Noninvasive electrophysiological imaging identifies 4D uterine peristalsis patterns in subjects with normal menstrual cycles and patients with endometriosis

Abstract

Throughout the menstrual cycle, spontaneous mild contractions in the inner layer of the uterine smooth muscle cause uterine peristalsis, which plays a critical role in normal menstruation and fertility. Disruptions in peristalsis patterns may occur in women experiencing subfertility, abnormal uterine bleeding, ovulatory dysfunction, endometriosis, and other disorders. However, current tools to measure uterine peristalsis in humans have limitations that hamper their research or clinical utilities. Here, we describe an electrophysiological imaging system to noninvasively quantify the four-dimensional (4D) electrical activation pattern during human uterine peristalsis with high spatial and temporal resolution and coverage. We longitudinally imaged 4968 uterine peristalses in 17 participants with normal gynecologic anatomy and physiology over 34 hours and 679 peristalses in 5 participants with endometriosis over 12.5 hours throughout the menstrual cycle. Our data provide quantitative evidence that uterine peristalsis changes in frequency, direction, duration, magnitude, and power throughout the menstrual cycle and is disrupted in endometriosis patients. Moreover, our data suggest that disrupted uterine peristalsis contributes to excess retrograde menstruation and infertility in patients with endometriosis and potentially contributes to infertility in this cohort.

Mapping uterine calcium dynamics during the ovulatory cycle in live mice

“…The molecular mechanisms that augment myometrial activity following ovulation could be common to both species. However, perhaps because it is periodic, most studies of human non-pregnant myometrial activity have focused on the peristaltic activity of the thin layer of subendometrial muscle which is most active in estrous (Kunz and Leyendecker, 2002; Wang et al, 2023). It is unclear whether mice have a similar layer, although in principle, subendometrial activity and mouse estrus activity could share hormonally sensitive activating mechanisms.…”

Editorial: New technologies improve maternal and newborn safety

“…Pioneering work by researchers at Washington University School of Medicine in St. Louis has led to the development of innovative imaging technology that enables real-time, three-dimensional visualizations of the intensity and spread of uterine contractions across the entire surface of the uterus during labor ( 51 ). This technology, an extension of imaging techniques previously used for the heart, provides a noninvasive, intricately detailed view of uterine contractions, surpassing the capabilities of current tools that only detect the presence of contractions ( 52 , 53 ). Although advancements in data recording technology have streamlined the process of gathering authentic clinical data, a significant portion of research still proceeds without experimental data.…”