Reply: T‐shaped uterus after oral contraception – considering myometrial contractions, endometrial volume and <scp>3D</scp> saline contrast sonohysterography in diagnosis

We thank Drs Leone and Cammarata for their interest in our systematic review sharing important observations on the possibility of overdiagnosis T-shaped uterus women taking oral contraceptives (OC). The authors observed that, a patient with normal uterus, appearance was noted after commencement (OC), while, an apparent during OC use, discontinuation OC. highlighted transient nature this uterine morphology risk unnecessary intervention. Indeed, diagnosis/overdiagnosis specific anatomic entities under term ‘congenital anomaly’, similarly to false assumption based biased before–after studies that correcting cavity shape perfect triangle is beneficial, expands market hysteroscopic interventions1, 2. Congenital Uterine Malformation by Experts (CUME) group suggested three sonographic measurements which can be used distinguish between types presence lateral indentation but no significant internal fundal indentation: uterus; borderline uterus3, 4. In contrast previous arbitrary classifications such as American Fertility Society (AFS) provided strict definition limited diagnosis diethylstilbestrol exposure utero, European Human Reproduction Embryology Gynaecological Endoscopy (ESHRE/ESGE) does not provide cut-offs thickened walls narrow and, thus, result misdiagnosis subjective judgment wall thickened, CUME classification provides detailed allow accurate reliable uterus. However, or any other criteria imply surgical intervention justified clinical practice1, 3. Our revealed highly debatable morphological entity mostly diagnosed subjectively, there high labeling T-shaped. Moreover, it uncertain whether congenital anomaly just variant morphology, condition has impact reproductive obstetric outcomes1. Even though some have described ‘improved’ pregnancy rates treatment study been able prove rather than regression towards mean, known higher probability successful miscarriage subsequent loss. Hence, should implies only expectant management use information research purposes increase knowledge about morphologic entity1, hollow muscular organ, similar balloon thick wall, yet, considerable part endometrium, lines inside may myometrial contractions appear repetition examination5. Also, these circular explain partly OC-related Cammarata. we speculate possible T-shape related low endometrial volume (similar empty balloon) when higher, distends losing its (Figure 1). also suggest prevalence likely influenced phase menstrual cycle. Repeating scan detection order rule out potential effect contractions, performing secretory limit 5. cases, saline sonohysterography (SCSH) more tool precise diagnosis. reproducibility at different timepoints high, variability muscle tension, assessment days cycle, examination before ages would disappearance same individuals. hope 3D ultrasound repeat scans timepoints, well three-dimensional SCSH, will help trustworthy evidence natural history prevent overdiagnosis. Sonologists inform medicine scientific societies do recommend correction, even recurrent loss6. declare competing interests.