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Help!  PMS symptoms....after 1 year post-op? Help! PMS symptoms....after 1 year post-op?

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Unread 04-09-2003, 04:00 PM
Help! PMS symptoms....after 1 year post-op?


Don't know if I'm posting in the right place or should be posting in the Hormone Jungle...that's where I feel I am.
I had my hyst in November 2001, ovaries in. I have not had any problems until now......
I seem to have PMS symptoms...moodiness (to put it nicely) is the main one. I can't seem to control my emotions. I'm up one minute and down the next. Also really tired all the time. Could this mean my ovaries are shutting down or beginning on menopause? I'm only 32.
I called my Doc and he said to wait a few more months and then we'll see what's up. In the mean time, I'm driving myself and my family crazy with irritability and weepiness.
Any suggestions or advice...if you had this experience would be helpful!!

Thank you, thank you, thank you!

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Unread 04-10-2003, 07:35 PM
Help! PMS symptoms....after 1 year post-op?

Hi Cally!

PMS symptoms can happen anytime you still have ovaries. Even if you had no symptoms you can develop some. Hormones levels can change. After my surgery last year I kept my ovaries and my PMS symptoms seem milder; however, my doctor did say that the symptoms can change. There are many medications that can help with PMS and depression symptoms. Often anti-depressants are helpful (Zoloft, Prozac, Effexor, Wellbutrin, Sarafem, etc.). My suggestion would be to not wait a few more months - I would give the doctor a call back and let them know that the irritability and weepiness are causing you problems. Depression is an illness that needs to be treated and monitored effictively. I hope you are feeling much better soon!

Sending s
Unread 04-11-2003, 05:53 PM
Help! PMS symptoms....after 1 year post-op?

Hi Cally

I also kept my ovaries when I had my TVH. Since then, I've been having months with extreme PMS pain, especially in the first 6 or 7 months after my ovaries came back to life. I've also had many months of barely no symptoms at all. However, for the past 6 months or so, I've been having increasing symptoms of peri-menopause, including moodiness, hot flashes, night sweats, dizzy spells and insomnia. I've also had increasing problems with incontinance, that seem to increase whenever the peri-menopausal symptoms increase. Vaginal dryness is also a problem.

One thing that I've insisted on is having my hormone levels tested. While she's at it, my doctor is also testing my thyroid levels (a malfonctionning thyroid can cause similar problems).

As ((((((LynnMary))))) mentions, hormone levels tend to vary through the months and years following a hyst. I've also seen some women who needed to have their natural hormones supplemented with HRT. That's still easier than replacing our hormones entirely.

I agree with ((((LynnMary))))): you should get in touch with your doctor and insist on having this addressed sooner. At least have your hormone levels tested.

Sending tons of gentle healing s your way. Please keep posted on how you're doing.
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Unread 04-12-2003, 10:20 AM
Help! PMS symptoms....after 1 year post-op?


I feel for you dear, this PMS stuff is no fun especially since you really don't have a clue when it is going to hit

I feel for my family cause I think mine is coming about every third week or so. My tension and frustration over the stupidest stuff is driving me and them crazy. I am trying to monitor mine again. I had depression hit pretty hard about 6 mos after my hyst and terrible mood swings. I tried Prozac but had terrible side effects, switched to Celexa with absolute no relief then to Zoloft. Zoloft helped greatly but did make me tired a lot. I have since came off it and am doing pretty well. I am watching my moods and etc very closely though cause I understand that this is not in my control. The chemical in our brains that makes us happy and able to cope, serotonin, can be drastically effected by hormones etc. and a number of other life or medical stresses. I will consider medical treatment again if it affects my quality of life or my families.

I think ((Dany)) and ((LynnMary)) are right in their suggestions to call the back and let him know you don't want to wait this out, you want to discuss it as soon as possible. I would especially demand it if you have any other signs of depression that have lasted longer than 2 weeks. I am not trying to say you are dealing with depression because I am not a medical professional but wanted to bring the symptoms to your attention. Again, so many issues, medical etc could bring on these symptoms. I dealt with PMS depression which would automatically be relieved as soon as I started my period, that was different than my bout with it after my hyst because it was long term. Please keep us posted okay.

