Angle of Uterine Flexion and Adenomyosis

Abstract

The aim of this study was to assess the prevalence of adenomyosis in symptomatic women in relation to the angle of flexion of the uterus. A total of 120 patients referring to our Chronic Pelvic Pain Center were prospectively enrolled. Each woman scored menstrual pain, intermenstrual pain, and dyspareunia on a 10 cm visual analogue scale and underwent a clinical examination and transvaginal ultrasound. MUSA criteria were used for the diagnosis of adenomyosis. The angle of flexion of the uterus on the cervix was categorized as <150° (75% of cases), between 150° and 210° (6.7% of cases) and >210° (18.3% of cases). Adenomyosis was diagnosed in 76/120 women (63.3%). In women with adenomyosis, the VAS of intermenstrual pain was higher than in women without adenomyosis (4.04 ± 3.79 vs. 2.57 ± 3.34; p < 0.034). The angle of uterine flexion >210° was more prevalent in women with than without adenomyosis (25.0% vs. 6.8%; p < 0.015). The odds ratio of suffering from adenomyosis markedly increased in the presence of an angle of uterine flexion >210° (OR 5.8 95% CI 1.19, 28.3; p > 0.029). The data indicate that the ultrasound-estimated angle of uterine flexion >210° is related to a higher prevalence of adenomyosis.

Elasticity of the Cervix in Relation to Uterus Position

“…The procedure was already described elsewhere [24]. During image acquisition, vaginal probe was positioned in the anterior vaginal fornix and displayed alongside to facilitate images interpretation [26]. A series of about 5 compression and decompression cycles, using sub-centimetric excursions, were applied perpendicular to the axis of the cervical canal [16,19,24] (Figure 2).…”

“…In the multiple regression models the variables that were not significantly associated with the dependent variable were gradually eliminated, beginning with the least relevant, to finally preserve only those variables that were independently related to the dependent variable. As previously performed in studies on menstrual pain [25] and adenomyosis [26], the angle of flexion of the uterus on the cervix was also categorized as ≤150 • , between >150 • and ≤210 • , and >210 • .…”

“…There are physiological variants of uterine positions, that can be described by uterine version and uterine flexion. Version is defined by the relation between the longitudinal axis of the uterus and that of the vagina, while flexion is defined by the anterior angle between the longitudinal axis of the uterine corpus and the longitudinal axis of the cervix [25,26]. In general, anteversion and retroversion indicate a uterus that forms an anterior angle with the vagina 180 • < or > to 180 • , respectively.…”

“…In general, anteversion and retroversion indicate a uterus that forms an anterior angle with the vagina 180 • < or > to 180 • , respectively. The angle of flexion is in general expressed as a continuous value, and in clinical studies it was also categorized as an angle < 150 • , to identify strong anteflexion, between 150 and 210 • to identify no marked flexion, and >210 • , to indicate a strong retroflexion [25,26]. The different angles of flexion were associated with a different intensity of menstrual pain [25], and a different risk of adenomyosis [26].…”

“…The angle of flexion is in general expressed as a continuous value, and in clinical studies it was also categorized as an angle < 150 • , to identify strong anteflexion, between 150 and 210 • to identify no marked flexion, and >210 • , to indicate a strong retroflexion [25,26]. The different angles of flexion were associated with a different intensity of menstrual pain [25], and a different risk of adenomyosis [26]. Determinants of uterine position are still elusive, but the tensile forces exerted by external ligaments and by the uterine corpus in uteri of different position can possibly determine a different structure of the cervix.…”