UTERINE ARTERY DOPPLER INDICES IN PATIENTS WITH THE FIBROIDS AND ADENOMYOSIS

Abstract

Background: Uterine fibroids and adenomyosis are common gynecological conditions in women of reproductive age and are frequently associated with symptoms such as pelvic pain, heavy menstrual bleeding, and infertility. These conditions can alter uterine vascular architecture, potentially affecting blood flow through the uterine arteries. Doppler ultrasound provides a non-invasive method to assess uterine hemodynamics through indices such as the Resistance Index (RI) and Pulsatility Index (PI). Evaluating these Doppler parameters in women with uterine masses may offer valuable insights into disease mechanisms and support improved diagnostic accuracy.
Methodology: A cross-sectional study was conducted on 103 women aged 25–50 years presenting with gynecological symptoms. Participants were stratified by age and evaluated for menstrual irregularities, pelvic pain, menorrhagia, dysmenorrhea, dyspareunia, and infertility. Transabdominal Doppler ultrasound assessed uterine artery hemodynamics, categorizing Resistance Index (RI) and Pulsatility Index (PI) into normal, mild, moderate, and severe ranges. Uterine mass types and numbers were documented via ultrasound imaging. Statistical analyses included frequency distributions, cross tabulations, and correlation coefficients (Pearson’s and Spearman’s) to examine the association between uterine masses and Doppler indices.
Results: The majority of participants (77.7%) were aged between 40 and 50 years. A high prevalence of clinical symptoms was observed, including irregular menstruation (74.8%), lower abdominal pain (80.6%), menorrhagia (67%), and dysmenorrhea affecting 80.5% of the women, with 41.7% experiencing severe symptoms. Ultrasound evaluations detected uterine masses in most participants, with fibroids present in 52.4% and adenomyosis in 37.9%, while 9.7% showed no detectable masses. Doppler ultrasound revealed elevated uterine artery Resistance Index (RI) and Pulsatility Index (PI) values in women with fibroids and adenomyosis compared to those without masses. Specifically, the right uterine artery RI showed moderate to severe elevation in 61% of cases and exhibited a moderate positive correlation with mass presence (Pearson’s R = 0.540). The right uterine artery PI predominantly demonstrated mild to moderate elevations and a strong positive correlation (Pearson’s R = 0.936). Conversely, the left uterine artery RI mostly showed mild to moderate values and had a weak correlation with the presence of masses (Pearson’s R = 0.086), while the left uterine artery PI mainly displayed mild elevations. Overall, increased Doppler indices were associated with clinical symptoms and the characteristics of uterine masses, the vascular changes linked to these conditions.
Conclusion: Fibroids and adenomyosis significantly alter uterine artery blood flow, as evidenced by elevated RI and PI values, reflecting increased vascular resistance. These hemodynamic changes are associated with symptomatic presentations including menstrual disturbances and infertility. Doppler ultrasound provides critical insights into uterine vascular status, enhancing diagnostic accuracy and informing clinical management of uterine masses.