Uterine Contractility of Adenomyosis Patients Normalises Under Hormonal Contraception Use

Comparison of uterine contractility (UC) in adenomyosis patients (AP) with and without hormonal contraception (HC) compared to healthy controls with HC, measured by transvaginal ultrasound (TVUS). Ongoing multi-centre prospective observational cohort study. Outpatient clinics of participating centres. 36 women with sonographic suspicion of adenomyosis without HC, 15 women with sonographic suspicion of adenomyosis with HC and 17 women with healthy uteri with HC were included. HC included oral combined hormonal contraception, progesterone only pill, and hormonal IUD. Uterine contraction frequency, amplitude, velocity, and coordination were assessed by applying a dedicated speckle tracking and strain analysis to 4-minute TVUS recordings in midsagittal section. AP with HC were compared to AP without contraception and healthy controls with HC. Age, BMI, parity and uterus volume were significantly higher in the women with adenomyosis compared to the healthy controls (p<0.05). The adenomyosis group with contraception compared to without hormonal contraception treatment showed and lower amplitude (0.46±0.02 vs. 0.60±0.03, p=0.022) and reduced contraction coordination (0.22±0.12 vs 0.28±0.13, p=0.049) compared to the adenomyosis group without hormonal contraception treatment. There were no significant differences in UC between the adenomyosis group with HC compared to the healthy control group with hormonal contraception treatment. The normalisation of UC under therapeutic use of HC compared to untreated AP, and the lack of differences in UC between AP and healthy controls with HC, confirms the therapeutic effect on adenomyotic symptoms. This presents a new therapeutic efficacy marker for adenomyosis.