OP12.01: Cyclical changes in myometrial vascularity: subjective and 3D power Doppler observations and implications in gynecologic decision making in a population wanting to conceive

Abstract

To confirm and quantify the observation that there are cyclical changes in myometrial vascularisation during the menstrual cycle and that this may influence the observed vascularity in uterine septa, fibroids and adenomyomas. 56 patients with regular cycles and absence of endometrial and ovarian structural anomalies on ultrasound were recruited into the study. All patients wished to conceive with timed intercourse and were not on ovulation stimulation protocols. Patients were studied with routine transvaginal scan protocols with additional 3D power Doppler evaluation on day 2 or 3, day 9 or 10 and on the day that the maturing follicle measured 18 mm or more. A GE Voluson E8 scanner was used. 3D power Doppler evaluation included calculation of the VI, FI and VFI of total myometrial vascularity using a shell contour method. If a uterine septum or focal myometrial lesion was evident, dimensions and 3D vascular indices of each observed lesion were obtained as well. 52 patients completed the study protocol.3D vascular indices were significantly higher in the menstruating myometrium than in the proliferative phase of the cycle. Three of four septa revealed higher flow indices during menstruation. Five of seven fibroids showed higher flow indices during menstruation. One adenomyoma was seen and this showed no change during the cycle. The myometrium shows significant increase in vascularity during menstruation. There is a concommitant transient increase in the observed vascularity of uterine septa and fibroids. Since vascularity is being increasingly used to assess the need for surgery in uterine septa and for fibroids with submucous components, it may be wise to assess these lesions after the period has cleared.