Many individuals who are about to undergo surgical menopause are already taking medications that influence their hormone levels prior to surgery. This can include GnRH analogues (which create a temporary chemical menopause), estrogen, or progesterone. For those with certain gynecologic conditions (e.g., uterine fibroids), GnRH agonists are frequently used prior to hysterectomy/oophorectomy to reduce uterine enlargement and related symptoms (e.g., due to fibroids). Therefore, most surgeons are accustomed to patients being on GnRH agonists leading up to surgery.
GnRH analogues can be continued on schedule prior to surgery in order to minimize the impact of surgery on hormone flux. This may be especially indicated for those who are using GnRH analogues to treat a brain hormone sensitivity (e.g., PMDD, PME). As always, it is important to discuss this issue with your medical professionals to determine what is right for you.
Many individuals who are being treated with GnRH analogues also take estrogen and progesterone hormone addback to prevent menopausal symptoms and risks. Because estrogens can increase the risk of blood clots, some surgeons may recommend discontinuing HRT prior to surgery. This may be dependent on how you are taking estrogen. Transdermal estradiol patches have been found to show lower risk of blood clots than other types of estrogen HRT, and this option may be more acceptable to your surgeon. Be sure to discuss this topic with your medical professionals to determine what is right for you.
Read more on HRT in surgical menopause for PMDD here:
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.