Ovarian stroma flow intensity decreases by age: a three-dimensional power doppler ultrasonographic study

This was a prospective comparative clinical study to test the hypothesis that the flow intensity of the ovarian stroma decreases in the order of the aging process. A total of 100 consecutive women who came to our outpatient clinic for Pap smear examination were recruited. They were divided into three groups. The premenopause group (58 women) had menstruated within the last 3 months and had normal ovaries (no polycystic ovary or any pathologic cyst or mass), as demonstrated on the baseline ultrasound (US) examination. The perimenopause group (20 women) had last menstruated between 3 and 12 months earlier and had normal ovaries. The postmenopause group (22 women) had had no menstrual cycle within the last 12 months and had normal ovaries. Three-dimensional power Doppler US was applied to quantify the blood flow and vascularization within the stroma of the bilateral ovaries. The results showed that the E2 level decreased in the order of: premenopause (mean +/- SD; 40.88 +/- 40.65 pg/mL), perimenopause (22.00 +/- 13.61 pg/mL), then postmenopause (17.25 +/- 16.40 pg/mL). The vascularization index (VI) (6.95 +/- 8.35; 1.11 +/- 0.93; 0.53 +/- 1.75; respectively), flow index (FI) (15.98 +/- 7.59; 12.00 +/- 3.86; 5.18 +/- 5.31; respectively) and vascularization-flow index (VFI) (1.25 +/- 1.59; 0.18 +/- 0.15; 0.09 +/- 0.32; respectively) all decreased significantly in the order of premenopause, perimenopause, then postmenopause. To the best of our knowledge, this is the first study using 3-D power Doppler sonography that proves that the flow intensity decreases along with the aging process in the ovarian stroma.