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Uterus removal

Uterus removal   or hysterectomy is one of the most common operations interventions in the field of gynecology. In some diseases, alternative treatment methods are possible.While, with   Uterine cancer , in most cases, radical hysterectomy is an absolute necessity. Gynecological surgery has various techniques.   removal of the uterus . Find out more about when a hysterectomy is needed and the current implications of uterine removal.

The content of the article

  • Which specialist doctor performs the operation to remove the uterus?
  • When is the uterus removed?
  • Ways to remove the uterus
  • Performing hysterectomy
  • Possible consequences of hysterectomy

When is the uterus removed?

The operation to remove the uterus is carried out in both benign and malignant gynecological diseases. The most common causes of hysterectomy include: uterine fibroids, abnormal vaginal bleeding, endometriosis, uterine prolapse, chronic pelvic pain, and cervical cancer, uterus, fallopian (fallolievyh) tubes or ovaries.

As a rule, frequent uterine fibroids are subject to surgical intervention only if they have a negative impact on health (for example, compression of other organs, abnormal vaginal bleeding, pain, red blood cell / erythrocyte deficiency). For pain in the lower abdomen and in the pelvic region, it is necessary to undergo a full examination to identify the causes of these pains and the conclusion of the actual need for a hysterectomy .

Hysterectomy is not always the only treatment. For example, in uterine myomas, if they require treatment at all, there are a number of alternative methods for treating uterus preserving (for example, conservative therapy, uterine artery embolization ). Quite often, women are faced with a choice - a life with slight pain and discomfort or removal of the uterus / hysterectomy . Before making a final decision in favor of the removal of the uterus / hysterectomy, it is necessary, without fail, to undergo a full consultation with a specialist in the field of obstetrics and gynecology.

The reasons for the removal of the uterus, depends on the choice of method of intervention, as well as the need to remove the cervix, ovaries and uterine ( phallium ) tubes.

Ways to remove the uterus

Depending on the volume of tissue to be removed, the following types of hysterectomy are distinguished :

  • Subtotal hysterectomy , or uterus amputation - removal of the uterus with preservation of the cervix; 
  • total hysterectomy , or uterus extirpation - removal of the uterus with the neck; 
  • hysterosalpingoovarectomy - removal of the uterus with appendages (fallopian tubes and ovaries); 
  • radical hysterectomy - removal of the uterus with the neck, appendages, the upper part of the vagina, the surrounding pelvic fiber and lymph nodes;

Performing hysterectomy

According to operational access, the following types of hysterectomy are distinguished :

  • abdominal hysterectomy
  • vaginal hysterectomy 
  • laparoscopic  hysterectomy

The choice of prompt access depends on the disease, the size of the uterus and the wishes of the patient.

Total abdominal hysterectomy is one of the most frequently used methods of hysterectomy . At the same time access to the uterus is carried out by opening the abdominal cavity.When hysterectomy, the uterus is removed, but the cervix is ​​left. If necessary, the fallopian tubes and ovaries are also removed. After the main stages of the operation have been performed, the doctor sews up wounds in the abdomen. A sterile dressing is applied. The operation abdominal hysterectomy is performed under general anesthesia, that is, the patient is unconscious during the operation. The disadvantages of abdominal hysterectomy can be called a large invasiveness for a woman, the formation of a large scar on the abdomen. In the postoperative period, painkillers and antibiotics are prescribed to the patient to prevent infectious complications. In a week, stitches are removed. You can return to normal work in 2-3 weeks. 

With vaginal hysterectomy, the uterus is removed through the vagina. First, the cervix is ​​removed, and then the rest of the uterus. Usually, vaginal hysterectomy is performed in women who have given birth, since their vagina is sufficiently expanded to expel the uterus through it. The advantage of vaginal removal of the uterus is that after such an operation there are no scars. Usually, with a vaginal hysterectomy, it takes only two days to stay in the clinic. In two weeks a woman can return to her usual job. Vaginalhysterectomy is performed when all the conditions are in place - the uterus of small size, the absence of cancer and the flexibility of the vaginal walls. If the uterus is large, a vaginal hysterectomy may not always be performed, but for those who have not given birth, it is practically not performed. In addition, during vaginal hysterectomy, it is impossible to remove the ovaries, as they are located in the pelvic cavity above the uterus. 

