Age, menstrual cycle regularity, and metabolic status as determinants of ultrasound reference values for uterine and ovarian parameters in adolescent girls
Razdrogina K.A., Istomina N.G., Baranov A.N., Trescheva N.D.
Background. Reproductive healthcare for adolescent girls is a priority in modern medicine, as puberty marks the completion of the morphofunctional maturation of the reproductive system. Diagnosis of gynecological pathology in this age group is challenging due to the lack of standardized ultrasound reference values for the uterus and ovaries that account for the dynamic nature of pubertal development. Morphometric parameters of reproductive organs are determined by several simultaneously changing factors: chronological and gynecological age, body mass index (BMI), and menstrual cycle characteristics. A strategy that integrates these factors is needed to establish an individual "normative track" and enable personalized patient management.
Objective. To assess the impact of chronological and gynecological age, body mass index, and menstrual cycle characteristics on clinical and ultrasound parameters of the reproductive system in adolescents, aiming to identify key determinants of age-specific norms during puberty.
Materials and methods. A prospective, non-randomized study with a diagnostic intervention (ultrasound monitoring) was conducted at Arkhangelsk City Clinical Outpatient Clinic No. 1. The study included 340 adolescent girls (aged 15–17 years) recruited from various educational institutions. The inclusion criteria were as follows: age 15–17 years, signed informed consent, absence of acute or exacerbated chronic diseases, and a history of menarche. All participants underwent serial pelvic ultrasound examinations (twice per menstrual cycle; total, n=2031 examinations). Statistical analysis was performed using the Kruskal–Wallis test, chi-square test (with Bonferroni correction), one-way analysis of covariance (ANCOVA), and univariate logistic regression.
Results. Chronological and gynecological ages were not independent determinants of clinical or ultrasound parameters (p>0.05), except for an expected increase in the proportion of regular cycles with advancing gynecological age (up to 90% at 6–8 years post-menarche, p=0.037). Menstrual cycle regularity was significantly associated with corpus luteum detection in the luteal phase (p<0.001), with irregular cycles associated with a markedly reduced probability of corpus luteum visualization (OR=0.209; 95% CI: 0.104–0.420). The newly defined "conditionally regular" cycle group represented a transitional phenotype: despite age similarity to the regular cycle group, ovarian ultrasound parameters (ovarian-uterine index [OUI], p<0.001; ovarian-uterine coefficient [OUC], p=0.016) were statistically closer to those of the irregular cycle group. BMI independently influenced ovarian volume (F=8.024; p=0.005) and ovarian-uterine indices (OUI: p=0.017), whereas uterine dimensions were not associated with BMI. OUI demonstrated greater sensitivity to intergroup differences than OUC.
Conclusion. Ovarian ultrasound is a sensitive tool for assessing the morphofunctional maturity of the reproductive system in adolescents and requires a multifactorial approach for result interpretation. Menstrual cycle regularity and BMI are key determinants of ovarian ultrasound morphology. Adolescents with conditionally regular and irregular menstrual cycles are at risk for ovulatory dysfunction, and ovarian-uterine ratios serve as sensitive markers for their identification. The findings will form the basis for a multilevel model of clinically applicable ultrasound reference values for the uterus and ovaries, incorporating age-related, functional, and metabolic characteristics of the animals.
Authors' contributions. Razdrogina K.A. – data collection, literature review, conception of the study, and drafting of the manuscript; Istomina N.G. – conception of the study, literature analysis, statistical analysis, and drafting of the manuscript; Baranov A.N. – design of the study and final editing. All authors confirm that they meet the international ICMJE authorship criteria. Each author has contributed substantially to the study's conception, data collection, or analysis; participated in drafting or revising the manuscript; and reviewed and approved the final version prior to submission.
Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. There was no funding for this study.
Ethical Approval. The study was reviewed and approved by the Research Ethics Committee of the Northern State Medical University.
Generative Artificial Intelligence. No artificial intelligence tools were used in the preparation of this manuscript.
Patient Consent for Publication. All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement. The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
For citation: Razdrogina K.A., Istomina N.G., Baranov A.N., Trescheva N.D. Age, menstrual cycle regularity, and metabolic status as determinants of ultrasound reference values for uterine and ovarian parameters in adolescent girls.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (9): 126-137 (in Russian)
https://dx.doi.org/10.18565/aig.2026.64
Keywords
adolescent girls
ovarian ultrasound
menstrual cycle
ovarian-uterine ratios
BMI
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Received 24.02.2026
Accepted 02.09.2026
About the Authors
Ksenya A. Razdrogina, PhD Student at the Department of Obstetrics and Gynecology, Northern State Medical University, Ministry of Health of Russia, 163000, Russia, Arkhangelsk, Troitsky Ave., 51, +7(8182)24-03-46, +7(999)270-29-25, ksushka08_91@mail.ru, SPIN: 9481-8909, https://orcid.org/0000-0003-3010-2983Natalia G. Istomina, PhD, Associate Professor at the Department of Obstetrics and Gynecology, Northern State Medical University, Ministry of Health of Russia, 163000, Russia, Arkhangelsk, Troitsky Ave., 51, +7(8182)24-03-46, +7(921)477-47-84, nataly.istomina@gmail.com, SPIN: 3839-9145, https://orcid.org/0000-0001-9214-8923
Alexey N. Baranov, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology, Northern State Medical University, Ministry of Health of Russia, 163000, Russia, Arkhangelsk, Troitsky Ave., 51, a.n.baranov2011@yandex.ru, SPIN: 5935-5163, https://orcid.org/0000-0003-2530-0379
Natalia D. Trescheva, PhD, Associate Professor at the Department of Obstetrics and Gynecology, Northern State Medical University, Ministry of Health of Russia, 163000, Russia, Arkhangelsk, Troitsky Ave., 51, +7(8182)24-03-46, +7(921)484-76-33, trescheva.nd@gmail.com
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