Ovarian Remnant Syndrome, a Reappraisal: The Usefulness of Clomiphene Citrate in Stimulating and Pelvic Ultrasound in Locating Remnant Ovarian Tissue

Our objective was to review the criteria for diagnosis of ovarian remnant syndrome and evaluate the role of pelvic sonography following stimulation of remnant ovarian tissue with clomiphene citrate. We evaluated 6 women with a history of previous bilateral oophorectomy with continued pelvic pain. All had premenopausal follicle-stimulation hormone and luteinizing hormone levels. Following a baseline pelvic ultrasound, we arbitrarily administered clomiphene citrate 100 mg daily for 10 days. We then obtained a pelvic sonogram to document the presence and location of presumed remnant ovarian tissue. In 4 women, cystic structures consistent with ovarian follicles were present. Surgery was successful in removing the remnant ovarian tissue in 3 of 4 women. Two women chose medical therapy consisting of ovarian suppression. One of these women had cyclic vaginal bleeding from endogenous hormonal stimulation of vaginal endometriosis as her major complaint. Two of the 3 women without histologic documentation of ovarian tissue had on pelvic sonography the presence of sonographic lucencies consistent with ovarian follicular development. Clomiphene citrate and pelvic sonography are useful in identifying the presence and location of remnant ovarian tissue in some patients. Additionally, the presence of cyclic vaginal bleeding following intended bilateral oophorectomy argues for the presence of residual ovarian tissue in the absence of hormone replacement therapy. (J GYNECOL SURG 11:33, 1995).