The laparoscopic hysterectomy methods consist in the fact that the operation is performed without any large incisions in the abdomen. The whole operation is performed usinglaparoscopic equipment, when tubes are inserted into the abdominal cavity through small incisions, and through them appropriate instruments, as well as a video camera. Through a cannula inserted at the very beginning, a gas is introduced into the abdominal cavity, which raises the abdominal wall above the organs, giving the surgeon an overview and the opportunity to gain access to the uterus.

Possible consequences of hysterectomy

Possible complications of hysterectomy include the risk of attaching an infection, the formation of a hematoma, numbness of the skin in the scar area, the formation of a keloid scar (with a predisposition), and the formation of adhesions in the abdominal cavity. In addition, when the uterus is removed along with the fallopian tubes and ovaries, the woman begins menopause.

In the body, sex hormones are synthesized, which are needed not only for the function of the genital organ and the menstrual cycle, but also participate in the metabolism.Therefore, usually such patients are prescribed hormone replacement therapy (HRT).

Uterus Removal: General Information

Hysterectomy is an operation to remove the uterus. In Russia, this method is one of the most common, but its purpose is advisable in special cases: in case of multiple myomatous masses , concomitant pathology of the ovaries, endometrium, and uterine cancer. Surgical intervention can be performed in several ways:

  • abdominal uterus amputation is used for serious organ damage. Access to the uterus through the incision of the anterior abdominal wall;
  • The vaginal method involves the incision in the vagina, through which surgery is performed. With this type of hysterectomy , a laparoscope can be used that crosses the ligaments of the uterus, after which the vessels are ligated, then in exceptional cases the ovaries and uterine tubes strike.

When the uterus is removed, the postoperative period is an important stage in the treatment of a woman, which allows you to avoid complications, improve the patient's condition and quality of life. However, the classical methods of preserving women's health are replaced by modern methods of combating common diseases. With uterine myoma, the probability of organ preservation and fertility is high with the help of uterine artery embolization . You have a chance   to make an appointment   to the gynecologist and get detailed information about this method of treatment.

The first days after surgery to remove the uterus

After the surgery and removal of the uterus, the woman is placed in the hospital and is under the supervision of doctors. The duration of the early postoperative period is determined by the general condition of the patient, the type of surgical access. In the first days after surgery, significant pain in the lower abdomen is possible. During this period, the woman should minimize activity and get enough sleep, which will contribute to a quick recovery. The duration of bed rest should be no more than a week. After this time, light exercise and short walks are recommended.

The postoperative period after removal of the uterus requires the woman to maintain proper nutrition. The daily diet of patients in this period includes foods with a high content of fiber, among which lead vegetables and fruits, as well as cereals, rye bread, dairy products and soups.

Prompt bowel movement is important after surgery, since constipation can cause seams and pain to become loose. A woman should not supercool after removing an organ to prevent the development of the inflammatory process, therefore antibacterial drugs are prescribed to prevent inflammation.

Features of late rehabilitation after surgery

After amputation of the uterus, a woman should be attentive to her state of health and follow the long-term recommendations of specialists:

  • to give up hot wrappings, visits to the solarium, saunas and baths for at least a month. This measure is the prevention of relapse;
  • postpone sexual intimacy for two months after surgery;
  • Do not lift heavy objects or perform physical work, as a result of this internal seams may disperse and bleeding may occur;
  • it is forbidden to use tampons for smearing;
  • Turn out from carbonated drinks, fatty, fried foods.

Compliance with medical recommendations allows you to speed up recovery and reduce the burden on the body. Surgery to remove the uterus is a serious surgical intervention, so the woman should monitor the state of health and timely visit the gynecologist.

Surgery to remove the uterus: the consequences

The duration and scheme of rehabilitation measures are determined by the individual characteristics of the patient, the volume of intervention and the nature of postoperative complications. The consequences of the operation to remove the uterus depend on the type of intervention and many other factors. When the removal is done qualitatively, the patient has no reason to doubt the positive outcome of the rehabilitation.

