PMDD is a sensitivity in the brain to hormonal fluctuations. For those with PMDD, it is important to note that, although the removal of the ovaries prevents the monthly cyclical hormone fluctuations that may trigger brain reactions to hormones (e.g., emotional or cognitive changes), your brain will always be abnormally sensitive to hormones, and surgical treatment will not change that. The surgery just takes away the main source of the fluctuations (ovulation). You cannot have PMDD when you no longer have a menstrual cycle - but you may feel PMDD-like symptoms when you have a fluctuation.
Since it may take quite some time to find the optimal dosages of HRT, many people with a history of hormone sensitivity still experience changes in their symptoms during this process. It does not mean that you still have PMDD - it just means that your brain is reacting to those fluctuations that are caused by a change in HRT, the natural depletion of hormones from your body, or the HRT not being correctly absorbed.
It should be noted that, in the case of PMDD, there is thought to be a time lag of about 2 weeks between hormone changes and brain reactions; therefore, frequent changes to HRT levels should be avoided, and every change should be evaluated for about one month before deciding if it is effective and tolerable.
Patient experience: "I definitely had lots of symptoms which felt like PMDD in the first 6 months - this continued, but got gradually lesser and fewer towards the 12 month mark! Don't panic if you are having 'bumps', It is very normal'"
Looking for support from others going through (or have been through!) the same? Check out the IAPMD - PMDD, Oophorectomy, Hysterectomy, & Life After Group