Consequences of removal of uterine fibroids. Removal of the uterus for fibroids: a rescue operation or an unnecessary surgical intervention? Is surgery to remove fibroids dangerous?

Are uterine fibroids removed independently or together with the uterus?

Uterine fibroids are a disease of the female reproductive system that occurs against the background of hormonal imbalances. This pathology is localized in the uterus and has many manifestations. The symptoms of this disease bring inconvenience and discomfort in a woman’s life. In addition, at a young age, uterine fibroids can cause infertility. Many women, when diagnosing the disease, have a question: “Is the uterus removed for fibroids?” If minor fibroid nodes are identified, hormonal therapy or conservative myomectomy may be prescribed. Is it possible to remove fibroids without removing the uterus and then get pregnant? Undoubtedly, conservative myomectomy is one of the methods of treating such conditions as infertility.

Removing fibroids while preserving the uterus is better for the body, since this organ is the point of application for ovarian hormones.

Hysterectomy of the uterus with fibroids

Removal of fibroids along with the uterus is mainly recommended for large and gigantic fibroid nodes.

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Service name	Price
Promotion! Initial consultation with a fertility specialist and ultrasound	0 rub.
Repeated consultation with a fertility specialist	1,900 rub.
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Hysteroscopy	RUB 22,550
Ultrasound gynecological expert	RUB 3,080
Therapeutic and diagnostic laparoscopy (difficulty category 1)	65,500 rub.
Therapeutic and diagnostic laparoscopy (difficulty category 2)	RUB 82,200
Program "Women's Health after 40"	RUB 31,770

In what cases are uterine fibroids removed?

If uterine fibroids have a symptomatic course, rapid growth, or put pressure on adjacent organs, disrupting their functioning, then this is an indication for conservative myomectomy. After removal of uterine fibroids, a histological examination is mandatory, which confirms or refutes malignant growth in this tumor.

The radical method for surgical treatment of uterine fibroids is called hysterectomy. Like all treatment methods, removal of fibroids from the uterus is carried out according to indications.

And it also has contraindications for this operation.

Surgery to remove the uterus for fibroids: indications for choosing such tactics for patient management.

The question often arises: is it necessary to remove uterine fibroids? In some cases this is a necessity.

Indications for removal of the uterus for fibroids:

• Against the background of the development of uterine fibroids, there is a significant deterioration in the woman’s general condition;
• For myomatous nodes that have reached large sizes more than 14 weeks of pregnancy. Removing large fibroids without removing the uterus may simply be impossible;
• Severe pain syndrome, difficult to relieve with painkillers;
• Frequent bleeding leading to chronic iron deficiency anemia;
• Multiple uterine fibroids. If the question is whether it is necessary to remove the uterus for fibroids with many nodes, then this answer is definitely positive;
• Uterine prolapse with gigantic tumor size;
• With the development of necrosis, as a result of twisting of the leg;
• In case of relapses of fibroids;
• If the functioning of neighboring organs is disrupted, resulting from compression of them by the large size of the fibroids;
• In cases where previous treatments have not had a positive effect;
• Confirmation of malignant degeneration of the myomatous node.

Removal of the uterus due to fibroids is contraindicated in the following cases:

• In case of contraindications from other body systems;
• In the presence of an acute phase of an infectious or inflammatory process;
• In case of exacerbation of existing chronic diseases;
• In cases where uterine fibroids are diagnosed in a nulliparous woman. In this case, removal of large fibroids while preserving the uterus is indicated.

Methods for removing the uterus for fibroids

How to remove the uterus for fibroids:

• Subtotal hysterectomy, or supravaginal amputation as it is called, the uterus is removed while maintaining the integrity of the cervix, that is, the cervix remains with the body of the uterus after removal of the fibroids;
• Total hysterectomy (hysterectomy) involves removing the uterus and cervix. Undoubtedly, in people of reproductive age there are certain consequences of removing fibroids along with the uterus;
• Hydrosalpingo-oophorectomy involves removing the uterus with the cervix, ovaries and fallopian tubes.

Removal of fibroids from the uterus is carried out using several methods. To access the uterus, the vaginal, abdominal and laparoscopic methods are used.

With the vaginal approach, the uterus is removed through an incision in the upper area of ​​the vagina. After all stages of cutting off the uterus, it is removed through a small incision in the vagina. This method is used for subtotal hysterectomy.

