Systemic Oxidative Stress in Women with Ovarian and Pelvic Endometriosis: Role of Hormonal Therapy

Abstract

This study was performed to evaluate the systemic oxidative stress balance in women with either ovarian or deep infiltrating endometriosis (DIE) and any alterations of the same during hormone therapy. Free oxygen radicals (FORT) and free oxidant radical defense (FORD) were measured in the capillary blood of 24 women without endometriosis, 26 women with endometrioma, and 26 women with DIE with or without endometrioma. Endometriosis was diagnosed by clinical and ultrasound assessment. Dietary factors, lifestyle habits, and intake of any substances interfering with the oxidative status were recorded. Women were prescribed contraceptive hormones, and the baseline assessments were repeated at the 3rd month of use, revealing a higher oxidative stress balance (FORT/FORD) in women with endometriosis than in controls (4.75 ± 4.4 vs. 2.79 ± 2.2; p = 0.05). The highest values were found in women with DIE (5.34 ± 4.6; p = 0.028 vs. controls). Regression analysis revealed an independent link between FORT/FORD and endometrioma (b 2.874, 95% CI 0.345, 5.403; p = 0.027) and DIE (b 4.419, 95% CI 1.775, 7.064; p = 0.001) but a negative correlation with HDL-cholesterol (b −0.063, 95% CI −0.125, −0.002; p = 0.043). In controls, the hormone therapy increased FORT (p = 0.003), but also FORD (p = 0.012), with the FORT/FORD balance remaining stable (2.72 ± 2.2 vs. 2.73 ± 1.8; p = 0.810). In women with endometriosis, FORT remained unchanged, but FORD increased (p = 0.004), and the FORT/FORD ratio significantly decreased (4.75 ± 4.4 vs. 2.57 ± 1.76; p = 0.002) to values similar to the control levels. These data indicate that systemic oxidative stress balance increased in women with endometriosis, particularly in those with DIE. The hormonal therapy did not change the oxidative stress balance in control women but significantly improved it in women with endometriosis, particularly those suffering from DIE.

Digestive system deep infiltrating endometriosis: What do we know

“… 32 Oxidative stress and its activity in the lesions of patients with DIE. 34 A previous study observed a correlation between the dysregulation of ROS in endometriosis and the dysregulated characteristics of ROS in tumour cells. 35 ROS regulates oxidative stress and cell proliferation by activating the ERK pathway.…”

“…Retrograde blood transports iron into macrophages and induces oxidative cellular damage, generating high levels of ROS and inducing cell proliferation and apoptosis 32 . Oxidative stress and its activity in the lesions of patients with DIE 34 . A previous study observed a correlation between the dysregulation of ROS in endometriosis and the dysregulated characteristics of ROS in tumour cells 35 .…”

Oxidative Stress: The Role of Estrogen and Progesterone

“…The method of determining oxidative status has already been reported in several publications [13,[23][24][25][26][27]. Reactive oxygen species were determined in 20 µL of capillary blood using the FORT test (FORM ® , CR 2000, Callegari, Parma, Italy)-a colorimetric assay based on the capacity of transition metals to stimulate the breakdown of hydroperoxides (ROOH) into derivative radicals-within the Fenton reaction.…”

“…The role played by gonadal steroids on oxidative stress is still unclear. Increased oxidative stress has been reported by several [6][7][8][9][10][11][12], but not all [13] studies, during the use of hormonal contraceptives supposedly due to a high-estrogen stimulus [12,14]. Viceversa data obtained in postmenopausal women indicate that the increase in oxidative status is due to a lack of estrogen, and that estrogen administration decreases it [15,16].…”

“…To this end, the oxidative status of women undergoing a stimulated cycle for in vitro fertilization was evaluated during a low estrogen-progesterone stimulus, a high-estrogen stimulus, and a high-estrogen-plus-progesterone stimulus. Oxidative status was determined by measuring total blood oxidants (FORT), antioxidants (FORD), and their ratio FORT/FORD [6,13,[23][24][25][26].…”