You aren't alone in the PMS scene, we are all here for you !

Unread 04-12-2003, 10:47 AM
Help! PMS symptoms....after 1 year post-op?

I havent experienced this but do have some good info pertaining to PMS after a Hyst that might be of some help:

Abdominal or Pelvic Pain Occurring Monthly:

Hysterectomy Factsheet:

Pelvic Pain Assessment Form:

Pain in pelvis/lower abdomen:

PMS Symptoms after Menopause?

Progesterone Cream and Menopausal Symptoms:

Muscle Pain Presenting as Pelvic Pain:

Hysterectomy & PMS:,00.html,00.html

PMS and You - Symptoms and Treatments - Premenstrual Syndrome:,00.html

while it may be hard to explain, physicians do report that patients find relief from PMS after a hysterectomy. ...

Although the symptoms of PMS are closely associated with the luteal (last half) of the menstrual cycle, most studies have not shown any consistent differences in levels of estrogen or progesterone between women with PMS and those without. It has been demonstrated, however, that permanent reduction of estrogen and progesterone with oophorectomy (removing ovaries) results in reduction of PMS symptoms even if estrogens are given back as hormone replacement after the surgery. See the two abstracts that follow.

If indeed you are at high risk for ovarian cancer, e.g. family history, bilateral oophorectomy substantially reduces but does not eliminate the risk of ovarian cancer. However, following their removal, your risk of heart disease, osteoporosis (bone thinning), pelvic floor relaxation problems, atrophic vaginitis (to name only a few) is substantially increased over your lifetime IF you are not committed to hormone replacement therapy (HRT). The problem is that most women, 10 years after surgery or menopause, are not taking their HRT. So if you do decide to proceed with removal of your remaining ovary because of your severe PMS and your high ovarian cancer risk, please remember to take your estrogen!

***** Am J Obstet Gynecol 1990 Jan;162(1):105-109
The effect of hysterectomy and bilateral oophorectomy in women with severe premenstrual syndrome.
Casper RF, Hearn MT
Department of Obstetrics and Gynecology, University of Western Ontario, Toronto, Canada.

The etiology of premenstrual syndrome is unknown, although this syndrome is linked to the menstrual cycle. Fourteen women with severe, debilitating premenstrual syndrome volunteered for a study of therapy by hysterectomy, oophorectomy, and continuous estrogen replacement. All had completed their families and had failed to benefit from previous medical treatment. The diagnosis and severity of premenstrual syndrome were assessed by means of prospective charting and psychological evaluation. All patients had clearly cyclic symptoms and psychological scores consistent with a major disruption of their lives before surgery. Six months after surgery, premenstrual syndrome symptom charting revealed complete disappearance of a cyclic pattern with scores equivalent to those of a normal population. Psychological measures 6 months after operation showed dramatic improvement in mood, general affect, well-being, life satisfaction, and overall quality of life. Surgical therapy, involving oophorectomy, hysterectomy, and continuous estrogen replacement, is effective in relieving the symptoms of premenstrual syndrome and is indicated for a small, selected group of women.


Am J Obstet Gynecol 1990 Jan;162(1):99-105
Lasting response to ovariectomy in severe intractable premenstrual syndrome.
Casson P, Hahn PM, Van Vugt DA, Reid RL
Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada.

A total of 14 women with severe premenstrual syndrome unresponsive to conservative medical therapy were treated with danazol in doses sufficient to suppress cyclic ovarian steroidogenesis. In each case medical ovarian suppression resulted in complete relief from symptoms. For ongoing symptom relief, each woman elected to undergo bilateral ovariectomy and concomitant hysterectomy. Both medical ovarian suppression and ovariectomy with low-dose conjugated estrogen therapy afforded lasting relief from cyclic symptoms of premenstrual syndrome and a corresponding improvement in overall quality of life. We conclude that cyclic ovarian steroidogenesis is a powerful determinant for the expression of premenstrual symptomatology.