The laparoscopic method is used for total and subtotal hysterectomy. Through small punctures in the abdominal cavity, under the control of a laparoscope, the uterus is cut off, the vessels are compressed and removal also occurs through the vagina.

In the case when fibroids are removed along with the uterus and its appendages, it is more advisable to use the abdominal approach. With this approach, a large incision is made in the abdominal wall, which allows for extensive access and visualization, and removal of large volumes.

What are the consequences of removing the uterus for fibroids: the consequences of removing the uterus for fibroids for a woman

Removing fibroids without removing the uterus allows a woman to perform her reproductive function, that is, to bear and give birth to a child.

Like all operations, removal of the uterus in the postoperative period may result in complications. These include the development of a hematoma, as well as the possible addition of an infection. This mainly happens when recommendations are not followed. Long-term consequences of hysterectomy include posthysterectomy syndrome. This condition occurs only if hydrosalpingo-oophorectomy of uterine fibroids was performed. After removal of the uterus and ovaries, a woman’s body stops producing hormones that control the functions of the uterus. A woman develops estrogen deficiency. It has been proven that the younger the patient is, the earlier she develops symptoms of posthysterectomy syndrome.

Sufficiently low levels of the hormone estrogen increase the risk of developing cardiovascular diseases. In older women, namely after 45 years, the risk of developing a heart attack increases after removal of the uterus. They are also more susceptible to high blood pressure, which can lead to strokes.

Consequences of surgery to remove the uterus for fibroids for the body as a whole

According to some reports, after medical research it was proven that the incidence of cancer of the thyroid gland, as well as the mammary glands and liver, is significantly higher in women who have undergone hysterectomy.

Against the background of changes in hormonal levels after removal of the uterus, a woman faces symptoms of postmenopause. She is worried about insomnia, the woman complains of depression. Throughout the day she feels so-called “hot flashes”.

After a woman has had her uterus or uterus and appendages removed, changes occur in the body that are associated with calcium metabolism. When this metabolic disorder occurs, an increased risk of fractures develops due to the fragility and brittleness of bones.

After removal of the uterus, a woman’s body undergoes changes in the genitourinary system. The most common manifestation of this syndrome is vaginal dryness. This brings discomfort and inconvenience during sexual intercourse, creating pain.

In addition, after the operation, the elasticity of the vaginal walls is impaired, which often leads to their prolapse. This entails a number of other problems, such as urinary incontinence.

Signs of metabolic syndrome also occur after hysterectomy. This manifests itself in endocrine disorders, namely the development of arterial hypertension and excess body weight.

All of these manifestations can be avoided with properly selected hormone replacement therapy and performing exercises aimed at strengthening the pelvic floor muscles. But still, most women have a question: “After removal of the uterus, can there be fibroids?” The answer to this question is clear: No! Since the source of pathological tissue growth has been removed.

Hysterectomy is a common operation that involves removing the uterus and is performed for certain indications. This is usually experienced by women after 45 years of age. Especially those who have lived with fibroids for many years.

Hysterectomy and panhysterectomy

Before the intervention, enteroscopy and hysteroscopy are performed, during which the uterine cavity is examined and then all manipulations are performed to eliminate it.

Hysterescomy is performed through laparoscopic openings and by open surgery. In the first case, the uterus is removed through the vagina with 1 cm long incisions, and a blind sac is formed. General anesthesia is given. The stitches are not removed, the woman is on sick leave for 14 days.

Extirpation of the uterus without appendages on the operating table (open surgery) extends sick leave to 1.5 months. Excision is carried out horizontally, in the future the scar is noticeable.

The second option involves removing the uterus through the abdominal wall (laparoscopy). General anesthesia is also given. The woman stays in the clinic for 2-3 days, with sick leave for a month. The stitches are removed after a certain time.

Pfannenstiel laparotomy is also considered a common way to approach the uterus. The laparotomy procedure is considered an open method, involving an incision in the peritoneum.

Panhysterectomy, what is it and how is it done, you can learn about it from your doctor. During the operation, not only the uterus is removed, but also the ovaries and appendages. Such radical manipulation changes a woman’s life.

Complete rehabilitation is 2 weeks. Extirpation of appendages can significantly change your lifestyle for the worse in sexual terms. During Wertheim's operation, the greater omentum, or part of it, is removed.

Supravaginal amputation of the uterus is also performed, which involves removing the organ while preserving the cervix. In the process, lymph is disrupted. The basic tactics of the procedure are no different from the above. According to Wertheim, they are excised in almost all open operations.

