Uterine peristalsis in women affected by adenomyosis: A step towards functional assessment

Alessandro Arena; Margherita Zanello; Benedetta Orsini; Eugenia Degli Esposti; Raffaella Iodice; Michele Altieri; Alessandra Borgia; Elisa Moro; Renato Seracchioli; Paolo Casadio

doi:10.1002/ijgo.15299

Uterine peristalsis in women affected by adenomyosis: A step towards functional assessment

Int J Gynaecol Obstet. 2024 May;165(2):666-671. doi: 10.1002/ijgo.15299. Epub 2024 Jan 11.

Authors

Alessandro Arena^{1

2}, Margherita Zanello^{1

2}, Benedetta Orsini^{1

2}, Eugenia Degli Esposti^{1

2}, Raffaella Iodice^{1

2}, Michele Altieri^{1

2}, Alessandra Borgia^{1

2}, Elisa Moro^{1

2}, Renato Seracchioli^{1

2}, Paolo Casadio^{1

2}

Affiliations

¹ Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
² Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.

PMID: 38205860
DOI: 10.1002/ijgo.15299

Abstract

Objective: The non-pregnant uterus shows an intrinsic contractility pattern, actively involved in early reproductive processes. Uterine contractility is characterized by endometrial waves that originate from the junctional zone and varies throughout the menstrual cycle due to fluctuations in the concentrations of hormones. The aim of this study was to compare the uterine contractility patterns in the periovulatory phase in a group of patients with isolated adenomyosis and a group of healthy women using transvaginal ultrasound (TVUS).

Methods: From March 2019 to March 2021, we enrolled consecutive nulliparous patients in the periovulatory phase of the menstrual cycle, divided in patients with isolated adenomyosis (group A, n = 18) and healthy patients in the control group (group B, n = 18). Patients who met the inclusion criteria underwent TVUS for the study of uterine contractility: the uterus was scanned on sagittal plane for 3 min and all the movies were recorded. Then, static images and video were evaluated offline and the uterine contractility patterns were defined.

Results: The patients belonging to the study group had a higher incidence of painful symptoms (dysmenorrhea, 6.11 ± 2.81 vs 1.39 ± 2.17; chronic pelvic pain, 2.56 ± 3.01 vs 0.39 ± 1.04) and a larger uterine volume (137.48 ± 117.69 vs 74.50 ± 27.58 cm³; P = 0.04). Regarding the uterine contractility, a statistically significant difference was observed about the retrograde patterns (group A, 27.8% vs group B, 72.2%, P < 0.01) and opposing (group A, 38.9% vs, group B, 5.6%, P = 0.02).

Conclusion: The study confirms the presence of altered uterine peristalsis in the periovulatory phase in patients with adenomyosis. The abnormal uterine peristalsis could lead to both structural and functional changes, which are the basis of the clinical manifestations of adenomyosis and the perpetuation of the anatomical damage.

Keywords: adenomyosis; endometrial waves; ultrasound; uterine contractility; uterine peristalsis.

MeSH terms

Adenomyosis* / diagnostic imaging
Dysmenorrhea / etiology
Endometrium
Female
Humans
Peristalsis
Uterus / diagnostic imaging