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Three-Dimensional Power Doppler Assessment of Uterine Vascularization in Women With Primary Dysmenorrhea

Department of Obstetrics and Gynecology, Clinica Universitaria de Navarra, University of Navarra, Pamplona, Spain.

Address correspondence to Pedro Royo, MD, Department of Obstetrics and Gynecology, Clinica Universitaria de Navarra, University of Navarra, Avenida Pio XII 36, 31008 Pamplona, Spain. E-mail: proyo{at}alumni.unav.es

Objective. The aim of this study was to assess myometrial vascularization with 3-dimensional (3D) power Doppler angiography (PDA) in women with different grades of primary dysmenorrhea at the moment of maximum menstrual pain in an effort to improve the pathophysiologic knowledge of one of the most common gynecologic conditions. Methods. This was a cross-sectional study involving 70 voluntary women that studied or worked at the Clinica Universitaria de Navarra between January 2006 and January 2008. All women underwent transvaginal sonographic 3D PDA on the day of maximum pain after the onset of menstruation or during the first 24 to 48 hours of the new cycle if no pain was present. Three groups were defined according to a visual analog scale: no pain to mild dysmenorrhea, moderate dysmenorrhea, and severe dysmenorrhea. Vascularity assessment was done on the basis of 3D vascularity indices: the vascularization index (VI), flow index (FI), and vascularization-flow index (VFI). Results. The mean VI and VFI for the inner 5 mm of the myometrium and the total myometrium were significantly higher in the women with severe dysmenorrhea than in those with no pain to mild dysmenorrhea (P < .05). The VI, FI, and VFI in the women with moderate dysmenorrhea did not differ significantly from those in the women with severe dysmenorrhea. Conclusions. This study evaluated the use of 3D PDA for assessing uterine and specifically myometrial vascularization. Our data indicate that women with severe dysmenorrhea have increased myometrial vascularization during the early menstrual phase compared with women without pain.

Key Words: myometrial vascularization • primary dysmenorrhea • 3-dimensional power Doppler angiography • 3-dimensional sonography

Abbreviations: FI, flow index • PDA, power Doppler angiography • PI, pulsatility index • RI, resistive index • 3D, 3-dimensional • VAS, visual analog scale • VFI, vascularization-flow index • VI, vascularization index • VOCAL, virtual organ computer-aided analysis