Most people with PMDD who have been carefully diagnosed with daily ratings (symptom tracking across the cycle), and who have failed to respond to other treatments, are satisfied with surgical menopause as a treatment option.
In the largest study conducted on this topic, 47 women with PMDD who underwent THBSO* were asked to rate their satisfaction with surgery as a treatment for PMDD (they could select “very satisfied,” “satisfied”, “dissatisfied”, or “very dissatisfied”. 80.9% of the patients reported being “very satisfied” with their outcome, 4.5% were “satisfied”, one patient was “dissatisfied” and one patient was “very dissatisfied.” To summarize, 96% of patients were happy with their outcome. Further, 89.4% of the sample reported that they would recommend surgery to a friend with PMDD. The patients in this sample had suffered for an average of 10 years before referral to a specialist clinic and had endured further ineffective treatments for an average of 6 years before surgery.
Therefore, the best available evidence suggests that THBSO is an acceptable and satisfactory treatment for PMDD in severe, treatment-resistant cases. Careful diagnosis with daily ratings and use of preoperative GnRH agonists to induce a reversible “chemical menopause” can, in many cases, help to predict the effects of surgery. However, in some cases, GnRH agonists are not tolerated (e.g. due to an allergy or severe physical symptoms, or it doesn’t fully suppress ovulation i.e you are still ovulating) such that a “fair trial” of these medicines cannot be conducted. When this is the case, surgery may still be an option.
Accreditation: SMAC
*Total Hysterectomy with Bilateral salpingo-oophorectomy (both ovaries and fallopian tubes removed)
Visit www.iapmd.org/surgery for lots of evidence-based information and resources for those considering, going through or recovering from surgery for PMDD/PME.