This campaign was brought together by a group of women in Surgical Menopause with a history of Pre-Menstrual Dysphoric Disorder that came together through a support group, in order to support one another to help direct our own post-surgical after care and hormone management of this condition. Between us we have had to research and empower one another to advocate for ourselves. 

There is currently zero post-surgical after care given by the NHS for this condition, even though the treatment pathway of a Total Hysterectomy and Bilateral Salpingo Oopherectomy  (THBSO) or any other medical procedure that puts a woman or non-binary into a surgical menopause, which is recommended and carried out by the NHS. There are currently no specific supporting NICE guidelines in place to help health care professionals manage and support women or non-binary in surgical menopause and those who need closer management when mainstream methods of HRT fail.

There needs to be a clear distinction made between the care and management of a natural menopause, where women or non-binary still have a natural supply of hormones and one which has been surgically induced with removal of ovaries, completely eradicating their natural hormone production and storage.

Many of these women or non binary, post-surgery, end up in a crisis situation due to being so chronically hormone deficient. Unable to work, unable to function, and have a severe deterioration in both physical and mental health.  With no recognition of symptoms by healthcare professionals, no after care or support. The majority of these women or non binary are forced to seek specialist private care in order to regain any form of quality of life to manage this life-long condition. For many, private care simply is not an option.

NHS waiting lists to see a menopause specialist are at least 12-18 months, and these women and non binary genders are not prioritised, even though they have NO natural hormone production, due to the removal of their ovaries and are left in a crisis situation.

These women and non-binary require life-long effective, well managed and balanced Hormone Replacement Therapy, in order to protect their long term physical and mental health, which should be supported by the NHS.

A large proportion of 'Women's Health' IS HORMONE HEALTH. Surgical Menopause highlights the complete ignorance from the medical system surrounding the importance of balanced sex hormone replacement for overall general health and mental wellbeing. If women's hormone health was researched more thoroughly and treated in a more appropriate natural way, this would drastically reduce the need for this surgical procedure.

We need a completely different approach for a failing system, that is failing hundreds of thousands of women.

It's also important to remember that many of these women and non binary, are mothers, and the children of these women are also impacted by the deterioration of their mothers physical and mental health, due to the neglectful level of medical care they receive.

We are calling for change. To be seen and heard.

The key focus of this campaign is to ask for help and support to deliver outcomes in the following area's split into 2 parts;

1. General Surgical Menopause
2. Surgical Menopause in women or non-binary with a history of PMDD/ Hormone Sensitivity.

General Surgical Menopause Outcomes

1. To create specific NICE Guidelines for the post-surgical after care and management of 'balanced' Hormone Replacement Therapy [HRT] for women in surgical menopause, which currently there are none.
2. To acknowledge that mainstream methods of HRT are sometimes not adequate enough to relieve menopause symptoms or protect women in surgical menopause from falling into a chronic hormone deficient state. Further investigations as to why these women struggle absorbing HRT should be made. We believe the missing link here is the role in which progesterone plays to keep oestrogen receptors sensitised. Progesterone is not prescribed to women without a uterus.
3. Support in balancing the replacement of all 3 hormones: Progesterone, Testosterone and Oestrogen. Currently Progesterone is not recommended to women without a Uterus as it is seen by the mainstream medical system to only protect the uterus. Progesterone is the most dominant hormone produced by women which is neuro-protective, anti-inflammatory and protects against the risks of cancer associated with high oestrogen levels. Unopposed Oestrogen (oestrogen only HRT without progesterone) is high risk for serious health concerns in women. Women in surgical menopause should NOT be prescribed Oestrogen only HRT. Why are the many important roles of progesterone as a hormone, completely disregarded?
4. To improve awareness and education amongst healthcare professionals about the differences between a natural menopause and a surgically induced one.
5. To prioritise 'Menopause Specialist' care and referrals for women in Surgical Menopause who are suffering the severe effects of being in a chronically low hormone deficient state. It should be recognised that these women or non-binary are the most vulnerable and are HIGH RISK for both physical and mental health deterioration, leading to crisis situations.
6. For the Department of Work and Pensions to recognise the severity of symptoms caused by 'Surgical Menopause' and the length of time it can take to stabilise this condition. Financial support should be available to those most vulnerable, who have had to terminate employment due to the mental and physical deterioration caused by the surgical procedure and lack of post-surgical after care and management.
7. ANY woman or non-binary, who have been recommended this treatment pathway of THBSO, or any other surgery which results in a surgically induced menopause, where the surgery has been carried out by the NHS, should NOT have to rely on or pay for Private Care, independent research and self-advocacy, as the ONLY options to resolve the post-surgical mental and physical deterioration.
8. For GP's and other primary health care professionals to recognise the need of 'unlicensed' doses of HRT [in particular progesterone] for effective management of symptoms in women experiencing a surgically induced menopause.

Surgical Menopause in women with a history of Pre-Menstrual-Dysphoric Disorder/ Hormone Sensitivity

1. Call for a review and refresh of adequate post-operative pathways for women or non-binary with PMDD who have had a THBSO.
2. We call for an independent investigation into the RCOG Treatment Guidelines for Pre-Menstrual Syndrome. Every single treatment pathway option outlined within these guidelines has a negative effect on natural hormone production. NO thorough hormonal investigations are done on PMS/PMDD women, to assess for any chronic hormone deficiencies of the endocrine system, which could potentially be treated with Body Identical HRT, PRIOR to been put down these treatment pathways that are destined to fail. High dose body identical progesterone treatment has been used to treat this condition successfully in the past by a UK Doctor called Katharina Dalton. Cyclogest- a body identical form of progesterone is licensed to prescribe to PMDD women at high doses. Why is this not an option on the RCOG treatment guidelines for Pre-Menstrual Syndrome? Why has this successful high dose body identical progesterone treatment been abolished? And why have the positive mental and physical health benefits of progesterone been brushed under the carpet?. Further independent investigations are needed to find out why this successful treatment was abolished, and now, many women’s lives are being destroyed with unsuccessful, profit driven, treatment guidelines and options (please note that mainstream medical research on progesterone has used ‘progestins’ NOT Body Identical Progesterone. Progestins are synthetic versions of natural hormones which carry side effects and long term health risks. Body Identical Hormones do NOT. Therefore the research that has used ’Progestins’, is flawed and misleading.
3. Put a STOP to a THBSO as a treatment option for PMDD, when it is unnecessary given the evidence we have for all of the above.
4. For primary care support of regular blood testing locally to support the management of hormone balance and stability throughout the first year post surgery.
5. Further education for clinicians to adequately treat women or non-binary who have undergone a THBSO for PMDD.
6. Individualised HRT dosage and management to maintain hormone stability and balance of all 3 hormones, under a personalised healthcare approach.
7. The need for thorough investigations and research in both pre and post-operative PMDD women. 
8. We need to highlight the fact that if this condition is not managed effectively post surgically, then the surgery is deemed ineffective, causing harm. A plan for post-surgical hormone replacement management should be established and a Menopause Specialist sought to undertake this management BEFORE surgery is carried out.
9. Research into the physiological effect of Chronic Stress, Trauma and PTSD on female sex hormones to establish the link between PMDD and Chronic Hormone Deficiencies and how this influences HRT post surgery.
10. For post-surgical women with a history of PMDD to be allocated specialist psychological and holistic support as guideline care to help overcome the trauma of this life-long condition and the outcomes of surgical menopause.

Please join us in supporting our campaign for change.  Not only for us but for the future generations.

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