215 Our results show the most statistically significant differences in UC between normal versus adenomyotic uteri during the LF and LL phases of the menstrual cycle. This might suggest an explanation for the link between subfertility and adenomyosis. With sperm transport and embryo implantation taking place during these menstrual phases, and being affected by aberrant UC in adenomyosis patients, subfertility seen in these patients could thereby be explained. The question of whether this dysperistalsis is a cause or effect of adenomyosis cannot be answered using our results and warrants further research. Additionally, we attempted to investigate the increased prevalence of dysmenorrhea in adenomyosis patients. Despite our results not showing statistically significantly different UC behaviour during menses versus controls, we did find differences when assessing UC according to reported VAS score during menstruation. We report that increased dysmenorrhea severity was associated with relatively lower contraction frequency, higher amplitude and lower velocity compared to adenomyosis patients with less severe dysmenorrhea. Increased contractile amplitude and decreased velocity logically result in heavier and longer menstrual cramps, which is supported by our findings that more severe dysmenorrhea is reflected in more aberrant UC during menstruation. We hereby pave the way for the development of an objective tool to assess dysmenorrhea in adenomyosis patients. The study has several strengths. Firstly, this is the first study to assess UC in adenomyosis patients compared to controls throughout the phases of menstrual cycle and therefore provides new insights into the condition for future clinical and research opportunities. Furthermore, as the method uses a TVUS, it is patient-friendly and easily accessible for future use in clinical practice. Moreover, the speckle tracking method of assessing uterine contractility is objective, reproducible and reliable (22,31). The study is a multi-centre study in an international setting, which allows for higher generalizability of the results. We also assessed uterine contraction features strictly according to menstrual cycle phase, which previous studies have not done in detail.
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