5 Changes in Uterine and Ovarian Perfusion with the Onset of Menopause

Abstract

OBJECTIVE: To measure the flow velocity of the ovarian, uterine, radial, and spiral arteries in different age groups. DESIGN: Serial measurements throughout the menstrual cycle in normal cycling women with documented fertility were compared with those in postmenopausal patients with and without hormone replacement therapy (HRT). SETTING: Department of Obstetrics and Gynecology, University of Zagreb, Sveti Duh Hospital, Zagreb, Croatia. PATIENTS: Two hundred fifty patients were analyzed: 120 healthy fertile women, 85 postmenopausal patients, and 45 postmenopausal patients receiving HRT. INTERVENTIONS: All patients were examined by transvaginal color and pulsed Doppler. MAIN OUTCOME MEASURE: Changes in the resistance index of flow velocity waveforms of the ovarian, uterine, radial, and spiral arteries. RESULTS: Ovarian artery Doppler measurements in postmenopausal patients showed a significant difference when compared with the ovarian artery on the side containing dominant follicle or corpus luteum in healthy fertile group. Uterine and radial artery flow velocity analyses demonstrated significant positive correlations between the resistance index and years of menopause. In patients receiving HRT, a lowering effect occurred in the resistance index of the main uterine artery and its intramyometrial branches. Visualization of clear Doppler signals from the spiral arteries was possible in 30% of women who were menopausal for < 5 years. Increased vascular impedance was the typical finding in this vessel for this group of patients. The addition of HRT resulted in higher visualization rates of the spiral arteries and lowered resistance index values. CONCLUSIONS: There are changes in the flow velocity patterns of the ovarian, uterine, radial, and spiral arteries with age. The fact that the uterine artery resistance index does not change significantly in the first postmenopausal years strongly supports the thesis that the aging process initially affects the uterus less than the ovary. Furthermore, the uterine environment can be manipulated more easily during the menopausal years by proper hormonal stimulation