Long-term results of bilateral oophorectomy for the treatment of chronic pelvic pain: relief of pain and special hormone replacement therapy requirements

Summary

A study was carried out to determine the efficacy of total hysterectomy and bilateral salpingo-oophorectomy in relieving intractable chronic pelvic pain up to 5 years postoperatively. The hormone replacement therapy requirements and its efficacy in alleviating postmenopausal symptoms and maintaining bone mineral density in these women was also assessed. This was a retrospective survey of a highly selected group of women attending a tertiary referral clinic for chronic pelvic pain. The subjects were 84 women who had previously undergone abdominal hysterectomy and bilateral salpingo-oophorectomy for intractable chronic pelvic pain. The main outcome measures were: pain scores; coital frequency: bone mineral densitometry and post-menopausal symptoms recorded at the most recent clinic visit. Pain relief was well maintained in 85 per cent of the subjects who reported no pain or occasional pain with minimal influence on their lives up to 5 years after surgery. More than half of the women on hormone replacement therapy required between two and five changes of treatment before obtaining satisfactory relief of symptoms. Bone mineral density distribution for the whole group at follow-up was within the normal range. Bilateral oophorectomy is an effective treatment for women with intractable chronic pelvic pain and relief of pain is sustained for up to S years. Hormone replacement therapy is an effective way of maintaining bone density and suppressing symptoms of oestrogen deficiency in these women hut several changes of hormone replacement therapy may be required. Particular attention must be paid to the dosage prescribed as a dose higher than that normally used for a spontaneously postmenopausal woman is often required to ensure that symptoms are adequately controlled.