Ovariotomy for menstrual madness and premenstrual syndrome--19th century history and lessons for current practice

Ovariotomy--the removal of normal ovaries, known as Battey's Operation--began in 1872 and became the fashionable treatment of menstrual madness, neurasthenia, nymphomania, masturbation and "all cases of insanity". This practice was supported by distinguished gynecologists and psychiatrists, becoming one of the great medical scandals of the 19th century. In modern times, if menstrual madness is considered to be premenstrual dysphoric disorder (PMDD), and ovariotomy, the surgical equivalent of ovulation suppression of GnRH analogues, it can be argued that the surgery would have been effective for this limited indication, although the side effects of long-term estrogen deficiency would have made the treatment unacceptable. Currently, the successful hormonal treatment of PMDD is one of suppression of ovulation and removal of the cyclical hormonal changes in the luteal phase, probably progesterone, which is the essential cause of PMDD. Such therapy would be by GnRH analogues, transdermal estradiol and, in a few cases, the surgical option of hysterectomy and bilateral salpingo-oophorectomy with adequate hormone replacement. A study of medical history can help us prevent the mistakes of over-enthusiasm but positive lessons can be learned.