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

PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.