title: Hysterectomy and bilateral oophorectomy for severe premenstrual syndrome.
abstract: BACKGROUND
  Premenstrual syndrome (PMS) is a chronic, poorly understood psycho-endocrine disorder severely affecting 5%; of women. Hormonal therapy which suppresses ovulation is the mainstay of medical treatment, but these interventions are rarely permanent. We evaluated the effectiveness and patient satisfaction with total abdominal hysterectomy/bilateral salpingo-oophorectomy (TAH/BSO) in PMS sufferers, and assessed the post-operative HRT continuation.
  
  
  METHODS
  All women undergoing TAH/BSO for severe PMS between January 1994 and April 2000 were interviewed and responses recorded by structured questionnaire.
  
  
  RESULTS
  Forty-seven women were interviewed. Median age was 42 years (interquartile range 39.8-46.6) at the time of surgery. They had suffered with PMS for a mean of 9.68 years (SD 6.8) and received treatment for a mean of 3.57 years (SD 2.0) prior to referral to a gynaecologist. Fifty-two percent were treated with estradiol patches and 48% with estradiol implants prior to TAH/BSO. Ninety-six percent of women were 'satisfied' or 'very satisfied' with TAH/BSO, and 93.6% declared complete resolution of their cyclical symptoms; 93.6% were continuing with HRT usually by implants of estradiol and testosterone for a mean duration of 3.8 years (SD 1.86) post-operatively.
  
  
  CONCLUSIONS
  Despite few reports of TAH/BSO as a treatment for severe PMS, we have found surgery, coupled with appropriate HRT, to be an extremely effective and well-accepted permanent cure for PMS.
authors.affiliation: Chelsea and Westminster Hospital, London, UK. w.cronje@ic.ac.uk
authors.forename: W H
authors.initials: WH
authors.lastname: Cronje
authors.forename: A
authors.initials: A
authors.lastname: Vashisht
authors.forename: J W W
authors.initials: JW
authors.lastname: Studd
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D004343:Drug Implants; D004958:Estradiol / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007407:Interviews as Topic; D008875:Middle Aged; D010052:Ovariectomy; D017060:Patient Satisfaction; D011182:Postoperative Care; D011293:Premenstrual Syndrome / Q000503:physiopathology* / Q000601:surgery*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013739:Testosterone / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D004343:Drug Implants; D013739:Testosterone; D004958:Estradiol