Uterine Contractility Changes in Adenomyosis: Evidence from a Systematic Review and Meta-Analysis.

Area of Science:

• Reproductive Medicine
• Gynecology
• Medical Diagnostics

Background:

• Adenomyosis, characterized by ectopic endometrial glands in the uterine myometrium, is linked to adverse fertility outcomes.
• Altered uterine architecture in adenomyosis may impact uterine peristalsis (UP), affecting sperm transport and embryo implantation.
• Understanding UP alterations is crucial for managing clinical symptoms and improving reproductive success in adenomyosis patients.

Purpose of the Study:

• To systematically review and meta-analyze existing literature on uterine peristalsis (UP) patterns in adenomyosis.
• To determine if adenomyosis is associated with significant alterations in UP compared to controls.

Main Methods:

• Systematic literature search of major databases (Medline, Embase, Cochrane, CENTRAL, Google Scholar) up to June 2025.
• Inclusion of clinical studies evaluating uterine contractility, excluding those with therapeutic interventions.
• Meta-analysis to compare uterine contractility direction and frequency between adenomyosis patients and control groups.

Main Results:

• Seven studies including 442 women were analyzed, revealing significant variations in uterine contractility.
• Women with adenomyosis demonstrated significantly reduced uterine contraction frequency (SMD -1.81, p=0.0039).
• Fewer antegrade contractions (OR 0.35, p=0.0423) and a trend towards more retrograde contractions were observed in the adenomyosis group.

Conclusions:

• Significant differences in uterine contraction patterns exist between adenomyosis patients and controls.
• Adenomyosis is associated with decreased UP frequency and an increase in retrograde contractions, potentially impacting fertility.
• Further research with larger cohorts is needed to explore diagnostic and therapeutic strategies for improving reproductive outcomes.