Ovariectomy with low-dose estrogen replacement is an effective alternative for the woman with debilitating premenstrual syndrome who does not respond to conventional interventions.

Does PMS go away after just hysterectomy alone?

It sounds as if you are considering a hysterectomy basically because of severe PMS symptoms. It is possible, however, that there are other causes of your symptoms such as menstrual cramps due to endometriosis or adenomyosis, or chronic pelvic pain due to varicosities, etc. I guess the first question I would ask is whether you have had a diagnostic laparoscopy to look at the pelvis and have you had any hormone therapy to suppress ovulation and menses? These things should be done before considering hysterectomy. Secondly, if you think the main problem is PMS, has your doctor had you fill out a prospective symptom calendar to confirm that the mood changes are not present more than the two weeks premenstrual? If we had an interactive, internet educational consultation we could better pin down whether hysterectomy is the next step for you. It really is essential to know exactly what we are treating in order to fully understand the risks and benefits of the treatment.

Let us assume for the sake of this writing that the diagnosis of PMS, and only that, has been confirmed. The question then becomes as to how successful hysterectomy is in curing PMS symptoms. Also, because you are still quite young, removal of the ovaries would be very undesirable, so the question is refined to "would hysterectomy without ovary removal cure the fluid retention, mood swings, depression, and 2 weeks of pelvic pain that follow ovulation of the egg from the ovaries?"

Women who fail lifestyle changes and medical therapy for PMS often inquire about hysterectomy for PMS. They are cautioned that if the ovaries, which cause the cyclical hormonal changes, are not removed, it is very possible that the symptoms will not go away. Some women continue to have PMS symptoms even after hysterectomy; on the other hand many women having hysterectomy note that their PMS symptoms disappear.

In some of the few studies which have evaluated hysterectomy in PMS patients, the accuracy of the PMS diagnosis suffers from a lack of prospective calendar symptom charting. Nevertheless, hysterectomy without ovary removal seems to cure about 75% of women who have PMS (1). With well documented, refractory-to-medical-therapy PMS, removal of the ovaries along with the uterus cures close to 100% of women (2).

In other studies that look at PMS symptoms in those women who have had a hysterectomy without removing the ovaries, there seems to be a question of whether there is not some other diagnosis than PMS which is causing the symptoms.

In one study of 36 women (3) who felt they still had PMS after a hysterectomy in which the ovaries were not removed, prospective symptom charting along with hormonal assessment to detect ovulation found that:

25% had no PMS
61% had sporadic symptoms not occurring each cycle
14% had true PMS

This probably reflects the lack of consistent criteria to diagnose PMS but it also indicates that many times, hysterectomy without ovary removal is curative of PMS. The bottom line is that about 25% of the time, a woman will undergo hysterectomy for what she thinks is PMS but symptoms of some sort will still persist; 75% of the time she will feel better. As long as you understand this, you can make some choices. In general, I would suggest making sure of the accuracy of the diagnosis for which you are considering surgical therapy.

premenstrual syndrome
PMS, premenstrual dysphoric disorder, PMDD, late luteal phase dysphoria, premenstrual tension,

General description:

This syndrome refers to a complex of physical and mood symptoms that worsen in the one to two weeks prior to a woman's menses and disappear by the end of a full menstrual flow.
Behavioral symptoms commonly include:
labile mood (anger/sadness)
crying spells
social withdrawal
difficulty concentrating
Physical symptoms commonly include:
abdominal pelvic bloating
breast tenderness
acne flare up
appetite changes
food cravings
extremity swelling
stomach upset

Is it common?
About 80% of women report premenstrual emotional and physical changes. About 20-40% of these women experience difficulty with these symptoms so that there is some change in behavior that is noticeable by themselves and others. This group would be considered to have menstrual distress. Approximately 3-5% of women in the reproductive age group report a significant impact of these symptoms on work, lifestyle or relationships. This degree of severity is called premenstrual syndrome .

