An ovary belated after the fortieth year of life atrophies, and menopause symptoms will often ensue in the course of a few months after the operation. The retention of an ovary minimizes the menopause disturbances, and they are never so acute and prominent under these conditions as they are when an acute menopause is induced by the sudden and complete removal of all ovarian tissue. Some experienced observers maintain that an ovary is a valuable possession to any woman who menstruates, even at the age of fifty years, the persistence of menstruation being obtrusive evidence that this gland is functional. Experimental evidence, obtained from rabbits, proves that the removal of the whole uterus has no deterrent effect on ovulation, and it does not prevent the occurrence of œstrus and ovulation at periodically recurring intervals. There is no necessity to appeal to experiments on animals in this matter, as clinical observations on women are most eloquent in proclaiming the great value of a conserved ovary when the uterus is removed on account of troublesome and dangerous fibroids.
In reference to the value of ovarian tissue after hysterectomy for fibroids, attention should be drawn to a modification of this operation known as the Abel-Zweifel method, by which a small segment of the menstrual area of the uterus is left as well as one or both ovaries: this permits menstruation to continue in a subdued form.
Doran has particularly studied this method and practised it, but I cannot express any opinion as to its value, never having had the courage to perform it.
My aim in performing hysterectomy for fibroids is to abolish as completely as possible the menstrual area of the uterus (Fig. 18), and up to the present my efforts have been successful, and I have no complaint from any patient that this disagreeable phenomenon has manifested itself, although I have been at great pains by my own exertions, as well as by the kind efforts of those who have been associated with me in my hospital work, to keep in touch with women who have been so unlucky as to require such a serious operation as the removal of the uterus.
References to the History of Hysterectomy for Fibroids
Baer, B. F. Supra-vaginal Hysterectomy without Ligature of the Cervix in Operation for Uterine Fibroids. A new method. Transactions of the American Gynæcological Society, 1892, xvii. 235.
Bardenheuer. Die Drainierung der Peritonealhöhle. Im Anhang: Thelen: Die Totalextirpation wegen Fibroid. Stuttgart, 1881, 271.
Goffe, I. Riddle. This surgeon furnishes an interesting account of the development of Total and Subtotal Hysterectomy for Fibroids, in The Transactions of the American Gynæcological Society, 1893, xviii. 372.
Koeberlé, E. Documents pour servir à l’histoire de l’extirpation des tumeurs fibreuses de la matrice par la méthode suspubienne. Gaz. med. de Strasbourg, 1864, xxiv. 17; 66; 158. 1865, xxv. 78; 118.