Abstract: Ovarian aging drives not only the progressive decline of female reproductive function but also the acceleration of multi-systemic aging. Aberrant extracellular matrix deposition and the consequent biomechanical changes in tissues disrupt the peri-follicular microenvironment, thereby contributing to both natural ovarian aging and premature ovarian insufficiency. This paper systematically reviews the mechanisms underlying ovarian fibrosis, integrating recent insights from single-cell and spatial multi-omics analyses to delineate the characteristics of the fibrotic and inflammatory microenvironment, summarizes the clinical potential of non-invasive assessment modalities, including shear wave elastography and humoral molecular markers, and evaluates current anti-fibrotic therapeutic strategies, aiming to provide valuable insights and directions for the early identification and clinical intervention of ovarian aging-related disorders.