Often one ovary is amputated in the pelvic area without touching the fallopian tubes. This is due to the presence of such a growth as a borderline tumor. Removing one ovary does not lead to significant changes. Fertility is preserved; you can get pregnant both naturally and with the help of IVF. The main thing is to prevent polycystic disease. The reasons for such an operation are extensive. Among them are cysts and cancer. Every woman needs a correct diagnosis.

It is also noted that it is possible to remove the uterine cavity during menstruation, but taking into account the current condition of the woman and the general results of the tests. During a caesarean section, the uterine cavity can also be removed if during such a birth there is a partial rupture or ruptures on its own. The fetus is extracted using a vacuum.

If there are no emergency prohibitions on the procedure, then a subtotal hysterectomy will take place. Contraindications – inflammatory processes, acute respiratory infections, infections of the cervix and vagina.

Removal of the uterus for fibroids

The hysterectomy procedure for fibroids 100% prevents the development of relapse, but here the inability to give birth to a child is at stake. For this reason, surgery is prescribed for those women who have already reached menopause.

A medical procedure for extirpation is prescribed in such cases as:

• Large fibroids (comparable to a 3-month pregnancy).
• Pronounced tumor clinic.
• Myoma together with uterine prolapse.
• Sumbucous fibroid with bleeding.
• Presence of a tumor on the leg.
• Traces of degeneration of fibroids into cancer.
• Pressure from the growth on nearby organs.
• Development of fibroids on the cervix.

Such an operation, when the fibroid is removed along with the uterus, is the worst development of the disease. They resort to surgery if other treatments have not produced any results.

After the procedure, you need to adjust your diet, lifestyle, and review the amount of physical activity.

If hysterectomy does happen after 40 years, despair is the last thing. After the operation, it is necessary to change your lifestyle and be more attentive to your health, to prevent the development of a cyst. In old age, after fibroids are eliminated, granulation takes longer.

Consequences after hysterectomy

After a hysterectomy is performed, a woman forgets about bleeding, pain, “movements” of organs, and a serious condition before menstruation.

When the organ is removed, a uterine stump remains, which means that some endometrium is still present. In this case, there will be cleaning, after which the tissue will be sent for analysis (histology). This means that there will be discharge and this is the norm.

The histology result will show the presence of malignant cells.

If endometriosis occurs during the recovery period, recovery will be delayed. Ablation may be used due to a disease such as adenomyosis.

A woman does not always discuss issues concerning her life and health with a doctor. The fair sex cares about their appearance, sexual relationships and quality of life in general. Not surprisingly, menstruation occurs after surgery. This is due to incomplete removal of the organ. It’s all due to hormonal imbalance and cavity remnants.

The consequences of the operation are quite obvious - the woman will no longer be able to give birth.

In addition, the organs in the pelvis will move slightly. If the procedure is done in a timely manner, the woman quickly comes to her senses and lives a normal life. In any case, it is important to monitor your health and be attentive to every little detail.

If you experience painful spasms in the peritoneal area or bleeding, you should consult a doctor as an emergency. No matter how many months have passed since surgery, you need to understand that this is a big risk.

Symptoms that may occur after hysterectomy surgery include:

• Painful cramps (back, lower abdomen). This is due to slow scarring of the incision or the formation of adhesions. It hurts to go to the toilet, the lower abdomen hurts both constantly and in surges.
• Hematoma. May occur on the abdomen after an open removal procedure.
• Discharge. The ichor comes out. A sign that the ovaries continue to work, and the cervix is ​​under pressure from sex hormones. Developed thrush indicates an infection; a doctor’s help is needed.
• Breast. It may swell and ache. The mammary glands are also subject to diagnosis.
• Temperature. It may increase slightly. Usually on the first day. At this time you need to be under the supervision of doctors.
• Bleeding. In some cases it can last for several weeks. If blood loss is already significant, there is a reason to consult a specialist.
• Cystitis. A burning sensation in the perineum when urinating is not uncommon. This cannot be called a disease, since the condition passes quickly.

If a woman is diagnosed with cervical cancer (oncology), they resort to radiation therapy, after which hair falls out.

Radio irradiation cannot be the only treatment, so the course of medication must be completed. Having completed therapy, the woman needs peace and competent care. There are many contraindications, but there are also many advantages. Irradiation is one of the most unpleasant disadvantages of therapy; hair loss is often observed.

