Structural abnormalities of the uterine wall in women with endometriosis and infertility visualized by vaginal sonography and magnetic resonance imaging

In women with endometriosis, the peristaltic activity of the uterus is sign ificantly enhanced and may even become dysperistaltic at midcycle, Since ut erine peristalsis is confined to the endometrium and the subendometrial myo metrium with its predominantly circular arrangement of muscular fibres it w as assumed that this dysfunction might be associated with structural abnorm alities that could be visualized by high resolution ultrasonography and mag netic resonance imaging (MRI), Therefore, the uteri of women with and witho ut endometriosis were subjected to endovaginal sonography (EVS) and to MRI. In EVS, women with laparoscopically proven endometriosis and infertility e xhibited an infiltrative expansion of the archimetra in that the halo surro unding the uterine endometrium and representing the subendometrial myometri um was significantly enlarged compared with controls. The expansion was mor e pronounced in older than in younger women. There was, however, no relatio nship between the width of the expansion and the severity of the endometrio tic disease. Similar data were obtained by MRI in that the 'junctional zone ' in women with endometriosis and infertility was expanded in comparison wi th controls. The res;lts of this study provide further support to the notio n that endometriosis is primarily a uterine disease.