Question 17 - Hysterectomy And PMS




Dr N,

I had a hysterectomy about 3 years ago, keeping my ovaries. The reason for the surgery was for bad PMS symptoms. I lived on Anaprox for years. A few months after I felt like the same symptoms came back. When I changed doctors I know he thought I should not of had one, but too late. Well he says my ovaries are now failing. And put me on Premarin .625. I have been on that 2 yrs. I still have the same symptoms. He tried giving me Prozac. That did not help. My family Dr. just tried me on Estratest cause my sexual desire is gone. Not sure if that is helping yet. I am getting very depressed. So he put me on Wellbutrin. But that has kept me at night so I just stopped it. I am thinking about trying...Sam-e......or remefemin or promensil .I am 43 years old and am now 30 lbs over weight. I just got my blood work back and FSH level is normal.. Do you have any suggestions? Thank you..I would appreciate any advice.

Right now as I am writing you...I feel like PMS bad..My lower back hurts, my breasts are sore and I am so irritable. I am on Estratest right now. I take Xanex as needed. He tried me on Wellbutrin because I was getting depressed. I tried it for about a week but could not sleep on it. I have Motrin 600 mg. that I take as needed. For Vitamins...multi....Vit. E....400mg....B complex...Vit. C 500mg...and Calcium 600 mg. Before the surgery I felt this way at least 2wks out of the month. And when I started my period it was a relief. But now I have no period so it is hard to tell. But it seems like often. Especially the mood swings. I just started taking Sam-e yesterday.. Any other information let me know...Thank you for your response...

Reply:

Hi,

PMS is sometimes called "Ovarian Cycle Syndrome". What this alludes to is that the group of symptoms that occur in the 7-10 days prior to menstruation are caused by the cycle of hormonal fluctuations that also precede menstruation.

If the uterus is removed and the ovaries that are left continue to function normally, these hormonal fluctuations would be expected to continue. The PMS symptoms would continue to occur at expected time in the cycle of hormonal fluctuation, without the menstruation and pelvic cramps as the uterus would no longer be present.

These "cyclic phenomena", or series of premenstrual events are experienced by many women who have had a hysterectomy and still have their ovaries. These phenomena are recognized by these women as an indirect sign that their ovaries are still functioning. It might be of help to you to keep a calendar of the PMS symptoms and you will be able to ascertain if they are grouped at the intervals you would expect for PMS, or if they fall randomly and are unrelated.

The bottom line is that a hysterectomy without removal of the ovaries is not a reasonable treatment for PMS. Some women who have had severe and life altering PMS symptoms have had their uterus and ovaries removed, as an aspect of their treatment, but this usually happens only in extreme circumstances.

However, if HRT is given and is absorbed efficiently enough to achieve blood levels sufficient enough to suppress ovarian function then these fluctuations should cease.

As you are already on HRT, it is difficult to know whether the problem is continued ovarian cycling because the HRT has failed to suppress the ovaries, or if your symptoms represent another problem. One approach would be to speak to your Dr about another HRT regimen and route of administration that might be more successful in either alleviating your symptoms or suppressing your ovaries.

If you have not already, read the Hysterectomy and Methods of HRT sections of the web site, as they will provide more insight.

Let me know what and how you do.

Dr N