Noemi Salmeri, Giorgia Di Stefano, Paola Viganò, Pamela Stratton, Edgardo Somigliana, Paolo Vercellini
{"title":"子宫内膜异位症和子宫腺肌症中子宫收缩功能的决定因素:系统回顾和荟萃分析。","authors":"Noemi Salmeri, Giorgia Di Stefano, Paola Viganò, Pamela Stratton, Edgardo Somigliana, Paolo Vercellini","doi":"10.1016/j.fertnstert.2024.07.026","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>Evidence suggests that aberrant uterine contractility in nonpregnant women with endometriosis and adenomyosis contributes to symptoms and potentially heralds their pathogenesis. However, uterine peristalsis remains understudied, inconsistently measured, and poorly understood.</p><p><strong>Objective: </strong>To summarize evidence on uterine contractility across the menstrual cycle phases in women with endometriosis and adenomyosis.</p><p><strong>Data sources: </strong>PubMed/MEDLINE, Embase, and Scopus databases searched up to May 2, 2024.</p><p><strong>Study selection and synthesis: </strong>Observational studies compared quantitative measures of uterine contractility using magnetic resonance imaging, ultrasound, electrophysiology, or direct intrauterine pressure recording across different menstrual cycle phases between women with endometriosis/adenomyosis and controls on the basis of predefined problem/population, intervention, comparison, and outcome criteria. Study quality was assessed using the Newcastle-Ottawa Scale. Pooled estimates for primary (risk ratios with 95% confidence intervals [CIs]) and secondary (mean difference [MD] with 95% CIs) outcomes were calculated using random-effects models.</p><p><strong>Main outcomes: </strong>Pooled risk of retrograde menstruation uterine contraction pattern in cases vs. controls; pooled MD in continuous measures of uterine contractility (frequency, amplitude, and velocity of contractions) across all the menstrual cycle phases in cases vs. controls.</p><p><strong>Results: </strong>Nine studies met the inclusion criteria; most were studies that evaluated women with endometriosis. An increased risk of retrograde uterine contractions during menstruation was observed in women with endometriosis compared with that in controls (risk ratio, 8.63; 95% CI, 3.24-22.95; I<sup>2</sup>, 0). The pooled MDs in contraction frequency between cases and controls were 0.82 (95% CI, 0.13-1.52; I<sup>2</sup>, 18.61%) in the menstrual phase and 0.52 (95% CI, 0.22-0.83; I<sup>2</sup>, 27.18%) in the luteal phase. Results for the follicular and periovulatory phases were more heterogeneous. Higher contraction amplitudes in women with endometriosis or adenomyosis were reported across all menstrual cycle phases. Because of the paucity of data, especially for adenomyosis, evidence certainty was graded as low for most comparisons.</p><p><strong>Conclusion and relevance: </strong>The approximately ninefold increased risk of retrograde pattern during menstruation in endometriosis supports the potential role of retrograde menstruation in its etiopathogenesis. Abnormal uterine contractility, likely not limited to the menstrual phase, may be a mechanical factor contributing to development of endometriosis and related symptoms, including menstrual pain and infertility, with limited, mostly concordant evidence for adenomyosis.</p><p><strong>Registration number: </strong>PROSPERO ID CRD42024512273-accepted on February 23, 2024.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":"1063-1078"},"PeriodicalIF":6.6000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11624067/pdf/","citationCount":"0","resultStr":"{\"title\":\"Functional determinants of uterine contractility in endometriosis and adenomyosis: a systematic review and meta-analysis.\",\"authors\":\"Noemi Salmeri, Giorgia Di Stefano, Paola Viganò, Pamela Stratton, Edgardo Somigliana, Paolo Vercellini\",\"doi\":\"10.1016/j.fertnstert.2024.07.026\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Importance: </strong>Evidence suggests that aberrant uterine contractility in nonpregnant women with endometriosis and adenomyosis contributes to symptoms and potentially heralds their pathogenesis. However, uterine peristalsis remains understudied, inconsistently measured, and poorly understood.</p><p><strong>Objective: </strong>To summarize evidence on uterine contractility across the menstrual cycle phases in women with endometriosis and adenomyosis.</p><p><strong>Data sources: </strong>PubMed/MEDLINE, Embase, and Scopus databases searched up to May 2, 2024.</p><p><strong>Study selection and synthesis: </strong>Observational studies compared quantitative measures of uterine contractility using magnetic resonance imaging, ultrasound, electrophysiology, or direct intrauterine pressure recording across different menstrual cycle phases between women with endometriosis/adenomyosis and controls on the basis of predefined problem/population, intervention, comparison, and outcome criteria. Study quality was assessed using the Newcastle-Ottawa Scale. Pooled estimates for primary (risk ratios with 95% confidence intervals [CIs]) and secondary (mean difference [MD] with 95% CIs) outcomes were calculated using random-effects models.</p><p><strong>Main outcomes: </strong>Pooled risk of retrograde menstruation uterine contraction pattern in cases vs. controls; pooled MD in continuous measures of uterine contractility (frequency, amplitude, and velocity of contractions) across all the menstrual cycle phases in cases vs. controls.