Uterus in motion

Uterus in motion
Uterus in motion
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It started with a personal motivation to diagnose endometriosis more quickly. Because just like many women where the uterus-like mucous membrane proliferates in and outside the uterus, it was also an exhausting search for her twin sister before the correct clinical picture could be diagnosed, Rees sighs. “Severe pain and a lot of blood loss every month; many women grit their teeth and try to get through it. Or their complaints are dismissed – “menstrual pain is part of it.” That makes me very angry, endometriosis is an underestimated condition that can seriously turn a woman’s life upside down.”

Rees turned her anger into decisiveness and dove into research to increase and spread knowledge about endometriosis in a scientific way. The common thread was the question of how the diagnosis can be made faster and in a less invasive way.

Overlooked

Because that has to change, Rees emphasizes. “On average, it takes about eight years before a woman with endometriosis receives the correct ‘label’. This is partly due to the female ‘you have to get through it’ mentality and a lot of misunderstanding, but also because this condition can manifest itself more and more intensely during your life. The teenager or twenties with incipient complaints are then quickly overlooked.”

Rees focused specifically on proliferation of mucous membrane in the uterus itself: adenomyosis. While suspicious spots of endometriosis and adhesions in the abdomen are still ‘relatively’ easy to see through keyhole surgery, the uterus is much more inscrutable, Rees explains.

“There is often nothing visible from the outside, and you have to be very experienced to recognize the growths on an ultrasound. Especially if there are additional conditions that complicate the ultrasound, but also if there are very mild abnormalities. Static ultrasound images are difficult to assess afterwards. Some hospitals therefore prefer to perform an MRI. But a clear protocol for what should be measured and on what criteria you use to diagnose adenomyosis is still lacking. Everyone does it differently.”

Predictive calculation model

So it was time for a clear approach, Rees and her promoters decided. Based on an extensive literature study, she identified various factors that can reliably predict the risk of adenomyosis. “Both the patient story and parameters that we can determine on MRI images are important. We have set up a predictive calculation model, which will hopefully soon be able to be used in the clinic after a few development steps.”

In addition to the MRI images, Rees also examined whether ultrasound methods are suitable for making it easier to detect adenomyosis. She also wanted to further investigate the functioning of an affected uterus. She linked up with ongoing TU/e ​​research into making uterine movements visible.

“We have not known for very long that the uterus is a muscle that is constantly moving. But these movements are very subtle, and therefore difficult to measure. With a measuring method previously developed at TU/e, we can now objectively monitor the movements of the uterus on an ultrasound film. Together with the Catherina Hospital and the Ghent University Hospital, we are creating a nice bridge between technology and practice.”

Adapted IVF process

With this new ultrasound method, Rees and her colleagues looked at how the uterus moves in healthy women, but Rees soon switched to women with adenomyosis. And where she normally sees organized movements, she was shocked by what she encountered in the affected uteri.

“A little chaos. A normally functioning uterus is most active around ovulation. A sperm cell must then be taken to the fallopian tube to fertilize the egg. And when the fertilized egg implants itself in the uterine lining, the movements are calmer.”

Disturbed uterine muscle

“Due to adenomyosis, the uterine muscle is disturbed and we see abnormalities in two important phases of the female cycle. During ovulation there is much less movement; the movements also go in all directions. This can make it much more difficult for a sperm cell to reach the target on time. or to reach a ripe egg at all. And in a later phase in which a possible egg has to settle, the uterus is actually more active.”

An early diagnosis of adenomyosis or endometriosis is extra important for a young woman, Rees emphasizes. “If we see on an ultrasound film that the uterine movement is disturbed, we can take this into account in future steps. We can try to normalize mobility again with medication. We can therefore use the new ultrasound method to monitor whether the medication is working. And if a natural pregnancy is not successful, we can opt for an adapted IVF process based on uterine contractility.”

The article is in Dutch

Tags: Uterus motion

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