Quantitative Ultrasound Measurement of Uterine Contractility in Adenomyotic Versus Normal Uteri: A multicenter prospective study

Objectives: To evaluate uterine contractility in adenomyosis patients compared to healthy controls using a quantitative two-dimensional transvaginal ultrasound (TVUS) speckle tracking method. Design: Multi-center prospective observational study took place in three European centers between 2014 and 2023. Subjects: 46 women with a sonographic or MRI diagnosis of adenomyosis were included. 106 healthy controls without uterine pathologies were included. Exposure: Four-minute TVUS recordings were performed and four UC features were extracted using a speckle tracking algorithm. Main outcomes measures: The extracted features were: contraction frequency (contractions/minute), amplitude, velocity (mm/s) and coordination. Women with adenomyosis were compared to healthy controls according to the phase of the menstrual cycle. Results: Throughout the different phases of the menstrual cycle, trends of increased amplitude, decreased frequency and velocity, and reduced contraction coordination were seen in adenomyosis patients compared to healthy controls. These were statistically significant in: the late follicular phase, with higher amplitude (0.087±0.042 vs. 0.050±0.018, p=0.001), lower frequency and velocity (1.49±0.22 vs. 1.68±0.25 contractions/minute, p=0.021, and 0.65±0.18 vs. 0.88±0.29 mm/sec, p=0.014, respectively), and reduced contraction coordination (0.34±0.08 vs. 0.26±0.17, p=0.015), in the late luteal phase, with higher amplitude (0.050±0.022 vs 0.035±0.013, p=0.038), lower velocity (0.51±0.11 vs. 0.65±0.13 mm/sec, p=0.027), and reduced contraction coordination (0.027±0.06 vs. 0.18±0.07, p=0.011), and in the mid-follicular phase, with decreased frequency (1.48±0.21 vs. 1.69±0.16 contractions/minute, p=0.013) in adenomyosis patients compared to controls. During menses, a higher pain score was significantly associated with lower frequency and velocity and higher contraction amplitude (p=0.012, 0.027 and 0.028 respectively). Results remained significant after correcting for age, parity and BMI. Conclusion: Uterine contractility differs in adenomyosis patient compared to healthy controls throughout the phases of the menstrual cycle. This suggests an etiological mechanism for the infertility and dysmenorrhea seen in adenomyosis patients. Moreover, it presents new potential therapeutic targets and diagnostic markers.