Nutrition for oncology should be selected by a doctor. If metastases are started, chemotherapy begins.

Total hysterectomy is rarely performed and requires serious reasons (cancer, large tumor).

Pericultitis may also occur, especially after 60 years of age, which can be successfully treated with Trichopolum and similar drugs. In any case, you need to consult a doctor and undergo tests.

Complications after removal

There are some complications, if they develop, you need to immediately go to the doctor or call an ambulance.

We are talking about conditions such as:

• Heavy bleeding.
• Festering stitches.
• Inflammation in the perineum (lymph nodes).
• Intense pain.
• Disturbed urination.
• Redness in the lower leg area (development of blood clots).

All complications after removal of the uterus are caused by physiological processes, since the functioning of the bladder and intestines is disrupted. Typically, the pelvic floor muscles become weak and cannot support the vagina as they once did. For this reason, Kegel strengthening exercises or vaginal tightening procedures are recommended after a hysterectomy procedure.

Resection of the uterus is a generally safe and fairly common operation, but after the procedure, urinary incontinence, vaginal prolapse and hemorrhoids, bladder prolapse, fistula formation, and regular pain may occur.

Late complications are cultitis and mastopathy. Usually appears 30 days after the procedure to remove the organ. Accompanied by pain (joints) and discharge.

Lymphocyst is a terrible complication. It is diagnosed at stage 3, so treatment is long, sometimes without results.

Only the attending physician can give a prognosis after examination and consultation.

Most patients are frightened by such a procedure, so they deliberately delay the removal process. It is important to understand that ignoring the problem will not solve the problem, but will only worsen the consequences after surgery.

Intimate life and sex

If the uterus was amputated without removing the ovaries, then the hormonal system does not fail. Consequently, libido remains as before, and sensations during sex are similar to previous ones. Intimate life will be normal.

When the uterus and ovaries are removed, the desire may fade a little or disappear. Everything will be restored later, when the course of drugs is completed.

Sexual life after removal of the uterus usually does not change, the only difference is the ability to feel arousal. With any gynecological pathology, the arousal function is impaired. As a rule, this is temporary.

An examination by a gynecologist should take place one month after extirpation. The doctor will evaluate the internal condition of the vagina and make recommendations.

It is possible that the first time you have sex will be uncomfortable. There is no need to be afraid of this, because over time it will return to normal.

The organ inside is removed, the clitoris remains. Therefore, a man should carefully and slowly relax his partner so that she does not feel pain.

Menopause after hysterectomy

Menopause in women that occurs after a hysterectomy is considered a long-term consequence. It must be remembered that if the uterus is removed without appendages, then menopause will occur as it should be genetically.

According to statistics, it turns out that menopause after surgery will occur 5 years earlier than expected.

There is no specific justification for this phenomenon, but it is believed that the blood supply to the ovaries after the removal of the organ begins to malfunction, and this affects the hormonal system.

To understand the problems of menopause, it is important to know the terms that doctors use.

• Natural menopause(cessation of menstrual cycles due to fading of the functioning of the gonads).
• Artificial menopause(cessation of menstruation due to removal of the uterus or suppression of ovarian function with the help of hormonal drugs Remens).
• Surgical menopause(Removal of ovaries and uterus).

The onset of surgical menopause is difficult to bear. This is caused by the inability of the ovaries to produce hormones. As a rule, the process of reducing hormones lasts several years.

When the uterus and appendages are removed, the body undergoes global changes. The consequences will be more serious if the woman could still give birth.

Symptoms of this menopause are noticeable a couple of weeks after surgery. First of all, hot flashes and sweating are of concern. They are followed by emotional lability and changes in appearance (withering skin, brittle nails). There is urinary incontinence and vaginal dryness. Bladder problems are a complaint of many.

If the uterus and ovaries are removed, then hormone therapy takes place. This is especially true for young women under 50 years of age. Estrogens (Divigel) and gestogens are usually prescribed.

It happens that the cavity is removed due to the development of large fibroids, then the woman must take not only pills, but suppositories with pills.

Hysterectomy with appendages performed against the background of endometriosis requires treatment with estrogen. As a rule, taking medications begins 30-60 days after the procedure. Hormone therapy reduces the risk of heart pathologies and osteoporosis.

