premenstrual%20dysphoric%20disorder
PREMENSTRUAL DYSPHORIC DISORDER
Premenstrual dysphoric disorder is a cyclical disorder presenting with distressing mood and behavioral symptoms that occur during the late luteal phase of the ovulatory cycle; it is a severe form of premenstrual syndrome.
It results in considerable impairment of the patient's personal functioning that occurs in approximately 5% of women of reproductive age.

Surgical Intervention

  • Considered only as a last resort when more conservative treatments have failed
  • Conduct a preoperative trial of GnRH agonist therapy to assess benefit and to ensure tolerance to hormonal therapy
  • Patients <45 years old should be counseled to use hormonal therapy after surgery 
  • Ovary-sparing endometrial ablation and hysterectomy in women with severe PMS are not recommended

Hysterectomy with Bilateral Salpingo-oophorectomy

  • May be considered if patient failed medical therapy, requires long-term GnRH agonist therapy, or has other gynecological conditions warranting surgery
  • Has been demonstrated to exert beneficial effect on mood and physical symptoms
  • Long-term Estrogen therapy must be given to prevent Estrogen deficiency symptoms

Bilateral Oophorectomy

  • Permanent invasive method which effectively abolishes symptoms
    • Progestogen requirement with any subsequent hormonal therapy regimen after surgery may again cause PMS-like symptoms
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