Elemental analysis in menstrual effluent of women with PCOS: association with oxidative stress mechanisms: a case-control study.

Abstract

Polycystic ovarian syndrome (PCOS) is a common endocrine disorder in women of reproductive age. Metal ions can disrupt antioxidant defenses, alter the endometrial environment, and contribute to its pathophysiology. To compare element levels in menstrual effluent (ME) between women with PCOS and healthy controls, and to assess their association with antioxidant defence mechanisms, a case-control study was conducted among women diagnosed with PCOS according to the Rotterdam criteria. ME was collected and analysed by Inductively Coupled Plasma Mass Spectrometry (ICP-MS) for elements. Antioxidant enzymes like catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx), non-enzymatic antioxidants glutathione (GSH), hydrogen sulfide (H₂S), oxidative stress markers lipid peroxidase (LPO), nitric oxide (NO), and myeloperoxidase (MPO) were measured in the ME-derived erythrocytes. Significant differences were observed in Boron (B), Barium (Ba), Calcium (Ca), Copper (Cu), Iron (Fe), Magnesium (Mg), Manganese (Mn), Sodium (Na), Potassium (K), Nickel (Ni), Phosphorus (P), and Zinc (Zn) in the ME of PCOS women compared to healthy controls. Elevated CAT, SOD and GPx correlated with elements like Mn, Cu, and Zn. LPO, NO, and MPO were correlated with Fe, Cu, Zn, Cd, Ni, Pb, Cu and Mn. GSH and H₂S levels decreased in women with PCOS, correlating with elements such as B, Ba, Cu, Fe, Ni, and Zn. Common proteins were found between metal-interacting and PCOS-related genes, implicating the role of elements in oxidative pathways. ME-based metal profiling offers a non-invasive approach for the early detection of oxidative stress-related inflammation in PCOS, with implications for cancer risk monitoring.