Large studies of estrogen in surgical menopause completed in both America and Denmark have demonstrated that long-term estrogen therapy in surgical menopause (e.g., 5+ years) may actually reduce risk for cardiovascular disease and breast cancer, and does not appear to alter risk of blood clots or stroke.

There are no studies on the role of smoking in the safety of hormone therapy specifically in surgical menopause; however, in natural menopause, smoking increases the risk that hormones will increase risk of blood clot.

Use of transdermal estrogen (rather than oral) has been found to be more appropriate for those who smoke in surgical menopause, and this may be a safer option in surgical menopause, too. Talk to your doctor about what kinds of hormone therapy might be safe and effective for you; it is also a good idea to ask your doctor about medications and therapies that can help you quit smoking.
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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.