ASSESSMENT OF UTERINE PERFUSION IN HEAVY MENSTRUAL BLEEDING DUE TO OVARIAN ENDOMETRIOMA USING DOPPLER TECHNIQUES: A CROSS-SECTIONAL STUDY

Abstract

Background: Heavy menstrual bleeding (HMB) is a prevalent and distressing manifestation among women with ovarian endometrioma, significantly affecting daily life and reproductive health. Evaluating uterine blood flow through Doppler ultrasound provides a non-invasive means to understand the hemodynamic alterations underlying endometriosis-related menstrual dysfunction. This study aimed to assess uterine perfusion parameters and identify clinical predictors of severe HMB in affected women.

Objective: To evaluate uterine perfusion indices and determine the key clinical predictors of severe heavy menstrual bleeding in women with ovarian endometrioma.

Methods: A cross-sectional study was conducted on 139 women aged 18–45 years with ultrasonographically confirmed ovarian endometrioma and HMB. Demographic and clinical data, including menstrual characteristics, PBAC scores, and pain symptoms, were recorded. Transvaginal Doppler ultrasonography was used to measure the uterine arterial Resistance Index (RI), Pulsatility Index (PI), Peak Systolic Velocity (PSV), End-Diastolic Velocity (EDV), and vessel diameter bilaterally. Statistical analysis was performed using Chi-square, Pearson or Spearman correlation, and multivariable logistic regression to identify predictors of severe HMB (PBAC ≥300). A p-value <0.05 was considered significant.

Results: Severe HMB occurred in 61.9% of participants and was significantly associated with chronic pelvic pain (p<0.001), dysmenorrhea (p<0.001), and bilateral endometriomas (p=0.001). Multivariate analysis identified chronic pelvic pain, dysmenorrhea, and bilateral endometriomas as independent predictors of severe bleeding. Mean Doppler indices showed slightly higher RI (0.89±0.04) and PI (2.95±0.20) in the right uterine artery than the left (RI 0.87±0.05; PI 2.88±0.18), suggesting mild lateral variation. No significant associations were observed for age, residence, or BMI.

Conclusion: Chronic pelvic pain, dysmenorrhea, and bilateral ovarian endometriomas emerged as strong clinical predictors of severe HMB, highlighting the need for early diagnosis and individualized management. Although Doppler parameters provided valuable insights into uterine hemodynamics, they were not directly correlated with bleeding severity. Integrating clinical and Doppler evaluations can enhance diagnostic precision and inform targeted therapeutic approaches in endometriosis-related HMB.