Association between Vitamin D Levels, Superoxide Dismutase (SOD), And Malondialdehyde (MDA) with Endometriosis

Lia Aswika Via Kosta; Fatmawati Madya; Anggrainy Dwifitriana Kouwagam; Nusratuddin Abdullah; David Lotisna; Imam Ahmadi Farid

doi:10.23750/abm.2026.18533

Authors

Lia Aswika Via Kosta Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Fatmawati Madya Fertility, Endocrinology, and Reproduction Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Anggrainy Dwifitriana Kouwagam Urogynaecology and Reconstruction Division, Department of Obstetrics and Gynaecology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Nusratuddin Abdullah Fertility, Endocrinology, and Reproduction Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
David Lotisna Urogynaecology and Reconstruction Division, Department of Obstetrics and Gynaecology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Imam Ahmadi Farid Urogynaecology and Reconstruction Division, Department of Obstetrics and Gynaecology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Keywords:

Endometriosis, Vitamin D , Superoxide Dismutase , Malondialdehyde

Abstract

Background and aim: Endometriosis is a chronic condition in which endometrial tissue grows outside the uterus, causing pain and fertility problems. Oxidative stress plays an important role in its pathogenesis, characterized by an increase in free radicals and a decrease in antioxidant activity. SOD functions as the main defense against free radicals, while MDA reflects the level of oxidative damage. In addition, vitamin D has anti-inflammatory and antioxidant effects that may be related to the development of endometriosis. The Aim of this study is to determine the relationship between vitamin D, SOD, and MDA levels and endometriosis.

Methods: A descriptive analytic case–control study was conducted involving 86 women of reproductive age, consisting of patients with histopathologically confirmed endometriosis and controls without endometriosis. Venous blood samples were collected to measure serum vitamin D, SOD, and MDA levels using ELISA. Data were analyzed using independent t-tests, chi-square tests, and receiver operating characteristic (ROC) curve analysis, with statistical significance set at p < 0.05.

Results: Vitamin D levels were lower in endometriosis compared to controls (16.4 ng/mL vs. 20.4 ng/mL; p = 0.003). SOD levels were also lower in endometriosis compared to controls (28.1 ng/mL vs. 39.6 ng/mL; p = 0.001). MDA levels were higher in endometriosis compared to controls (29.1 ng/mL vs. 22.7 ng/mL; p = 0.024). Vitamin D deficiency was more common in endometriosis than in controls (58.2% vs. 41.8%, p = 0.04). MDA level of 24.1 ng/mL had a sensitivity of 62.0% and specificity of 60.5% in diagnosing endometriosis.

Conclusions: Patients with endometriosis have lower vitamin D levels, decreased superoxide dismutase, and increased oxidative stress, specifically malondialdehyde.

References

1. Clower L, Fleshman T, Geldenhuys WJ. Targeting Oxidative Stress Involved in Endometriosis and Its Pain. Biomolecules. 2022;12:1055. doi:10.3390/biom12081055

2. Parasar P, Ozcan P, Terry K. Endometriosis: Epidemiology,Diagnosis, and Clinical Treatment. Curr Obstet Gynecol Reprod. 2017;6(1):34-41. doi:10.1007/s13669-017-0187-1.Endometriosis

3. Checa J, Aran JM. Reactive oxygen species: Drivers of physiological and pathological processes. J Inflamm Res. 2020;13:1057-1073. doi:10.2147/JIR.S275595

4. Sayegh L, Fuleihan GEH, Nassar AH. Vitamin D in endometriosis: A causative or confounding factor? Metabolism. 2014;63(1):32-41. doi:10.1016/j.metabol.2013.09.012

5. Brunty S, Santanam N. Current assessment of the (dys)function of macrophages in endometriosis and its associated pain. Ann Transl Med. 2019;7(S8):S381-S381. doi:10.21037/atm.2019.12.119

6. Rowlands IJ, Abbott JA, Montgomery GW, Hockey R, Rogers P, Mishra GD. Prevalence and incidence of endometriosis in Australian women: a data linkage cohort study. BJOG An Int J Obstet Gynaecol. 2021;128(4):657-665. doi:10.1111/1471-0528.16447

7. Yagur Y, Schneyer R, Hamilton K, et al. Is Endometriosis a Progressive Disease? Examining Age-Related Trends in disease Severity and Surgical Complexity. Fertil Steril. Published online 2025. doi:https://doi.org/10.1016/j.fertnstert.2025.09.024

8. Jin W, Chen X, Lin X, et al. Should patients undergo endometrioma surgery before IVF/ICSI? a retrospective study with propensity score matching. Reprod Health. 2025;22(1):177. doi:10.1186/s12978-025-02141-8

9. Lee HJ, Yu EH, Joo JK, Na YJ. Correlation between serum anti-Müllerian hormone levels and radiological markers assessed using ultrasonography and magnetic resonance imaging in patients with unilateral endometrioma: a retrospective study in Korea. Kosin Med J. 2025;40(3):199-206. doi:10.7180/kmj.25.108

