Life After Surgery for Premenstrual Dysphoric Disorder

Surgery to remove the ovaries, an oophorectomy, is a last resort for treating premenstrual dysphoric disorder (PMDD). It permanently stops female hormones from circulating and induces menopause.

Unlike menopause that occurs gradually and naturally, induced menopause is abrupt and symptoms are often sudden and intense. Induced menopause also increases the risk of a number of diseases and conditions, and even is associated with a shortened lifespan.

Hormone replacement therapy (HRT) is almost always necessary to help prevent these side effects in women whose ovaries are removed. In addition, there are ways to help minimize the side-effects of early menopause after PMDD surgery. In this article you will learn about the most important ones and how to incorporate them into your lifestyle.

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Protect Your Bones

Bone loss is an inevitable side effect of menopause. When menopause is induced at an early age, it lengthens the amount of time bone loss takes place, which means more bone than normal may be lost.

To preserve bone, keep your skeleton strong, and lower your risk of fractures, there are several measures you can take:

Exercise

Weight-bearing activities such as running, walking, and bicycling put stress on bones that induces growth. Strength-training with weights or other forms of resistance does the same. Certain yoga poses have been found to both increases and preserve bone as well.

If you aren't already exercising regularly, the onset of menopause is an important time to start.

Diet

Several vitamins and minerals are particularly important for bone health. There is some evidence increasing intake of these nutrients may help protect bones and prevent fractures.

Calcium: It's well-known calcium is important for bones. The best dietary sources of this mineral are dairy products, canned fish such as sardines and salmon with the bones, fortified fruit juices and plant-based milks, and cooked greens, especially collards.

Vitamin D: This nutrient is essential for helping the body absorb calcium. It can be hard to get enough D from foods. The best sources milk fortified with vitamin D, liver, and fatty fish such as wild mackerel, salmon, sardines, and tuna. 

Magnesium: Deficiencies of this mineral, which are common among people who eat a traditional Western diet of processed foods, have been linked to brittle bones. Foods rich in magnesium include green vegetables, nuts, seeds, whole grains, and legumes such as lentils, peas, garbanzo beans (chickpeas), soybeans, and peanuts.

Vitamin K: There are three forms of vitamin K. Each one plays a different and equally important role in bone health and there is some evidence low levels of K are linked to osteoporosis.

Among the foods that are good sources of vitamin K: green leafy vegetables, such as kale, spinach, turnip greens, collards, Swiss chard, and other leafy greens; Brussels sprouts, broccoli, cauliflower, and cabbage; fish, liver, meat, and eggs; and prunes. Fermented foods, in particular a Japanese product called natto, also are rich sources of K.


Calcium: The National Osteoporosis Foundation (NOF) says women who are no long menstruating (having periods) should get at least 1,200 milligrams (mg) of calcium per day from food and supplements, and not more than 2,000 to 2,500 mg.

Vitamin D: The NOF says people 50 and over need between 800 international units (IUs) and 1,000 IUs of vitamin D per day.

Magnesium: According to the National Institutes of Health (NIH), women 31 and older need 320 mg of magnesium per day.

Vitamin K: The NIH says females 19 and over should get 90 micrograms (mcg) of vitamin K per day.

Supplements

If you aren't able to get enough of the nutrients important to bone health in your diet, your healthcare provider may suggest you take supplements. There's some controversy around calcium supplements, however. Some studies have suggested they can reduce the risk of hip fractures, while others have found they may increase the risk.

A 2015 review of hundreds of studies found neither was true. According to more recent research, in 2019, the most effective way to use supplements to prevent bone fractures is to take vitamin D and calcium supplements together.

Because there are lots of questions about whether taking calcium, vitamin D, or other supplements will benefit bone health and, more specifically, prevent bone loss and fractures after menopause, the best strategy is to ask your healthcare provider for guidance. A nutritionist also can help you fine-tune you diet to make sure you're getting all the nutrients you need.

Recap

Surgery to remove the ovaries (oophorectomy) is a last resort treatment for premenstrual dysphoric disorder (PMDD). It induces early menopause as well as the health risks and side effects that go along with the end of menstruation. An important one is bone loss, which can be prevented with exercise and getting enough calcium, vitamin D, magnesium, and vitamin K in the diet or by taking supplements.

Watch Your Weight

It's a common belief weight gain is inevitable after menopause. This actually is not the case. Nor is it true HRT causes women to put on extra pounds.

What does happen, though, is the loss of estrogen likely causes a loss of lean body mass (muscle). Body fat also tends to shift to the waist.

Another potential cause of weight gain after menopause is insomnia and sleep loss. Getting too little sleep can put on pounds in a number of ways—by making you hungrier, increasing the number of hours you're awake when you can eat, and affecting the types of foods you eat.

If you're overweight when you have your PMDD surgery or find the pounds start creeping on afterwards, take a look at your diet, your activity level, and the amount of sleep you're getting.

Weight gain after menopause can have a serious impact on body image. In fact, depression, anxiety, mood swings, and other mental health challenges are common side effects of menopause. If you experience any of these, whatever the cause, consider mind-body practices such as meditation and yoga. You might also see a therapist. Sometimes antidepressants can help.

Take Care of Your Heart

Surgical treatment of PMDD is bad for your heart. Multiple studies have shown that women who have a bilateral oophorectomy, meaning both ovaries are removed, and go through induced menopause before age 45 are at a significantly increased risk of cardiovascular disease.

Taking estrogen can help to lower those odds, but it's also important to protect your cardiovascular health in other ways, such as maintaining a healthy weight and getting enough exercise.

If you have high blood pressure, high cholesterol ,or diabetes, it is important to talk with your healthcare provider about any changes you should make to your current treatment in light of your early menopause.

Keep Your Sex Life Going Strong

Sexual desire is controlled in large part by hormones produced by the ovaries. When they're removed, your libido may decline and you'll become less interested in sex. This can have an effect on your relationship.

It also can have an impact on the health of your vagina. Without enough estrogen, the wall of the vagina will become thin, dry, and fragile, and will lose elasticity. These side effects can make sex painful and even cause bleeding during penetration.

To deal with these issues, there are a number of vaginal moisturizers you can buy over the counter. These typically are used every two or three days. They will prevent dryness overall. You also can use a lubricant during sex.

Summary

Removal of the ovaries to treat premenstrual dysphoric disorder leads to premature menopause, which impacts health and well-being in a number of ways. Hormone-replacement therapy is always necessary to prevent serious complications of induced menopause. Other measures for managing the side effects of early menopause after surgery for PMDD include protecting bone health with exercise, diet, and, sometimes, nutrition supplements; maintaining a healthy weight; understanding heart disease risk; and dealing with vaginal changes.

Deciding on surgical management for medication-resistant PMDD is not an easy decision for many reasons. Surgery provides relief for this reproductive mood disorder but it puts you into menopause many years before the normal time. For sure, getting out from under the debilitating symptoms of PMDD will help you take better care of your overall health and wellness. Combining a healthy lifestyle and estrogen replacement will help you to live well after the surgical management of PMDD.

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