Some authors have tried to divide PMS into 3 severity stages: low level symptoms, PMS regular or standard symptoms (menstrual distress), and premenstrual magnification symptoms (2, 3, 4). The latter would be identified by most physicians as PMS.

Premenstrual syndrome does not occur in women before menarche (start of menses), after menopause or without ovulation. It takes ovulatory menstrual cycles to have PMS. Evidence supports the theory that premenstrual symptoms are caused primarily by changes in brain chemicals that transmit between nerves and cells (neurotransmitters) brought about by cyclical fluctuations in ovarian hormones.

An ovulatory cycle has slightly higher estrogen and massively higher progesterone levels in the two weeks before a menses than in the two weeks after a menses. There is some debate as to whether progesterone causes or relieves PMS symptoms (5, 6, 7, 8, 9), but the consensus seems to be that progesterone and synthetic progestins can cause PMS types of mood symptoms (10). Since progesterone and progestins can also relieve symptoms it seems best not to prejudge its role in the cause of PMS. It is interesting that anti progesterone drugs (RU-486) do not make the symptoms go away (11).

Studies have looked at whether the hormones in the luteal phase are at different levels in women with and without PMS. Essentially they found no differences in estrogen and progesterone levels. Cortisol, which is a stress hormone is lower in women with severe PMS symptoms but this is more likely an effect than a cause, i.e., the stress hormone has been depleted by the stress (12, 13). Thyroid hormone has been looked at and except for the about 5% incidence of hypothyroidism found in women presenting for PMS, abnormal thyroid function has not been found to be associated with premenstrual syndrome.

Differentiating features:
Mood and physical symptom questionnaires in the follicular phase (days 4-9) and the luteal phase (days 22-27) of the menstrual cycle or a prospective symptom calendar tracking 4 or more prominent symptoms is necessary to differentiate this condition from other medical and psychologic conditions which may just worsen somewhat with menstrual physiology. There should be a symptom free interval from about day 4 to day 12 of a menstrual cycle and at least a 30% higher symptom score in the last 7 days before a menstrual period. Other mental health and medical conditions need to be ruled out as underlying problems:

Mental health disorders
major depression
minor depression (dysthymia)
generalized anxiety
panic disorder
bipolar illness (mood irritability) Medical disorders
autoimmune disorders
seizure disorders
chronic fatigue syndrome
collagen vascular disease

A serum TSH to check thyroid function and a screening inventory for depression, anxiety disorder and panic disorder have the highest yield to rule out the most commonly confusing conditions.

Other features:
Painful menstrual cramps (dysmenorrhea) may present with PMS but they are not usually considered to be a part of the syndrome and probably have a different etiology. Breast soreness (mastalgia) can go along with PMS but it often occurs as a separate condition without accompanying mood problems. It is estimated that as many as 50-60% of women with the complaint of severe PMS have other medical or psychiatric conditions. Over 150 symptoms have been attributed to PMS so the symptom list can be extensive. It can even include hot flashes, heart palpitations and dizziness (1).

An ovulatory cycle has slightly higher estrogen and massively higher progesterone levels in the two weeks before a menses than in the two weeks after a menses. There is some debate as to whether progesterone causes or relieves PMS symptoms , but the consensus seems to be that progesterone and synthetic progestins can cause PMS types of mood symptoms Since progesterone and progestins can also relieve symptoms it seems best not to prejudge its role in the cause of PMS. .

Studies have looked at whether the hormones in the luteal phase are at different levels in women with and without PMS. Essentially they found no differences in estrogen and progesterone levels. Cortisol, which is a stress hormone is lower in women with severe PMS symptoms but this is more likely an effect than a cause, i.e., the stress hormone has been depleted by the stress . Thyroid hormone has been looked at and except for the about 5% incidence of hypothyroidism found in women presenting for PMS, abnormal thyroid function has not been found to be associated with premenstrual syndrome .

