Treatment of Extremely Severe, Treatment-Resistant Premenstrual Syndrome
Clinical Scenario
This protocol addresses premenstrual syndrome at its most severe — cases that are extremely disabling and have not responded to prior management. For this select group, a definitive intervention pathway exists beyond standard medical approaches.
Treatment Approach (partial)
A definitive surgical approach is available for carefully selected patients with extremely severe, treatment-resistant PMS. Structured pre-operative evaluation is an essential prerequisite before surgery can be considered. The complete protocol — including the specific surgical components, the required pre-operative steps, and the hormonal management strategy — is available via the link below.
References
- When treating women with severe PMS, hysterectomy and bilateral salpingo-oophorectomy has been shown to be of benefit.
- When treating women with PMS, surgery should not be contemplated without pre-operative use of GnRH analogues as a test of cure and to ensure that HRT is tolerated.
- It is essential that adequate hormone therapy is given (including consideration of testosterone replacement) to prevent simply replacing one set of symptoms with another.