LOW 25OHD IN ENDOMETRIOSIS- RISK FACTOR OR CONSEQUENCE?!

Abstract

Active vitamin D-1.25OHD (1,25Dihydroxyvitamin D, calcitriol) in the endometrium of women with endometriosis seems to be enhanced compared to healthy controls. Evidence is insufficient on how this process reflects vitamin D metabolites-25OHD (25 Hydroxyvitamin D, calcifediol), 1.25OHD, and calcium blood concentrations.

Aim: Determination of vitamin D's significance in the pathogenesis of endometriosis by analyzing the levels of 25OHD, 1.25OHD, and calcium in patients with endometriosis before and after laparoscopic treatment.

Materials and methods: This study is an anterograde comparative analysis, that investigates the variation of vitamin D metabolite and calcium levels between the preoperative assessment and the subsequent measurement following surgical treatment of endometriosis. Results before the intervention were also compared to the healthy control group. Levels of 25OHD,1.25OHD, and calcium before required surgical treatment and 3 months post-laparoscopy were measured. Data analyses were made using IBM SPSS 27.

Results: Women with endometriosis have significantly lower mean 25OHD (p-0.002) and a higher 1.25OHD (p<0.001) and total calcium levels (p-0.03) compared to controls. The endometriosis stage and size of endometrioma negatively correlate with 25OHD levels (p<0.001). After surgical removal of endometriotic lesions, 1.25OHD, and calcium showed a significant decrease whereas 25OHD blood concentrations increased statistically significantly.

Conclusion: Women with endometriosis have a lower 25OHD, a higher 1.25OHD, and total calcium levels in the bloodstream compared to the control group. Usually, a low concentration of 25OHD is characterized by low/normal 1.25OHD and hypocalcemia. Hypercalcemia in the study group may be attributed to increased levels of active vitamin D- 1.25OHD, which seems to be the result of a higher conversion rate of 25OHD to 1.25OHD in the endometrium of women with endometriosis. Removal of endometriotic heterotopies was followed by significant changes, which could indicate that the levels of vitamin D metabolites have been influenced by endometriosis. It is reasonable to conclude, that diminished levels of 25OHD might be interpreted as an outcome of a high demand in endometriosis, instead of a risk factor.