187 observed an increase in presence of uterine contractions during the periovulatory phase after the treatment of leiomyomas by uterine artery embolisation (UAE), ultrasound-guided high-intensify focussed ultrasound treatment (USgHIFU), uterine fibroid embolisation (UFE) and myomectomy compared to before treatment (247,251,255,258). Contraction frequency The case-control study by Orisaka et al. observed almost identical peristaltic patterns regarding contraction frequency in patients with leiomyomas (n=19) versus healthy controls (n=3) during all phases of the menstrual cycle (252). Two studies, on the other hand, observed altered peristaltic patterns in patients with leiomyomas and suggested the influence of leiomyomas on contraction frequency seemed menstrual-phase dependent (246,249). A decreased contraction frequency in patients with leiomyomas (n=20) was reported during the periovulatory phase (246), whereas an increased frequency was noticed in some patients with leiomyomas (n=20) during the mid-luteal phase compared to controls (n= 20) (249). Leiomyoma localisation seemed to have no effect on the contraction frequency (250). In three controlled prospective studies, initially altered uterine peristalsis normalised after treatment of uterine leiomyomas, including myomectomy, UAE and USgHIFU (247,248,258). After treatment, a relatively decreased contraction frequency was noted during the mid-luteal phase (248), whereas an increase in frequency was observed during the periovulatory phase (247,258). Contraction amplitude The contraction amplitude in patients with leiomyomas has not been compared yet with the contraction amplitude in healthy controls. A study by Szamatowicz et al. reported a higher contraction amplitude after myomectomy however (255). Contraction direction In five studies, the contraction direction during the periovulatory phase was observed form cervix-to-fundus in both patients with leiomyomas and healthy controls (246,247,250,252,258). One of these case-control studies also concluded that contraction direction in the follicular and late luteal phase was almost identical in patients (n= and healthy women(n=. Differences in contraction direction between patients with leiomyomas (n=19) and healthy
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