When I signed up for a radical hysterectomy and oophorectomy in 2019 to rid myself of PMDD once and for all, I envisioned myself strolling through life with serene hormonal equilibrium, utterly free of ovary-induced dramas. But there I was, six weeks post-op, sitting across from my surgeon, asking, “Why do I feel like I’m still on my period?”
The answer? With a shrug, he said, “Ah, your brain just hasn’t caught on yet. Give it time.” And with a certain flippancy, he prescribed Sertraline to “trick” my brain. Oh, lovely! Because surely, after surgeries, nasal sprays, injections, and some rather gnarly GnRH analogues, what I really needed was more trickery.
Now, fast-forward nearly five years, and here I am, still graced by PMDD’s presence each month, like an unwanted spectral house guest. I’ve been scanned twice for “ovarian remnants”—apparently, that’s when rogue ovary tissue might decide to go solo and produce estrogen on the sly. But no rogue tissue was found. And yet, the hormonal rhythms continue. This curious phenomenon has baffled even some very clever consultants across the UK. Enter: the mystery of the pituitary gland and the underestimated power of the brain.
The Phantom Cycle: Science, Monkeys, and My Rogue Hypothalamus
Right, here’s where I entered a very specific rabbit hole (with all due respect to my consultants). In a study with female rhesus monkeys—our distant, hormone-cycling cousins in the animal kingdom—researchers discovered that even without ovaries, these monkeys were still experiencing monthly hormone surges. Why? Because, as it turns out, the brain itself can produce a sort of “backup” estrogen called neuroestradiol. When the ovaries go MIA, the brain’s hypothalamus can pick up the slack, swooping in to provide enough estrogen to keep hormonal rhythms on track.
In lay terms, when the ovaries are gone, the hypothalamus says, “Oh, no worries, I’ve got this covered!” and starts nudging the pituitary gland to keep producing the usual reproductive hormones, as if the cycle is still on. It’s a phenomenon I’ll lovingly dub the “phantom cycle,” where we keep having hormonal ups and downs courtesy of our brain’s DIY estrogen production.
Neuroestradiol and the Pituitary: A Little Love Story
So back to those clever monkeys: in the study, scientists gave the hypothalamus a little prod with estrogen. To their surprise, this brain-made estrogen triggered GnRH (the hormone that initiates ovulation), which then nudged the pituitary to release LH and FSH. Without any ovary involvement, they maintained a hormonal “cycle,” leaving these monkeys—and, apparently, some of us in the human population—cycling despite everything.
Even more fascinating, when scientists blocked neuroestradiol, all those GnRH pulses stopped. It turns out neuroestradiol doesn’t just fill in the gaps; it actively sustains these hormonal pulses, mimicking the menstrual cycle close enough to make our bodies think the show’s still going.
Why Am I Still on the Hormone Rollercoaster?
By now, the picture is beginning to take shape. Despite the best efforts of modern medicine, my hypothalamus just won’t quit, determined to keep my pituitary firing like it’s 2018. So, while the ovaries have gone off to greener pastures, my brain has become a one-person hormonal orchestra, recreating the entire menstrual cycle—just without the physical means to carry it out.
These “phantom cycles” give us that surreal hormonal déjà vu, a kind of “Menopause Lite.” And while my consultants initially gave me a puzzled look, they’ve since taken a closer look at this phenomenon. It’s like my brain’s neuroestradiol steps in as the understudy, keeping the hormonal drama alive just when I thought I’d taken my final bow.
Managing the Aftermath: HRT to Quiet the Cycle
The fix for this hormonally haunting dilemma? Well, a bit more complex than your usual HRT plan. With the hypothalamus still busy impersonating my ovaries, it’s all about finding the right balance to keep both brain and body in line. By providing a steady dose of external estrogen, I can signal to my brain that it doesn’t need to whip up its own batch of neuroestradiol. Adding a little testosterone helps bring a sense of hormonal balance, supporting things like mood and libido, which surgical menopause often strips away.
The Bottom Line
So here I am, in medical menopause but still in the hormonal limbo of yesteryear. My pituitary and hypothalamus are on a mission, determined to keep me cycling as if they missed the “We’re done!” memo. And while I may not have all the answers, I at least have some baffled consultants and rhesus monkey data on my side. In the meantime, I’ll keep pinging my specialists with the latest brain-research findings because, if monkeys have taught us anything, it’s that the brain can be hilariously stubborn—no matter how many times the ovaries call it quits.