In the process of any surgical intervention, various damage to the tissues and vessels occurs. After removal of the uterus, the woman should be prepared for the consequences of the intervention. So, at the initial stage of recovery, there may be a divergence of the seam, which is associated with physical activity and weight lifting. After healing of the suture with abdominal removal, an ugly scar remains on the body. The section of tissue dissemination may be inflamed, hematomas may appear on this site. Patients who are in the hospital during the first days after surgery may experience pain syndrome, at the appearance of which, doctors prescribe painkillers.

After removal of the uterus, the organism is rearranged, which results in posthysterectomy syndrome, which is similar to that observed during menopause. At this time, the patient's quality of life deteriorates. Before the operation, the doctor should warn about the possible consequences, in particular, about the possibility of the development of this syndrome. For its prophylaxis on the day after the intervention, Liviala is necessary . The drug helps to prevent premature aging of the body after removal of the body, associated with impaired blood supply to the ovaries.

Sexual life after surgery

Hysterectomy involves the removal of an important female organ of the uterus, so after surgery, the likelihood of changes in sex life is high. The data of modern studies do not allow to make an unambiguous conclusion about the relationship between removal of an organ and the quality of sex life.

After amputation of the uterus, some women note an improvement in sex life, increased attraction and the appearance of pleasure. Perhaps these changes may be due to the fact that previously, due to pain, they could not lead a full-fledged sex life. Other patients note the fact that the pleasure of sexual contact has disappeared. The process of the formation of sensations in a woman is rather complicated, so at the moment researchers cannot fully explain the effect of the intervention.

Quality of life after surgery

The postoperative period after surgery to remove the uterus in women is different. Many women are depressed because they cannot experience the joy of motherhood. In this case, the support of a qualified psychotherapist and family is important. Other patients report improvement in their condition, absence of pain, bleeding, and marked sexual desire.

Surgery to remove the uterus - reviews of patients indicate positive and negative points of the procedure. The health of a woman after surgery depends on the specific disease, psychological attitude and actions of doctors. After the operation, it is important to visit the gynecologist at least twice a year and pass the necessary tests, which will allow to make a conclusion about the state of the body.

After surgery to remove the uterus, a woman can return to her usual life without experiencing any unpleasant sensations. Removal of the uterus is important to experience psychologically, as well as during the rehabilitation period to comply with the recommendations of the gynecologist and the surgeon.

Uterine artery embolization as an alternative to uterine removal with myoma

Surgery to remove the uterus for a long time was one of the most used methods for the treatment of myoma nodes. In 1979, for the first time, uterine artery embolization was used to treat diseases of the uterus, uterine bleeding . Doctors began to use embolization for the treatment of fibroids since the beginning of the 90s.

The essence of this method is the introduction to the uterine arteries supplying the myoma, the emboli , as a result of which the blood flow through these branches stops. After cessation of blood supply, fibroid tissue is replaced by connective tissue, which leads to a significant reduction in the size of the node or its disappearance.

Embolization is performed by endovascular surgeons in specially equipped operating theaters. The procedure is performed under local anesthesia, and the patient does not experience discomfort. In the process of embolization, a woman may experience heat or a burning sensation in the lower abdomen. These sensations are explained by the action of a contrast agent used to visualize the arteries. The operation can last from 10 minutes to 2.5 hours.

Many women are concerned about whether their weight gain will occur after the procedure. Experts do not trace the relationship between weight gain and EMA. If this situation occurs, it is recommended to contact a nutritionist or psychotherapist to find the true causes.

An important advantage of uterine artery embolization is the preservation of reproductive function. Data from recent studies show that women after EMA may become pregnant and give birth to a healthy baby. Pregnancy can not occur only in the case when the inner lining of the uterus - the endometrium - is thinned. However, this can occur when using anembolization drug with small particles that blocked the small branches of the uterine vessels. Currently, these materials are not used for uterine artery embolization .

