OP06.01: Quantitative ultrasound measurement of endometrial waves in adenomyosis versus women with normal uteri: the WAVES study

Comparison of uterine contractions via quantitative 2D transvaginal ultrasound measurements in women with adenomyosis compared to healthy controls. In this multicentre prospective observational cohort study, 29 women with adenomyosis with a natural menstrual cycle were compared to 70 women with normal uteri and menstrual cycles. Patients were included from September 2014 - January 2022 in 3 centres. Primary outcomes were the contraction frequency (contractions/minute), amplitude, direction (Cervix-to-fundus, Fundus-to-cervix), and coordination. Women underwent a 4-minute ultrasound of the uterus in mid-sagittal section. Uterine motion analysis was implemented by a dedicated speckle-tracking algorithm; with frequency, amplitude, coordination and velocity-related features extracted from the derived signals to characterise uterine contractions. Measurements were carried out at different points of the menstrual cycle (Menstrual phase, Periovulatory phase and Luteal phase). Results differed most significantly between groups in the periovulatory phase, with women with adenomyosis showing lower frequency, higher amplitude and lower velocity of uterine contractions (P 0.05). Across all phases, women with adenomyosis showed a trend towards reduced contraction coordination. This was statistically significant in the late luteal phase (P = 0.018). Our results confirm differences in uterine movement in abnormal versus healthy uteri. This could add to the etiological understanding of clinical symptoms of these conditions. The notable difference between groups regarding coordination identifies this features a s a potential etiological or therapeutic marker (i.e. for dysmenorrhoea). Further research in women with (other) benign uterine disorders will hopefully lead to a better understanding of the clinical implications of abnormal uterine contractility in this population.