Development and Correlation of Menopausal Symptoms, Vaginal Smear and Urinary Gonadotrophin Changes Following Castration in 27 Women1

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Abstract
Twenty-seven bilaterally oophorectomized [female][female] were observed at regular intervals for development of changes in urinary gonadotrophins, vaginal smear values and menopausal symptoms from the time of operation until post-castra-tional changes were firmly established. The first and most striking change occurred in the urinary gonadotrophic titers. All with normal pre-operative levels showed a significant rise in gonadotrophin excretion as early as the 6th to 10th post-operative day. The menopausal zone was reached by the 6th day in 58%, by the 10th day in 86%, and by the next assay, conducted at the end of 1 mo., in all cases studied. Five patients with pre-operative levels in the menopausal zone maintained these levels after castration. Menopausal symptoms made their appearance and attained their maximal severity between the 27th and 66th post-castrational day in the avg. patient. The most common symptoms were hot flashes, nervousness and sweating. Loss of libido was common. Retrogression of vaginal cytology occurred in most cases but could not be correlated with either the rise in gonadotrophins or with development of symptoms. Four of 5 patients whose pre-operative gonadotrophic titers were high and whose ovaries, uteri and vaginal mucosa were atrophic responded to castration by developing menopausal symptoms. This suggests that atrophic-ovaries may still be secreting minimal amts. of estrogen and should be preserved at operation if possible.

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