</p><p><strong>Results: </strong>Nine studies met the inclusion criteria; most were studies that evaluated women with endometriosis. An increased risk of retrograde uterine contractions during menstruation was observed in women with endometriosis compared with that in controls (risk ratio, 8.63; 95% CI, 3.24-22.95; I<sup>2</sup>, 0). The pooled MDs in contraction frequency between cases and controls were 0.82 (95% CI, 0.13-1.52; I<sup>2</sup>, 18.61%) in the menstrual phase and 0.52 (95% CI, 0.22-0.83; I<sup>2</sup>, 27.18%) in the luteal phase. Results for the follicular and periovulatory phases were more heterogeneous. Higher contraction amplitudes in women with endometriosis or adenomyosis were reported across all menstrual cycle phases. Because of the paucity of data, especially for adenomyosis, evidence certainty was graded as low for most comparisons.</p><p><strong>Conclusion and relevance: </strong>The approximately ninefold increased risk of retrograde pattern during menstruation in endometriosis supports the potential role of retrograde menstruation in its etiopathogenesis. Abnormal uterine contractility, likely not limited to the menstrual phase, may be a mechanical factor contributing to development of endometriosis and related symptoms, including menstrual pain and infertility, with limited, mostly concordant evidence for adenomyosis.</p><p><strong>Registration number: </strong>PROSPERO ID CRD42024512273-accepted on February 23, 2024.</p>\",\"PeriodicalId\":12275,\"journal\":{\"name\":\"Fertility and sterility\",\"volume\":\" \",\"pages\":\"1063-1078\"},\"PeriodicalIF\":6.6000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11624067/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Fertility and sterility\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.fertnstert.2024.07.026\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/25 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Fertility and sterility","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.fertnstert.2024.07.026","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/25 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
Functional determinants of uterine contractility in endometriosis and adenomyosis: a systematic review and meta-analysis.
Importance: Evidence suggests that aberrant uterine contractility in nonpregnant women with endometriosis and adenomyosis contributes to symptoms and potentially heralds their pathogenesis. However, uterine peristalsis remains understudied, inconsistently measured, and poorly understood.
Objective: To summarize evidence on uterine contractility across the menstrual cycle phases in women with endometriosis and adenomyosis.
Data sources: PubMed/MEDLINE, Embase, and Scopus databases searched up to May 2, 2024.
Study selection and synthesis: Observational studies compared quantitative measures of uterine contractility using magnetic resonance imaging, ultrasound, electrophysiology, or direct intrauterine pressure recording across different menstrual cycle phases between women with endometriosis/adenomyosis and controls on the basis of predefined problem/population, intervention, comparison, and outcome criteria. Study quality was assessed using the Newcastle-Ottawa Scale. Pooled estimates for primary (risk ratios with 95% confidence intervals [CIs]) and secondary (mean difference [MD] with 95% CIs) outcomes were calculated using random-effects models.
Main outcomes: Pooled risk of retrograde menstruation uterine contraction pattern in cases vs. controls; pooled MD in continuous measures of uterine contractility (frequency, amplitude, and velocity of contractions) across all the menstrual cycle phases in cases vs. controls.
Results: Nine studies met the inclusion criteria; most were studies that evaluated women with endometriosis. An increased risk of retrograde uterine contractions during menstruation was observed in women with endometriosis compared with that in controls (risk ratio, 8.63; 95% CI, 3.24-22.95; I2, 0). The pooled MDs in contraction frequency between cases and controls were 0.82 (95% CI, 0.13-1.52; I2, 18.61%) in the menstrual phase and 0.52 (95% CI, 0.22-0.83; I2, 27.18%) in the luteal phase. Results for the follicular and periovulatory phases were more heterogeneous. Higher contraction amplitudes in women with endometriosis or adenomyosis were reported across all menstrual cycle phases. Because of the paucity of data, especially for adenomyosis, evidence certainty was graded as low for most comparisons.
Conclusion and relevance: The approximately ninefold increased risk of retrograde pattern during menstruation in endometriosis supports the potential role of retrograde menstruation in its etiopathogenesis. Abnormal uterine contractility, likely not limited to the menstrual phase, may be a mechanical factor contributing to development of endometriosis and related symptoms, including menstrual pain and infertility, with limited, mostly concordant evidence for adenomyosis.
Registration number: PROSPERO ID CRD42024512273-accepted on February 23, 2024.
期刊介绍:
Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.