Uterine and cervical tissue stiffness assessed by ultrasound elastography in women with dysmenorrhea, with or without endometriosis: a scoping review

This scoping review aims to systematically map the available literature on uterine and cervical tissue stiffness assessed by ultrasound elastography in women with dysmenorrhea, with or without endometriosis or adenomyosis. Dysmenorrhea is one of the most prevalent gynecological complaints among women of reproductive age, with a substantial impact on quality of life and a significant socioeconomic burden. Increased uterine and cervical stiffness, particularly at the level of the internal cervical os, has been proposed as a contributing mechanical factor to menstrual pain. However, the available evidence remains heterogeneous and fragmented across populations, elastography techniques, and anatomical regions assessed. To date, no review has specifically addressed the relationship between tissue stiffness, evaluated by ultrasound elastography, and dysmenorrhea — irrespective of the underlying gynecological condition. The review follows the methodology recommended by the Joanna Briggs Institute (JBI) for scoping reviews and is reported according to the PRISMA-ScR guidelines (Tricco et al., 2018). The research question is structured according to the Population–Concept–Context (PCC) framework. A comprehensive electronic search was conducted across PubMed, Web of Science, Embase, Cochrane Library and Scopus, complemented by hand-searching of reference lists. Original peer-reviewed studies in English, French, German and Dutch are considered eligible. Two independent reviewers perform study selection and data charting using a standardized extraction form, with Rayyan used to support the screening process. The expected outcomes are: (i) to identify the elastography techniques used to assess uterine and cervical stiffness in this population; (ii) to describe the anatomical regions and measurement protocols reported; (iii) to characterize the populations investigated, including dysmenorrhea phenotypes and associated gynecological conditions; (iv) to synthesize the main findings on the relationship between tissue stiffness and clinical outcomes, particularly menstrual pain; and (v) to identify current knowledge gaps and guide future research directions.