OVARIAN REMNANT SYNDROME, A REAPPRAISAL - THE USEFULNESS OF CLOMIPHENE CITRATE IN STIMULATING AND PELVIC ULTRASOUND IN LOCATING REMNANT OVARIAN TISSUE

Our objective was to review the criteria for diagnosis of ovarian remn ant syndrome and evaluate the role of pelvic sonography following stim ulation of remnant ovarian tissue with clomiphene citrate, We evaluate d 6 women with a history of previous bilateral oophorectomy with conti nued pelvic pain, All had premenopausal follicle-stimulation hormone a nd luteinizing hormone levels, Following a baseline pelvic ultrasound, we arbitrarily administered clomiphene citrate 100 mg daily for 10 da ys, We then obtained a pelvic sonogram to document the presence and lo cation of presumed remnant ovarian tissue, In 4 women, cystic structur es consistent with ovarian follicles were present, Surgery was success ful in removing the remnant ovarian tissue in 3 of 4 women, Two women chose medical therapy consisting of ovarian suppression, One of these women had cyclic vaginal bleeding from endogenous hormonal stimulation of vaginal endometriosis as her major complaint, Two of the 3 women w ithout histologic documentation of ovarian tissue had on pelvic sonogr aphy the presence of sonographic lucencies consistent with ovarian fol licular development, Clomiphene citrate and pelvic sonography are usef ul in identifying the presence and location of remnant ovarian tissue in some patients, Additionally, the presence of cyclic vaginal bleedin g following intended bilateral oophorectomy argues for the presence of residual ovarian tissue in the absence of hormone replacement therapy .