198 Introduction: Uterine peristalsis (UP) occurs in the endo-myometrial layer of the non-pregnant uterus. On transvaginal ultrasound (TVUS) it can be visible in the junctional zone (JZ) and appears as wave-like movements (70,237). UP is thought to have physiological function and its behaviour is cycle-phase dependent (237,261,262). During menstruation, the peristalsis is directed from fundus-tocervix (F2C), supporting the expulsion of endometrial lining, with a relatively low frequency. During the periovulatory phase, UP switches to cervix-to-fundus (C2F) contractions and has the highest frequency and velocity. It is thought that contractions in this phase are especially directed towards the ipsilateral side of the dominant follicle, supporting sperm transport (262,263). Disturbances herein may affect sperm transport and thus fertilization. After ovulation, contractions in the luteal phase are relatively quiescent in order to facilitate embryo implantation, with the lowest contraction frequency (CF) of all phases seen. During this phase, opposing contractions occur, directed toward the midcorpus of the uterus from both the cervical and fundal regions. Similarly, disturbances in this phase of uterine contractility may affect the ability of an embryo to implant successfully. Recent work by our group has been able to measure this uterine peristaltic behaviour in an objective manner using a dedicated speckle tracking method on 2D-transvaginal ultrasound (263,264). Adenomyosis is characterized by disruption of the uterine junctional zone (JZ). It is generally associated with abnormal uterine bleeding (AUB), dysmenorrhea, subfertility and chronic pain. As contractile function of the nonpregnant uterus is thought be concentrated in the JZ, this hypothetically leads to a disturbance of the uterine peristalsis (UP) in the context of adenomyosis (8,76,77). Aberrant uterine contractility has also been posited as an etiological mechanism for the development of adenomyosis and endometriosis (76,77,148), but evidence on this front is lacking (265). Few studies have assessed differences in UP between non-pregnant women with adenomyosis and healthy women. The studies that do exist have been done using (subjective) methods which are not able to characterize all aspects of uterine motion in a quantitative manner (266). More knowledge on the physiological differences between these groups could contribute to a better understanding of adenomyosis, more accurate diagnosis, and potentially more
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