Ovarian management during radical hysterectomy in the premenopausal patient

To determine whether the ovaries should be retained or removed in premenopausal women undergoing radical hysterectomies for cervical carcinoma.

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 ovarian tissue were asked to have serum gonadotropin levels measured.

Eighty-four of 124 eligible women (68%) responded. Sixty-eight respondents were premenopausal at the time of surgery. Thirty-eight had a bilateral salpingo-oophorectomy (BSO), 20 had one ovary preserved, and ten retained both ovaries. Six of 30 (20%) who retained ovaries developed early hormonal failure. Two of these 30 (7%) required oophorectomies subsequently. Twenty-seven of 38 BSO patients (71%) were compliant with their hormone replacement regimens. Fourteen of 15 women (93%) age 40 or younger were compliant, whereas 13 of 23 (57%) over age 40 were compliant (P < .05). Twenty-three of 34 BSO respondents (68%) reported improved or unchanged sexual relations, compared with 24 of 27 (89%) who retained ovaries (P > .05).

Twenty-seven percent of our premenopausal women with retained ovaries have experienced early 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 medication was high in our young patients. Sexual function was not adversely affected following castration. A hypothetical cost comparison favored removing, rather than retaining, the ovaries. We recommend that elective BSO be performed on most premenopausal women undergoing radical hysterectomies for cervical carcinoma.