10. Wiebe N, Tonelli M. Associations of body fat and inflammation with non-communicable chronic diseases and mortality: a prospective cohort study of the UK Biobank. BMJ Open. 2025;15(10):e092962. doi:10.1136/bmjopen-2024-092962

11. Arablou T, Khodaverdi S, Kolahdouz-Mohammadi R, Farhangnia P, Delbandi AA. Body mass index and endometriosis: Is there a relationship? J Endometr Pelvic Pain Disord. 2022;14(2):87-91. doi:10.1177/22840265221092872

12. Oliveira HGDS, Dos Santos AAP, Silva JDSB, Tavares NV da S, de Farias KF, Machado GV de O. Prevalence of painful symptoms in women with endometriosis in a capital of Northeastern Brazil. Rev Enferm. 2024;32:1-7. doi:10.12957/reuerj.2024.80769

13. Shafrir AL, Farland L V, Shah DK, et al. Risk for and consequences of endometriosis: A critical epidemiologic review. Best Pract Res Clin Obstet Gynaecol. 2018;51:1-15. doi:https://doi.org/10.1016/j.bpobgyn.2018.06.001

14. Burghaus S, Klingsiek P, Fasching P, et al. Risk Factors for Endometriosis in a German Case–Control Study. Geburtshilfe Frauenheilkd. 2011;71(12):1073-1079. doi:10.1055/s-0031-1280436

15. Sarria-Santamera A, Orazumbekova B, Terzic M, Issanov A, Chaowen C, Asúnsolo-Del-barco A. Systematic review and meta-analysis of incidence and prevalence of endometriosis. Healthc. 2021;9(1):1-16. doi:10.3390/healthcare9010029

16. El-Hadad S, Lässer D, Sachs MK, et al. Dysmenorrhea in adolescents requires careful investigation of endometriosis—an analysis of early menstrual experiences in a large case-control study. Front Reprod Heal. 2023;5(August):1-9. doi:10.3389/frph.2023.1121515

17. Muselli M, Mancinelli M, Limoncin E, et al. Investigating Unhealthy Behaviors Associated with SF-36 Domains in Women with Endometriosis—Findings from a Web-Based Survey Data Set. Behav Sci (Basel). 2024;14(3). doi:10.3390/bs14030199

18. Alson S, Jokubkiene L, Henic E, Sladkevicius P. Prevalence of endometrioma and deep infiltrating endometriosis at transvaginal ultrasound examination of subfertile women undergoing assisted reproductive treatment. Fertil Steril. 2022;118(5):915-923. doi:10.1016/j.fertnstert.2022.07.024

19. Sun L, Tian Y, Ling L. The association between shorter disease course and sarcopenia in women with endometriosis: a retrospective analysis of NHANES 1999–2006. Sci Rep. 2025;15(1):1-7. doi:10.1038/s41598-025-03511-9

20. Abesadze N, Kristesashvili J, Asatiani K. Association of vitamin D deficiency and endometriosis - Study of fertile women. 2025;(June):22-27.

21. Kalu E, Sumar N, Giannopoulos T, et al. Cytokine profiles in serum and peritoneal fluid from infertile women with and without endometriosis. J Obstet Gynaecol Res. 2007;33(4):490-495.

22. Mier‐Cabrera J, Jiménez‐Zamudio L, García‐Latorre E, Cruz‐Orozco O, Hernández‐Guerrero C. Quantitative and qualitative peritoneal immune profiles, T‐cell apoptosis and oxidative stress‐associated characteristics in women with minimal and mild endometriosis. BJOG An Int J Obstet Gynaecol. 2011;118(1):6-16.

23. Polak G, Kotarski J. Total oxidative status of peritoneal fluid in women with endometriosis. Ginekol Pol. 2010;81(12).

24. Turkyilmaz E, Yildirim M, Cendek BD, et al. Evaluation of oxidative stress markers and intra-extracellular antioxidant activities in patients with endometriosis. Eur J Obstet Gynecol Reprod Biol. 2016;199:164-168.

25. Oral O, Kutlu T, Aksoy E, Fıçıcıoğlu C, Uslu H, Tuğrul S. The effects of oxidative stress on outcomes of assisted reproductive techniques. J Assist Reprod Genet. 2006;23(2):81-85.

26. Janša V, Osredkar J, Verdenik I, Rižner TL, Ban Frangež H. Oxidative stress markers cannot be used as endometriosis biomarkers in infertile patients. Gynecol Endocrinol. 2023;39(1). doi:10.1080/09513590.2023.2242956

27. van Tienhoven XA, de Chávez Gascón JR, Cano-Herrera G, et al. Vitamin D in Reproductive Health Disorders: A Comprehensive Review focusing on Infertility, Endometriosis and Polycystic Ovarian Syndrome. Published online 2025. doi:10.20944/preprints202502.0237.v1

28. Oleiwi WJ. The Role of Vitamin D Supplementation in Improving Endometrial Receptivity and Live Birth Rates in Women Undergoing Frozen Embryo Transfer in Baghdad , Iraq. Published online 2025. doi:10.59324/ejmhr.2025.3(5).28