Choosing surgery to treat PMDD is a personal decision. One must evaluate the risks and benefits before considering any type of surgical procedure. As of this writing, a total hysterectomy with salpingo-oophorectomy is the only cure for this disorder. Studies have shown that by removing the ovaries a vast majority of sufferers experienced complete relief of PMDD symptoms. A 2009 study showed 96% of women who underwent a total abdominal hysterectomy/bilateral salpingo-oophorectomy (TAH/BSO) to treat "severe PMS" were extremely satisfied with the results.1,2 

Procedure Options

There are several procedure options for surgery. You will want to talk with your doctor and medical team to determine the right procedure for you. Considerations will be based on any number of factors including a history of cesareans, cancerous tumors, cysts, or fibroids as well as the availability of needed technologies and the skills of the surgeon performing the operation. Recovery time will vary depending on the method used and can be anywhere from 2 to 8 weeks.3

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Surgical Menopause

Once the ovaries are removed, your body immediately stops producing estrogen and progesterone. Your follicle stimulating hormone (FSH) will skyrocket in an attempt to make contact with ovaries that no longer exist. Unlike women who go through menopause naturally, women wake up after a bilateral oophorectomy in immediate estrogen withdrawal. It's that sudden: One day you have a normal menstrual cycle, the next day you have none whatsoever. This can cause you to become, understandably, more depressed, and you'll also feel the physical symptoms of estrogen loss far more intensely than a woman in natural menopause. 

Symptoms can include:

  • Hot flashes, flushes, night sweats and/or cold flashes, clammy feeling
  • Bouts of rapid heart beat
  • Irritability
  • Mood swings, sudden tears
  • Trouble sleeping through the night (with or without night sweats)
  • Loss of libido
  • Vaginal dryness
  • Crashing fatigue
  • Anxiety, feeling ill at ease
  • Feelings of dread, apprehension, doom
  • Difficulty concentrating, disorientation, mental confusion
  • Memory lapses
  • Itchy, crawly skin
  • Headache change: increase or decrease
  • Depression
  • Electric shock sensation under the skin and in the head
  • Tingling in the extremities
  • Osteoporosis
  • Changes in fingernails: softer, crack or break easier

Fortunately, you most likely won't experience all of these symptoms, and the ones you do have will vary in degree and duration.4 

Hormone Replacement Therapy

Progesterone is a suspected cause of PMDD symptoms so patients choosing this course of treatment must (1) have both ovaries removed and (2) can not have progestin as part of hormone replacement therapy (HRT) following surgery. Progestin is a synthetic (sometimes natural) progesterone typically prescribed following an oophorectomy to protect the lining of the uterus. Without the added back progestin, a woman would be at risk of uterine cancer and other diseases and complications of the uterus. Because of these concerns, the uterus is also often removed at the same time as the ovaries.5

Estrogen is considered a "safe" hormone to use following an oophorectomy to help combat the symptoms of menopause including hot flashes, vaginal dryness, and thinning of the bones. Patches and gels are easier on the liver than pills taken by mouth although they can be more expensive. Many women are able to stop using estrogen treatments when they reach a normal age of menopause.6 

Some doctors will prescribe testosterone as part of an HRT plan. There are limited studies that suggest testosterone can help with libido following surgery, however, more research is needed. 

Peer Support Resources

There are many women who have chosen surgery as a final treatment option for PMDD. Here are several valuable resources from women who have undergone an oophorectomy specifically for PMDD to help you in your research.

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