Uterine contractile patterns in adenomyosis patients normalize under hormonal contraception use: the WAVES study

Abstract Study question Comparison of uterine contractility (UC) in adenomyosis patients (AP) with and without hormonal contraception (HC) compared to controls with HC, measured by transvaginal ultrasound (TVUS). Summary answer AP with HC show better contraction coordination compared to untreated AP. AP with HC show comparable UC compared to controls with HC. What is known already Adenomyosis is a disease of the uterus that can cause dysmenorrhoea, menorrhagia, dyspareunia and subfertility. These symptoms could be explained by the different contraction patterns in women with adenomyosis compared to healthy controls. Therapeutic use of hormonal contraception reduces the symptoms experienced by women with adenomyosis. This could be explained by the normalization of contraction patterns, which has not yet been objectively quantified due to the absence of a suitable measurement tool. A novel speckle-tracking and strain analysis by 2D TVUS recordings has recently been used to assess differences in contraction coordination, contraction frequency, velocity and direction in healthy women. Study design, size, duration This study is part of an ongoing multi-centre prospective observational cohort study investigating UC on TVUS. Our study includes the TVUS recordings of 23 women with adenomyosis without hormonal contraception treatment, 15 women with adenomyosis undergoing hormonal contraception treatment, and 17 women with healthy uteri undergoing hormonal contraception treatment. Patients were included in 3 centres from 2017 to 2023 (Catharina Hospital Eindhoven, Fertility Clinic Thessaloniki and University Federico Napels). Participants/materials, setting, methods 23 women with sonographic suspicion of adenomyosis without HC, 15 women with adenomyosis undergoing HC treatment and 17 women with healthy uteri with HC were included. HC included oral combined HC, progesterone only pill and hormonal IUD. UC frequency, amplitude, velocity and coordination were assessed by applying a dedicated speckle-tracking and strain analysis to 2-4-minute TVUS recordings in midsagittal section. AP with HC were compared to AP without contraception and to healthy controls with HC. Main results and the role of chance 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 showed more contraction coordination compared to the adenomyosis group without hormonal contraception treatment (0.23 ±0.10 vs. 0.29 ±0.11, p = 0.041). There was a tendency towards higher contraction frequency (1.53 ±0.21 vs. 1.42, p = 0.153) and lower amplitude (0.56 ±0.04 vs. 0.65 ±0.04, p = 0.159) in the adenomyosis group with hormonal contraception treatment compared to the adenomyosis group without hormonal contraception treatment. There were no significant differences in uterine contractility between the adenomyosis group with hormonal contraception treatment compared to the healthy group with hormonal contraception treatment. Limitations, reasons for caution No sub-analysis was done to assess effects of additional adenomyosis and contraception characteristics due to this being an ongoing study. Women with extensive adenomyosis were not included due to impossibility to perform analysis of ultrasound recordings. AP were older, had higher BMI and larger uterus volumes than healthy controls. Wider implications of the findings The normalization 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. Trial registration number NL52466.100.15 Study funding Yes Funding source Funding by commercial/corporate company(ies)