Unnecessary studies:
serum blood measurements of estradiol (estrogens), progesterone, or testosterone.

natural history untreated:
In the age range of 25-45, PMS symptoms develop and quickly peak within several months. After that they tend to stay at a fixed level and not progressively worsen as do some of the other medical or mental health conditions. Unless the symptoms are treated in some manner, they stay the same until menopause when the cyclicity goes away as ovulation stops.

Goals of therapy (Rx):
The main goal of treating PMS symptoms is to reduce those symptoms in intensity to the point where they do not cause difficulty with family and work relationships, they do not cause time lost from work or leisure activities, and they do not cause a woman to alter her daily activities just because of where she is in the menstrual cycle.
1st choice therapy:

After the diagnosis of PMS without underlying medical or mental health problems is confirmed, the primary treatment is lifestyle changes aimed at reducing the overall baseline stress level. This means discontinuance of all caffeine and alcohol which are known to aggravate stress states (15, 16, 17, 18), beginning a restricted diet such as a low fat, vegetarian or high complex carbohydrate diet (19), and starting a regular exercise or conditioning program (20, 21). All of these need to be instituted before additional over-the-counter or prescription treatment is begun. If prescription medication is needed, fluoxetine (Prozac®), 10-20 mg/day is effective with low side effects.

Other therapies used:
Effective non prescription treatments include:
Vitamin B-6 up to 100 mg/day (22)
Calcium 1000 mg/day (calcium carbonate)(23)
Magnesium (Mg) 200 mg/day as MgO (24)
Naproxen sodium 550 mg twice a day (eg, Alleve®)(25)
Effective prescription therapies include:
fluoxetine (Prozac®)(26) 20 mg/day
sertraline (Zoloft®)(27) 50-150 mg/day
paroxetine (Paxil®)(28, 29)10-30 mg/day
clomipramine (Anafranil®)(30, 31) 25-75 mg/day (14 days before menses)
alprazolam (Xanax®)(32, 33, 34) 0.25 mg/ 3-4 times/day (6-14 days before menses)
buspirone (Buspar®) 25-60 mg/day (12 days before menses)
GnRH agonist Lupron®(35, 36, 37) 3.75 - 7.5 mg/monthly I.M.
GnRH agonist Buserelin (38) 400-900 ug/day intranasal
propanolol (39) 20 mg/day between menses and 40 mg/day during menses Removal of both the uterus and ovaries cures PMS (40, 41) but this is generally not an option for younger women. PMS symptoms do not always return following a hysterectomy with oopherectomy for PMS if replacement hormones are given after surgery (42). By itself, hysterectomy without removing the ovaries does not cure PMS but it often decreases many of the physical symptoms to a point where a woman can tolerate the remaining cyclical symptoms. In general, 75% of women who have a hysterectomy without oophorectomy will be permanently relieved of their symptoms, while 25% will still complain of PMS.

Treatments to avoid:

Herbal treatments have not yet been shown to be effective for PMS. Progesterone efficacy has conflicting studies and since many women get mood side effects from progesterone and progestins, these are not used as treatment. For the same reason birth control pills and progesterone shots such as depomedroxyprogesterone acetate (DepoProvera®) may be used since they block ovulation, but some women have worsened symptoms on these treatments.

Premature Ovarian Failure:

What is the difference between PMS and PMDD? Learn about symptoms:

Ovarian Failure:

Hysterectomy-Leave the Ovaries-Gabe Mirkin, M.D.

PMS Symptoms after Menopause?

Hysterectomy & PMS:,00.html,,166046,00.html

FAQs about hysterectomy concerns and post operative problems:

PMS - Treatment of Premenstrual Syndrome:

PMS~ Menopause/Hormone balance:

Hysterectomy & Ovarian Health:

Support for PMS and Menopause Symptoms, After Hysterectomy:

Good Luck with finding some relief..pls keep us posted...(((hugs)))

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