PMS: A last resort

For years Rachael Douglas has been looking for a treatment that would permanently put an end to the misery caused by her premenstrual syndrome. Now she thinks she's found one: hysterectomy

External links

www.pms.org.uk

Life as a single parent on £100 a week is hard enough. Life as a single parent on £100 and suffering from severe premenstrual syndrome (PMS) could make anyone consider the surgeon's knife. For many years I have been cursed by something that is not an illness and as such is not taken seriously, but nevertheless has left me at a disadvantage to cope with the pressure of bringing up a child by myself and holding down a job for any length of time.

Each month I spend at least two sleepless nights crying uncontrollably over nothing. On occasions I have phoned up an emergency helpline because I feel suicidal. I usually experience bad migraines back-to-back for a week. Other times I am freezing cold and feel unable to face challenging situations because I lack confidence.

Looking back I partly blame PMS for my divorce and other failed relationships. I cannot have been easy to live with as sometimes I would curl up in a ball in the corner of a room and sob for hours. My partner would say: "Do I need this?" In the end he admitted he couldn't be bothered comforting me as he couldn't see any reason for my depression. Yet the very thing I needed at that moment was an arm around me.

Work suffered as well, and I have spent the past five years in and out of the doctor's surgery asking for some miracle new cure, but every time I am told the same thing: "Most people find the pill works." I have tried the pill on several occasions and found it makes my depressions even worse.

Other sufferers have recommended a range of alternative remedies but none of them worked. Instead they cost me a great deal of money and a range of them remain on my kitchen shelf. My GP prescribed anti-depressants (not for PMS), which I think do help, but not with any consistency.

So when I was told about a permanent cure for PMS, I felt a huge sense of relief. Gynaecologists agree that radical surgery, known as the hysterectomy and bi-lateral salpingo oophorectomy (HBSO) is the only permanent cure for severe PMS. This cure involves major surgery – the removal of the uterus and ovaries. But to me it seems the only answer. I am 37 and realise the operation will leave me sterile but I have got to the point where my life is so adversely affected that the need for a permanent cure over-rides any thoughts of re-marrying or having another baby.

At first I was shocked to hear that women in their thirties are having their uterus and ovaries removed for PMS, but I was assured by the top gynaecologists I spoke to that this measure is a "last resort" when nothing else has proved to work. The operation costs around £4,000 if done privately but more often than not it is available on the NHS. However, the NHS is unlikely to sanction an operation for severe PMS if a woman is under the age of 35.

The first gynaecologist I spoke to was Professor Shaughn O'Brien, the academic head of obstetrics and gynaecology at Keele University Postgraduate Medical School who recommended that I change my anti-depressant to Prozac rather than have an operation. He told me: "Women get PMS because their brains are more sensitive to progesterone so you either make them insensitive to progesterone or do something more drastic. If someone is suffering from PMS and tried other cures unsuccessfully, then maybe you can justify having the HBSO, bearing in mind the complications having undergone major surgery."

Professor O'Brien, who is no advocate of operating on women with severe PMS, admitted: "All these treatments, such as drugs, only provide temporary relief. A full hysterectomy and removal of the ovaries is the only permanent cure. If you don't remove the ovaries, then you still have PMS." He also revealed he had performed an HBSO on a woman in her late twenties and said: "I am pro taking out the uterus and ovaries only if a woman demands it. If you are under 35, then that is a very drastic decision as you are removing the hormones 15 years early."

For most it will be necessary to take HRT for a period of some years to avoid the menopausal symptoms that will come with the removal of these hormones and to reduce the risk of developing osteoporosis (brittle bones). HRT is itself not without its risks and side effects. These may include weight gain, bloating, depression, hair loss, high blood pressure and an increased risk of breast and endometrial cancer.

Nick Panay, consultant gynaecologist at Queens Charlotte's & Chelsea Hospital says that between five and 10 per cent of women in Britain (about 800,000) "are so severely incapacitated by PMS that it dominates their life". He also says that "at a guesstimate thousands of working days are lost due to PMS in Britain alone". Panay, who is also the chairman of the National Association for Premenstrual Syndrome (NAPS) says he has increasing numbers of sufferers referred to him but adds: "I think there are a lot of women out there suffering in silence because of a lack of awareness among the medical profession."

One gynaecologist I spoke to put me in touch with a 45-year-old woman who had the operation five years ago. Clair Howells told me how she got her "life back" after years of suffering from PMS. She had suffered violent mood swings and aggression that made her feel like she "really wanted to kill people". Her suffering got worse throughout her thirties and Howells couldn't find a GP who understood what she was going through. Then she was referred to Richard Penketh, at the University Hospital Wales in Cardiff.

Penketh tried various treatments and asked her to keep a record of her symptoms for three months before gently proposing she had a hysterectomy. She was put on a test drug (gonadotrophin releasing hormone analogues, injected through the stomach) for three months to give her a temporary menopause. The result: her symptoms disappeared, proving that her aggression, mood swings and weight gain were caused by PMS. Although Clair had completed her family she felt unsure about having such radical surgery. It was another six months before she made her decision.

Penketh said that one out of every four hysterectomies he performs each month is to treat a severe case of PMS. "Sometimes you have got a situation where PMS is so bad, you really need to do something major. But afterwards most women say they are pleased with the result."

The most up-to-date method of HBSO being carried out by Penketh and other gynaecologists is done vaginally, as opposed to an abdominal or laparoscopic operation – the type used on Clair Howells. It involves just a 24-hour stay in hospital and "women are normally back at work in four to six weeks time". Following the operation, women are treated with a long course of hormone replacement therapy to treat the symptoms of an early menopause.

My thoughts on having the operation come at a time when the Royal College of Obstetricians and Gynaecologists' is raising concerns about the number of needless hysterectomies for non life-threatening problems such as heavy bleeding. In this case, the reverse is true as it seems that women are asking gynaecologists for a permanent cure and, drastic though it seems, this operation provides just that. So for women who suffer as I do and who have some way to go before they hit the menopause, I believe it is the best option.

For advice on PMS contact the NAPS helpline (01732 760012) or go via the website www.pms.org.uk