OVARIAN MANAGEMENT DURING RADICAL HYSTERECTOMY IN THE PREMENOPAUSAL PATIENT

Objective: To determine whether the ovaries should be retained or remo ved in premenopausal women undergoing radical hysterectomies for cervi cal carcinoma. Methods: Questionnaires were sent to all women who had radical hysterectomies without further therapy for cervical carcinoma at our institution over a 16-year period. Those who had retained ovari an tissue were asked to have serum gonadotropin levels measured. Resul ts: Eighty-four of 124 eligible women (68%) responded. Sixty-eight res pondents were premenopausal at the time of surgery. Thirty-eight had a bilateral salpingo-oophorectomy (BSO), 20 had one ovary preserved, an d ten retained both ovaries. Six of 30 (20%) who retained ovaries deve loped early hormonal failure. Two of these 30 (7%) required oophorecto mies subsequently. Twenty-seven of 38 BSO patients (71%) were complian t with their hormone replacement regimens. Fourteen of 15 women (93%) age 40 or younger were compliant, whereas 13 of 23 (57%) over age 40 w ere compliant (P < .05). Twenty-three of 34 BSO respondents (68%) repo rted improved or unchanged sexual relations, compared with 24 of 27 (8 9%) who retained ovaries (P > .05). Conclusions: Twenty-seven percent of our premenopausal women with retained ovaries have experienced earl y loss of hormonal function or required subsequent oophorectomies. For an accurate estimate of ovarian longevity, all patients would have to be followed through menopause. Compliance in taking hormone medicatio n was high in our young patients. Sexual function was not adversely af fected following castration. A hypothetical cost comparison favored re moving, rather than retaining, the ovaries. We recommend that elective BSO be performed on most premenopausal women undergoing radical hyste rectomies for cervical carcinoma.