This will vary from person to person and will depend on a number of factors. Those who are already on HRT pre-op may find that they don’t even have menopausal symptoms as their levels are kept at a good level.
The dosage and timing of HRT should be discussed with your surgeon prior to the operation. Some doctors we surveyed reported that they prefer to begin HRT as soon as the patient leaves the hospital (provided medical safety for the individual patient); however, there is no clear scientific guidance about when or at what level to start. Studies suggest that HRT is underused in surgical menopause, so it is important to have discussions with your doctor prior to surgery about how you will work together to optimize HRT in surgical menopause.
Remember that you may also experience short-term emotional symptoms during this transition. Several studies show that people with PMDD experience abnormal negative emotional reactions during hormone changes. However, recent studies ALSO show that these negative emotional reactions usually go away about one month after starting HRT. Therefore, if you can tolerate the symptoms in the first month following the start of HRT (or any changes in HRT), symptoms usually subside. So while it can be a difficult start, many can with PMDD can take HRT during surgical menopause.
If you’re concerned about your ability to cope with initial symptoms in the first month of HRT, we encourage you to start with a low dose and build up slowly. It is wise to be aware that this can be a difficult time of increased symptoms, and plan ahead to increase support from family, friends, and healthcare providers during this time. For example, some people are able to start HRT during a “quiet month” where there is less stress in their life. Some may also choose to see a supportive health care provider more frequently during the first month of HRT, or ask those around them to provide additional support during this time.
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.