Uterine morphology in normogonadotropic anovulation: a comparative study of polycystic ovary syndrome and hypothalamic-pituitary-ovarian dysfunction

Purpose To compare uterine ultrasound measurements in women with normogonadotropic anovulation, specifically those with polycystic ovary syndrome (PCOS) and hypothalamic-pituitary-ovarian dysfunction (HPOD), with those of regularly menstruating women, and to assess the influence of clinical and biochemical parameters on these measurements. Methods Uterine length, width, height, and volume, along with endometrial thickness and volume, measured using two- and three-dimensional transvaginal ultrasonography, were prospectively compared in women aged 18 to 45 from the aforementioned groups. Correlations between clinical parameters and uterine measurements, as well as between biochemical parameters and these measurements in anovulatory women, were analyzed. Results Women with normogonadotropic anovulation had significantly reduced uterine and endometrial measurements compared to healthy women (all p ≤0.001). Women with PCOS showed significantly lower uterine length (p=0.045), height (p=0.004), and volume (p=0.009) than those with HPOD, with no significant endometrial differences. Among women with PCOS, those with hyperandrogenemia had thicker endometrium (p=0.036), with no significant differences in other measurements. All myometrial measurements significantly negatively correlated with anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH), while positively correlating with estradiol and prolactin. Endometrial measurements negatively correlated with AMH and FSH concentrations, and positively with estradiol, prolactin, 17-hydroxyprogesterone, fasting insulin, and insulin resistance. Conclusions A significant association was identified between menstrual cycle regularity and uterine morphology, influenced by hormonal, metabolic, and clinical factors. Estrogenic stimulation and metabolic status significantly affected uterine and endometrial dimensions, indicating that uterine morphology reflects the cumulative impact of reproductive and endocrine-metabolic influences, with important clinical implications for women with normogonadotropic anovulation.