But it is worth taking into account individual characteristics; such treatment is not prescribed for everyone. You should not start taking medications if you have:

• Breast cancer.
• Surgery (uterine or cervical cancer).
• Thrombophlebitis.
• Pathology of the kidneys and liver.
• Meningioma.

Treatment with HRT lasts for a long time - from two to five years. For example, with the drugs Femiton Feminorm, Femoston.

You should not expect rapid improvement during postmenopause and the disappearance of climatic manifestations.

Adhesions after surgery

Any operation on the abdominal cavity and within it is accompanied by the development of adhesions. Adhesions after surgery to remove the uterus are cords that connect the peritoneum and internal organs. They are also located between the organs inside.

After a hysterectomy, about 90% of the female population experiences a similar condition, the cause is unknown.

The process of development of adhesions after removal of the uterus depends on several factors:

• Duration of the procedure.
• Volume of operation.
• Loss of blood (leakage, bleeding).
• Development of infection after surgery.
• Genetics.
• Asthenic physique.

If after the operation you feel pain, aching in the lower back, difficulty urinating and constipation, then it is likely that this is a signal of adhesions.

To prevent their occurrence, antibiotics, anticoagulants, and physiotherapy are prescribed. Rehabilitation must be arranged competently; this is the only way to avoid unpleasant consequences.

Treatment after surgery

Antibacterial therapy is prescribed mainly for prevention, since the organs have had contact with air. This means that infectious agents could get inside. The course of treatment is a week.

Anticoagulants are allowed in the first days after surgery. They are able to thin the blood, protect against the formation of blood clots and the development of thrombophlebitis. Intravenous medication is given on the first day after surgery. This replenishes blood loss.

HRT with the uterus and ovaries removed is important for a woman. The drugs will help normalize imbalances and support the body. Hormone replacement therapy is important, otherwise the system will fail extensively, after which all body functions will fail.

If after removal of the uterus the condition does not worsen and no symptoms appear, then the postoperative period is considered easy. You can judge further consequences by the first week. Without an ovary in the first 3 days after the procedure it will be more difficult than with the removal of one uterus.

After amputation of the uterus, you need to take painkillers.

Recovery period

Postoperative replacement therapy is aimed at restoring water balance and preventing inflammation.

The support of the patient is important, so you need to pay attention to the psychological aspect. Any operation brings stress to the body, and intervention in gynecology is a serious shock.

A woman must adhere to a diet - do not eat foods that irritate the mucous membranes.

It is necessary to remove from the menu such drinks and food as:

• Chocolate.
• Cottage cheese.
• White bread.

To get your intestines back on track, you should eat often, but in small portions. Water consumption – up to 4 liters per day.

It is allowed and approved to eat porridge and drink meat broths. The main thing is to stick to the diet that the doctor prescribed for the first days after discharge.

During the rehabilitation period after surgery to remove the uterus and ovaries, you should not put stress on the body. You cannot lift more than 5 kg. Physical exercises and gymnastics are allowed to be performed only after the stitches have completely healed.

Most doctors advise after surgery (on the 3rd day) to get up and slowly walk if your legs don’t hurt. Such a load will speed up the blood, and recovery will go faster. In addition, 30 days after abdominal surgery it is allowed to pump up the press.

A hysterectomy often changes a woman's lifestyle.

For a quick and successful recovery, experts recommend:

1. If the course of the postoperative period is smooth, you need to continue to engage in prevention aimed at the occurrence of long-term consequences, then changes in the body will be minimal.
2. Bandage. Is a good help. Women whose abdominal muscles are weakened even without surgery should wear a bandage. There is more than one type of corsets of this type. You need to choose the one with less discomfort. The main thing is that the width of the “accessory” should be 1 cm above and below the scar.
   
3. Sex after hysterectomy. It is better to refrain from intimacy. Your doctor will tell you when you can have sex. Each woman is individual, and sexual life begins when the patient herself feels it. If you left the ovaries, then you don’t have to worry about libido. Sexual rest is necessary for a long time. When intimacy begins, you need to protect yourself so as not to introduce a new infection.
4. gravity. Until the seam is healed, you should not lift weights exceeding 5 kg. This is fraught with suture divergence and repeated visits to doctors. The doctor's testimony must be taken into account from beginning to end.
5. Discharge. After removal of the uterus, they will last 1-1.5 months. During this period, it is advisable not to lift anything heavier than a plate, otherwise there is a high risk of bleeding inside the peritoneum. Hygiene must be maintained.
6. Gymnastics and exercises. To strengthen the vaginal muscles, you should perform exercises using a special exercise machine (perineal gauge). It is this that provides the effect of intimate gymnastics. It is also recommended to perform Kegel movements, which are also aimed at strengthening the vaginal muscles.
7. Sport. This means yoga, Pilates, shaping, swimming, fitness. You can think about classes only after 90 days from surgery. And then provided that there were no complications. You can play sports, but only light physical activity. If you want to spin a hoop, you definitely need to talk to a doctor.
   
