200 Materials and Methods: Study objectives: Evaluate uterine contraction features (frequency, amplitude, velocity, direction, and coordination) using a dedicated speckle-tracking algorithm by 2D transvaginal ultrasound measurement in women with adenomyosis versus women with normal uteri throughout the menstrual cycle. Study design & setting: This multi-centre observational prospective cohort study was carried out in the outpatient gynaecology departments of the Catharina Hospital in Eindhoven, the Netherlands, the University of Naples, Federico II Naples, Italy, and the Embryolab Fertility centre in Thessaloniki, Greece. Participants: Between September 2014 and January 2023, 179 women were included from of the participating centres. Women were included if they were ≥18 years of age, pre-menopausal and had a natural menstrual cycle (NMC). No power calculation was done due to lack of relevant published data on this topic. Exclusion criteria were: 1) pregnancy, 2) unable to give informed consent, 3) significant language barrier, or 4) other benign uterine pathology (congenital or otherwise, e.g., leiomyomas, caesarean section scar, or other uterine surgery affecting the myometrial integrity) and 5) use of hormonal contraceptive methods or intra-uterine devices. Ultrasounds of included women were assessed retrospectively by two experts independently to confirm the presence or absence of uterine abnormalities. After enrolment, all TVUS recordings also were subjected to a quality check. Recordings could be considered of low quality due to several factors, including insufficient resolution, out-of-plane motion, intestinal shadowing, and suboptimal orientation of the uterus limiting the view of the endo-myometrium. In case of low quality, the recording was excluded from the study. Figure 2 presents a flow chart of patient inclusion. Healthy women: The control group consisted of healthy women with sonographically normal uteri. A normal cycle was defined as: regular (duration 28 (± 2) days), no dysmenorrhea (reported VAS <4 during menses), no menometrorrhagia.
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