Surgical Menopause, PMDD & Work

An Introduction to PMDD & Surgical Menopause

Navigating surgical menopause as a person who lived with PMDD is a fairly unique experience. 18 months in, and I’m still finding new ways to understand and support my experiences and symptoms!

But what is surgical menopause, and how did I end up here?

Over the years, I’ve worked my way through the PMDD treatment pathway and it’s been quite a journey! I can’t count the amount of things I’ve tried: therapy, oral contraceptives, SSRIs, lifestyle measures, chemical menopause – and that’s just off the top of my head. It turns out that I had to trade PMDD for menopause to get the relief that I needed.

The last line of treatment for PMDD is an oophorectomy, which is the removal of the ovaries. This removes the monthly hormone fluctuations that we PMDD folk have a severe sensitivity to. For those of us who are progesterone intolerant, a hysterectomy is also necessary: if you keep your uterus, you are required to take progesterone and that was simply not an option for me.

Surgical menopause is quite literally menopause that is a result of this surgery. People end up in surgical menopause for a variety of reasons, including cancer treatment, endometriosis, or if you’re like me, PMDD.

Now you know how I got here, here are some of the things that have helped me to navigate surgical menopause at work:

Bracing for HRT changes

As someone who is extremely sensitive to hormonal fluctuations, HRT changes can be a challenging and disruptive time for me; it always feels like I’m in the midst of PMDD again! So, how do I navigate those fluctuations at work?

I remind myself that it isn’t permanent. Studies have shown that reactions to HRT changes usually disappear within a month[1], and I’ve found that to be true for me. My oestrogen has changed a number of times over the last 18 months, and I now know that the worst of it will be over in about 2 weeks. Tracking HRT changes, and my responses to them, has been essential for me!

Once I knew that each and every HRT change would impact me, I could plan ahead. If I know I have a medication change coming up, I’ll be transparent about it. Letting the team know that I might be struggling for a while means that we’re all ready to flex as needed.

When brain fog means I can’t handle complex numbers, I either put it on hold, pass it to a colleague, or work in chunks of time with short breaks in between.

If my irritability levels are through the roof, I’m upfront with my colleagues that I’m struggling due to hormonal fluctuations and that I might need to lay low for a while. If that’s not possible, I’ll take extra breaks as needed and focus on deep breathing to try to take the edge off. Full disclosure: deep breathing doesn’t always work, but it’s worth trying for the times that it does!

Intrusive thoughts? Usually this is a sign that it’s hitting bad and, while I haven’t been a risk to myself since surgery, things can still get pretty dark and distressing when my hormones shift. I’ll share my concerns with my husband and make sure that I’m supported both at home and at work, just in case we enter risky territory. When intrusive thoughts are particularly bad, I may retreat back to my self-soothing box, which is full of things I love and soothes my senses.

Managing Symptoms

Menopause symptoms are so vast and changeable that it can be hard to identify what’s menopause and what’s not! It’s important to note that if you’re on HRT and your menopause symptoms are still debilitating and impacting your daily wellbeing, then you’re probably not on the right dose – or perhaps you aren’t properly absorbing it.

It is also worth noting that HRT requirements can differ quite drastically between someone who is entering the menopause naturally, and someone who is younger and entering the menopause surgically. Experts such as Dr Louise Newson have noted that their younger patients require higher levels of hormones to reach adequate levels; she briefly touches on this in her surgical menopause booklet.

Here are a couple of the symptoms I’ve been dealing with and how I’ve managed them at work:

Hot flushes

All hail the mighty fan that blows a gale on me daily! Though my hot flushes seem to be much better these days, they do seem to be triggered in warmer weather or on a random Thursday, when the wind simply blows in the wrong direction…

I’m fortunate enough to work from home, which means my surroundings can be totally tailored to my needs. Not everyone is in this position, but a fan is a totally reasonable adjustment that many people can consider. If a standing fan isn’t possible, a handheld mini fan can sometimes take the edge off; I also find cold drinks to be soothing and supportive!

Achy joints

I really struggle with achy joints when my oestrogen levels aren’t right. After much tracking, I now know that they’re usually the first sign that my hormones need to increase.

I’ll be honest, in my experience achy joints are not the easiest thing to accommodate at work. Painkillers don’t touch it (for me) and I can’t work from a hot bath, which is where I need to be when it’s really bad! A microwave heatpack has been an absolute life-saver for me as it can mould to my hips. A hot water bottle may do the trick, too, but if you’re office based there may be health and safety protocols that restrict the use of one. For those who prefer a hidden solution: there are sticky heat pads that can be placed on your skin – they might be worth a shot!

Finally, I want to remind you that this is my own, unique experience of living and working with PMDD and surgical menopause. We’re all different and will find different strategies to navigate challenges and changes. While I’m hopeful that this is supportive for others, I’m aware that it might not be practical, aligned or realistic for some!

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Sources

[1] https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2017.16101113