L26/O-279 Assessment of uterine peristaltic patterns of women with adenomyosis by means of intracavitary electrohysterography: preliminary results

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Abstract Study question Do uterine electrophysiological contractile parameters across the menstrual cycle differ between women with adenomyosis and healthy controls? Summary answer Women with adenomyosis show altered cycle-dependent uterine electrophysiological patterns, with higher contraction frequency and contraction time, and reduced amplitude across all menstrual phases. What is known already Adenomyosis is a pathological condition where endometrial invasion into the myometrium disrupts the junctional zone, causing altered uterine peristalsis. These disturbances can severely impair directed sperm transport and may negatively affect embryo implantation or preservation Despite the recognised contribution of such mechanical dysfunctions to subfertility and increased miscarriage rates, uterine peristalsis in women with this condition has not been evaluated in detail and objectively due to the limitations of image-based monitoring techniques. IC-EHG is an innovative technique which has been demonstrated to facilitate a thorough and objective evaluation of uterine peristalsis in healthy women. (Alberola-Rubio, 2025; Imaz-Higuera, 2025). Study design, size, duration This prospective cohort study included 40 healthy women and 20 women diagnosed with adenomyosis who underwent IC-EHG recordings during three menstrual phases: mid-follicular (MF), early luteal (EL), and late luteal (LL). The study was conducted as a prospective multicentre cohort across five fertility clinics in Spain (IVI Madrid, IVI Valencia, IVI Barcelona, IVI Bilbao, and GineFiv Madrid). Participants/materials, setting, methods Participants underwent 30-minute IC-EHG recordings using a multipolar catheter positioned under ultrasound guidance. Only the signal from the uterine fundus was studied. Uterine contractions were identified automatically and three electrophysiological parameters were computed: contraction frequency, amplitude, and time percentage (Alberola-Rubio et al., 2025). Between-group comparisons (adenomyosis vs healthy) were performed using the Wilcoxon rank-sum test for each phase. In order to perform between-phase comparisons, the Wilcoxon signed-rank test was utilised for each group.. Main results and the role of chance Women with adenomyosis exhibited distinct uterine electrophysiological patterns compared with healthy controls. Between-group analyses revealed higher contraction frequency in adenomyosis, reaching statistical significance during the EL phase (p = 0.022). Contraction amplitude was consistently lower in adenomyosis across the menstrual cycle, reaching statistical significance in the MF and EL phases (p = 0.019 and p = 0.018, respectively). Furthermore, contraction time percentage tended to be higher throughout the cycle in adenomyosis group, with significant differences observed in LL phase (p = 0.020). Cycle-related trends were similar for healthy and adenomyosis groups in the frequency of contractions s. However, statistically significant differences between menstrual phases in adenomyosis were restricted to contraction frequency, whereas healthy women exhibited phase-dependent differences across all three electrophysiological parameters. Overall, these findings suggest that adenomyosis is associated with an alteration of uterine electrophysiological activity across the menstrual cycle, characterized by increased contractile frequency, reduced amplitude, and greater time in contractile state. The selective loss of cycle-dependent modulation for amplitude and contraction time in adenomyosis is unlikely to be attributable to chance alone and may reflect disease-related alterations in myometrial structure or electrophysiological regulation. Limitations, reasons for caution The study’s limitations include a restricted sample size and the absence of direct hormonal level measurement. The findings of this study should be confirmed in larger cohorts. The present study focused exclusively on the activity of the uterine fundus; it should be extended to include other regions of the uterus. Wider implications of the findings The potential of IC-EHG to provide objective biomarkers capable of differentiating adenomyosis from healthy uterine physiology and of capturing cycle-dependent abnormalities is of great clinical and research interest. This approach may support creating diagnostic composite scores, developing natural conception biomarkers, and optimizing individualized clinical treatment plans through longitudinal evaluation. Trial registration number No

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