Ultrasound assessment of uterine morphology in menorrhagia: case control study

This was a prospective study to evaluate transvaginal ultrasound measurements in investigating patients with menorrhagia through detailed morphological assessment of the uterus and ovaries by comparing the study group with menorrhagia with a control group with no previous history of menorrhagia. 92 women participated in the study of whom 46 had a history of menorrhagia and 46 were control cases. Mean age of participants was 34.6 years with mean BMI of 27.2. Uterine volume was significantly larger in the index group (p = .024) having reduced uterine mobility (p = .002). 36% of women with menorrhagia were found to have vascular flow within the inner half of the myometrium (p = .002). Women in the study group documented higher pain score both during menstruation and during transvaginal examination compared with controls (p = .008). Uterine fibroids were found in 15% of women with menorrhagia, not significantly more frequently than women without menorrhagia (8.7%) (p = .33).Impact statementWhat is already known on this subject? Transvaginal ultrasound is the non-invasive diagnostic tool of choice in evaluating uterine morphology for menorrhagia in the recognition of the subtle myometrial changes of adenomyosis, fibroids and polyps.What do the results of this study add? Reduced mobility of the uterus against the rectum was more frequent in the study group suggesting the presence of adhesions between the uterus and rectum most likely due to history of endometriosis. Women with menorrhagia had a higher pain score experienced during transvaginal ultrasound as a result of a retroverted and less mobile uterus, hence the movement of the probe against structures which are adherent to each other can cause discomfort during the scan.What are the implications of these findings for clinical practice and/or further research? This study was performed in the hope that the findings obtained will help medical practitioners to provide more accurate information to patients regarding the cause of their menorrhagia, as well as potentially tailoring more specific treatments for menorrhagia based on their ultrasound findings.