BILATERAL OOPHORECTOMY AND HYSTERECTOMY IN THE TREATMENT OF INTRACTABLE PELVIC PAIN ASSOCIATED WITH PELVIC CONGESTION

Objective - To determine whether bilateral oophorectomy combined with hysterectomy is an effective treatment for chronic pelvic pain due to congestion. Design - Prospective non-randomized single centre study. Setting - Tertiary referral centre to a specialist pelvic pain clinic in a teaching hospital. Subjects - 36 women, 33 of whom had failed to obtain long term relief of pain on medical therapy. Main outcome measures - Relief of pain, coital frequency, and effect on daily life. Histology of uterus and ovaries. Results - Median pain score on visual analogue scale fell from a pre-operative value of 10 to 0 at one year. Twelve of the 36 women had some residual pain at one year postoperatively, but in only one woman was the pain affecting her daily life. Thirty women were noted to have pelvic tenderness pre-operatively, at one year, 26 had no tenderness and four minimal tenderness on pelvic examination. The median frequency of sexual intercourse increased from once per month preoperatively to eight times per month one year postoperatively. The uterus was histologically normal in 25 women, adenomyosis was present in eight of whom two had ovarian endometriosis. Fibroids were present in three and endometriosis was found confined to the ovaries in one woman. Multiple peripheral cysts were present in the ovaries of 25 women. Conclusion - Bilateral oophorectomy combined with hysterectomy and hormone replacement therapy is an effective treatment for chronic pelvic pain due to venous congestion, which has failed to respond to medical treatment and leads to restoration of normal coital function and daily life.