8. After a hysterectomy, for 60 days you cannot take baths, use tampons, douche, go to a sauna or bathhouse, or swim. If there is any discharge, you should use pads exclusively.
9. Nutrition. A proper diet is important after surgery. To prevent constipation and bloating, you need fluid and fiber. These are vegetables and fruits in any form. You cannot drink strong tea or coffee drinks. Alcohol is strictly prohibited; it also has the ability to provoke bleeding. A woman should receive the bulk of her calories before lunch. You should also remove fatty, smoked and fried foods from the menu. Vitamins and regimen are required.
10. Sick leave. The average period of incapacity for work is 40-45 days. This is relevant if not, and there were no complications. If they are available, the sick leave is extended. During this period, at least 2 ultrasounds should be done. Doctor's supervision is required.
11. A tan. You shouldn't hide from the sun, but it's not recommended to sunbathe on purpose. You can go to the sea, but you shouldn’t swim, it’s better to walk along the shore. A trip to a sanatorium, where the woman will be provided with a therapeutic massage, will be told what prevention against complications is, and, if necessary, will be given compression stockings, will not hurt.

Forecast

Many people do not know that a hysterectomy is a cause of disability. This depends on the extent of the procedure, the reason for removal and any complications encountered.

It happens that a disability group is assigned, but only for 1 year. If you want to extend it, most likely there will be a refusal. There are no options for lifelong disability for this operation.

Removal of the uterus with fibroids occurs more often in late reproductive age, but is also possible in young women 25-35 years old. This creates a state of artificial early menopause, which occurs with symptoms reminiscent of physiological menopause.

Fibromyoma, leiomyoma, myoma are names of the same disease, which is a benign tumor of the muscle tissue of the uterus. It can grow closer to the internal cavity and form nodes on the leg, located in the thickness of the muscles or closer to the outer surface of the uterus.

Benignity means that the cellular structure of the tumor does not differ from healthy tissue and is not capable of spreading metastases to other organs. Removal of the uterus with fibroids leads to relief from the disease, but creates another pathological condition.

Indications for surgery

For young women who want to have children, they try to carry out organ-preserving operations - remove the myomatous node itself or get rid of it by ligating the supplying vessels. Sometimes hysterectomy cannot be avoided. There are clear indications for this:

1. Uterine size over 14-16 weeks of pregnancy often accompanied by compression of neighboring organs and a significant increase in the abdomen. Also in large nodes the blood supply is disrupted and necrosis develops. To avoid such consequences, fibroids are disposed of within the specified time frame.
2. Rapid tumor growth. This is considered to be an increase in the size of the node by 4 weeks of pregnancy per year. In this case, the development of sarcoma is suspected - a tumor with malignant growth.
3. Growth of fibroids in postmenopause. This is an unfavorable symptom, because During this period, hormonal stimulation by estrogen normally stops and the tumor should undergo reverse development.
4. Cervical node growth. This tumor is accompanied by severe pain, difficulty urinating and defecating.
5. Node power failure– an acute condition in which cells die and disintegrate. This is accompanied by acute pain and requires emergency intervention.
6. Changes in the functioning of neighboring organs– bladder and intestines when compressed by a tumor.
7. Frequent heavy bleeding during menstruation and between them lead to the development of severe anemia and exhaust the woman.
8. Ineffectiveness of hormonal treatment, which did not lead to a reduction in lesions.

Peculiarities

At a young age, in nulliparous patients who plan to have children, they try to preserve the organ and remove only the nodes. If such women have to have their uterus removed, the consequences of the operation are more difficult to bear than those who are approaching natural menopause.

The operation is easier to tolerate at a young age, when the number of concomitant diseases is minimal.

Methods

Surgery to remove the uterus is called a hysterectomy.

You can approach the organ abdominally - through the opened abdominal wall, or vaginally, without leaving any incisions on the abdomen. In the first option, two methods of operation are used.

