Doppler ultrasound assessment of uterine artery blood flow in women with adenomyosis

Objective: to investigate changes in uterine artery blood flow across stages I–II of adenomyosis.  

Material and methods: a prospective cohort study was conducted in 45 women of reproductive age. The main group consisted of 31 patients with adenomyosis (18 with stage I, 13 with stage II). The control group included 14 healthy women without gynecological or other medical condition. All participants underwent spectral Doppler examination of the uterine arteries with assessment of the pulsatility index (PI), resistance index (RI), and systolic-diastolic ratio. Statistical analysis was performed using the Mann-Whitney U test.  

Results: the study demonstrated pronounced stage-dependent variability of uterine artery blood flow parameters in adenomyosis. In stage I adenomyosis, a significant decrease in vascular resistance compared to the control group was observed (RI 0.77±0.003 vs 0.91±0.005; p<0.001), which may reflect enhanced local vascularization and reduced arteriolar tone. In stage II adenomyosis, a phenomenon of “pseudonormalization” of hemodynamic parameters was identified (PI 2.97±0.003), which could be indirectly related to subsequent structural remodeling of the myometrium, including possible fibrotic changes and vascular compression.

Conclusions: the hemodynamic profile of uterine arteries in adenomyosis is dynamic and changes with disease progression: from hypervascularization and decreased vascular resistance in early stages to a relative increase in vascular resistance.

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