Removal of the uterus, the postoperative period after which can last up to a year, is performed with large sizes of myomas, multiple nodes. Embolization of uterine arteries in some cases can replace this method. The effectiveness of the procedure is indicated by the normalization of symptoms, reduction of nodes or their disappearance from the uterus. Uterineartery embolization is a safe method, characterized by high efficiency and preservation of the ability to give birth to children.

Six myths about life after uterus removal

How surgery affects the hormones of a woman, her libido and the quality of her sex life

The operation to remove the uterus is called a hysterectomy . Doctors   recommend   her women in menopause with some benign diseases, such as uterine myoma, with excessive and irregular bleeding during the premenopause ( if other treatment options do not help ), chronic pelvic pain or prolapse of the uterus. In addition, removal of the uterus may be necessary for precancerous conditions and cancer of the uterus, cervix and ovaries.

In countries where hysterectomy is common (USA, Mexico, Brazil), women who do not plan to become pregnant often themselves ask doctors about the possibility of performing an operation in their particular case. In Russia, patients themselves know not so much about the removal of the uterus, there are a lot of myths around this operation. Let's dispel some of them. You will learn what the consequences of hysterectomy entails , how a woman’s life changes and whether her sexual partner feels the difference.

Myth one: early menopause

By itself, hysterectomy does not involve removal of the ovaries. They continue to function normally: follicles mature, ovulation occurs, and even premenstrual syndrome is often preserved. There is only menstruation. And the climax comes as expected, at about 51 years. The exception is when the uterus is removed before the age of 35 years, then menopause may occur a few years earlier.

The decision to remove the ovaries is made separately. Such an operation is called oophorectomy , and if necessary it can be performed simultaneously with a hysterectomy . In England, The National Institute for Health and quality of health care ( National Institute  for  Health  and  Care Excellence (NICE) recommends oophorectomy if there is a significant, genetically determined risk of diseases such as ovarian cancer .   

Myth Two: Premature Aging

Hysterectomy can not accelerate aging or affect hormones, it is determined by the ovaries. When they are removed at any age, menopause occurs, estrogen production decreases. Because of this, many women experience night sweats, hot flashes, mood changes, sleep problems, and dryness in the vagina. When symptoms really interfere with life, the doctor may prescribe menopausal hormone therapy (MGT). Such treatment is perceived by many patients as protection against premature aging, but there is no scientific evidence to support this. The purpose of MGT has a number of serious contraindications, therefore it is recommended only for women for whom the benefits outweigh the risks.    

Myth three: masculinization

The opinion that a woman can grow a mustache after the uterus is removed, and her voice becomes lower and coarse is surprisingly common. This is certainly not the case. Hormonal background after hysterectomy is fully preserved, femininity, too.

Myth Four: decreased libido

Libido is not determined by the presence of the uterus. Here an important role is played by androgens, which are formed in the adrenal glands and, in small quantities, in the ovaries. Therefore, after a hysterectomy, sexual desire remains exactly the same as it was before the operation.

Myth Five: reduced quality of sex life

The quality of sexual life after hysterectomy is not reduced. And in some cases, even improved. For example, if surgery is recommended due to sprains and prolapse of the uterus, then after surgery women feel much better and more confident in sexual terms. Many polls on quality of life, in which women and their partners participated, confirm this information. Moreover, men say they did not feel any difference after the removal of the uterus from their partner. 

Myth Six: it is important to preserve the cervix

There is a myth that the cervix allows you to save the ligamentous apparatus, which supports the pelvic floor and protects the pelvic organs from falling out. Research does not confirm this. Also There is no evidence that removal of the cervix leads to a decrease in sexual function. In addition, if the uterus is removed for cancer, then maintaining the cervix increases the risk of disease progression.    

Hysterectomy is usually performed by laparoscopic method, and rehabilitation takes from two to four weeks. The only change after removal of the uterus will be the inability to have children. While preserving the ovaries, it remains possible to receive eggs, fertilize and transfer into the uterus of a surrogate mother. Nevertheless, the gynecologist should always consider alternative treatment options, for example, organ-preserving surgery on the uterus in benign tumors in young women who want to give birth to their own.