0.05 considered significant.

Twenty-nine patients were included (8 controls, 21 with endometriomas). Age (39.4 ± 5.1 vs. 37.1 ± 4.6 years, p = 0.269), BMI (33.6 ± 10.6 vs. 29.5 ± 7.8 kg/m², p = 0.310) were similar between groups. Racial distribution, nulliparity, hormonal therapy use, and smoking status were also comparable. The average endometrioma size was 6.6 ± 2.8 cm. All molecular markers showed higher percent positivity in the endometrioma group compared to the control group. γH2AX demonstrated a statistically significant increase (63.6% vs. 50.1%, p = 0.033). 8-Oxo (67.5% vs. 55.8%, p = 0.070) and 4-HNE (65.1% vs. 61.8%, p = 0.168) were also elevated in the endometrioma group but did not reach statistical significance.

Patients with endometriomas demonstrated increased follicular DNA damage, with elevated γH2AX expression, supporting the notion that endometriomas may impair follicular quality through DNA damage mechanisms.