Surgery

In the past, some women with premenstrual dysphoric disorder (PMDD), the severe form of premenstrual syndrome, were treated with surgical removal of the ovaries (oophorectomy) and the uterus (hysterectomy). Without functioning ovaries, a woman's body doesn't make eggs, estrogen, and progesterone and no longer has a menstrual cycle.

Surgical removal of the ovaries for PMDD is highly controversial and rarely done. It is only considered if a woman meets all of the following criteria:

• PMS symptoms are severe and regularly disrupt her quality of life.
• She has no future plans to have biological children, and she is many years away from natural menopause.
• Symptoms improve with the use of medicines that produce a condition similar to menopause (such as danazol or a gonadotropin-releasing hormone agonist [GnRH-a]). But even if symptoms improve during danazol or a GnRH-a treatment, it is possible that the medicine is not the reason for the improvement.
• All other treatments have failed.
• All or most of the symptoms are directly related to PMDD. Other problems, such as psychological or nonmedical problems in her life or environment, do not appear to contribute to the symptoms.

Although oophorectomy ends premenstrual symptoms, it also leads to early menopause and perimenopausal symptoms that tend to be more severe than those of natural menopause. Early menopause also increases the risk of osteoporosis because low estrogen leads to bone density loss. Because of this, women with no ovaries are advised to take estrogen (HRT or ERT) at least until menopausal age to protect against bone loss.

• Estrogen-progestin hormone replacement therapy (HRT) is used when the ovaries but not the uterus are removed, to reduce the risk of estrogen-related uterine (endometrial) cancer.
• Estrogen replacement therapy (ERT) is used after both the ovaries and uterus are removed. (Additional progestin isn't necessary to protect against uterine cancer when there is no uterus present.)

Surgery also has risks related to the procedure or anesthesia. For more information, see the topic Hysterectomy.