1. Laparotomy. It is performed under general anesthesia. This method is used for large fibroids and suspected tumors of poor quality. This access is convenient for the operating doctor and allows you to examine the ovaries. The operation itself is more difficult to tolerate; intervention in the abdominal cavity often leads to the development of adhesions.
2. Laparoscopy- This is an intervention using a video camera - a laparoscope. Several punctures are made in the skin of the abdomen, through which guide tubes for instruments and a video camera are inserted. The method is suitable for small tumors. Recovery time after surgery is reduced, complications develop less frequently.
3. Vaginal access used for small tumors. The entire operation takes place through the vagina, but with this method the cervix is ​​always removed. This method is used in women who have given birth.

If the cervix is ​​not changed, then they try to preserve it; it participates in the formation of the ligamentous apparatus of the small pelvis. Removing the cervix leads to a narrowing of the vagina, which can affect the quality of sexual life.

After a hysterectomy, the ovaries continue to function as before. But the risk of developing tumors in them increases. Therefore, one ovary is removed to reduce risks, but the second is left for women who have not reached menopause.

This helps ensure the necessary hormonal levels. Over time, due to decreased blood flow in the pelvis, the remaining ovary regresses, as during natural menopause.

How abdominal surgery is performed is shown in this video:

Rehabilitation

The length of hospital stay depends on the type of surgery. If a laparotomy was performed, you can be discharged in good condition after 7-10 days of stay. After laparoscopy, it is possible to go home on the 3rd day after the intervention.

To avoid thrombosis, the legs are bandaged with elastic bandages or compression stockings are worn. They continue to be worn after surgery for a week to a month. Getting out of bed early helps restore normal blood flow in the extremities and helps intestinal function.

In the first few hours after coming out of anesthesia, it is important to urinate. This will indicate that the functioning of the kidneys and bladder is not impaired. Defecation is expected on the 3rd day; if there is no defecation, a laxative (castor oil, lactulose) is given.

Prevention of thrombosis is carried out with low doses of aspirin. It is often recommended to take it for a month after returning home. Women with concomitant heart pathology, atherosclerosis, and varicose veins may need to take aspirin for life.

After surgery you cannot:

• lift weights;
• 2 months of exercise;
• sunbathe in the sun and in a solarium;
• go to the sauna, bathhouse, take hot baths.

Rehabilitation is carried out using physiotherapy methods:

• electrotherapy;
• laser therapy;
• hyperbaric oxygen therapy;
• acupuncture;
• hydrotherapy.

Sex life

You can return to sexual activity no earlier than after 1-1.5 months. During this period, the internal sutures will completely heal, and the organs will return to their usual location. Technically, a woman can have sex and experience pleasure, but artificial menopause can lead to decreased libido and vaginal dryness due to a lack of estrogen.

This can be eliminated by using lubricants and hormonal therapy prescribed by a doctor.

Further treatment

Hysterectomy with ovarian preservation leads to the development of symptoms that resemble menopause. They can develop immediately after surgery or in the late period - from 1 month to a year.

Treatment is hormone replacement therapy (HRT). The doctor selects the most suitable drug. Self-medication in this case is unacceptable.

Monopreparations containing only estrogens. Their use is permitted only in case of hysterectomy. They are not suitable for treating natural menopause because they promote the development of tumors.

1. Gynodian depot can be used immediately after surgery. The drug is administered intramuscularly, which quickly achieves the required concentration of estrogen. The effect lasts up to 4-6 weeks.
2. Klimara patch can be used after the previous drug. Glue it once every 7 days, each time in a new place. It ensures the gradual entry of estrogens through the skin, which maintains their concentration in the blood.
3. Divigel– a preparation for local use. Apply 1 g of gel once a day to clean, dry skin of the abdomen, shoulders, lower back, and buttocks. The application location changes daily. Then wait for it to dry. The skin should not be wetted for an hour so as not to wash off the active substance.

Combination drugs contain estrogens and gestagens. Their use is acceptable after eliminating the severe symptoms of posthysterectomy syndrome.

1. Femoston contains two hormonal components, the dosages of which are selected to simulate the natural hormonal cycle. 1 tablet is taken once a day at the same time. There is no break between cycles.
2. Klimonorm also contains two hormones and valerian extract. The package contains 21 tablets, which are taken at one time. After finishing, take a 7-day break and resume taking it.
3. Trisequence Prescribe 1 tablet per day continuously.
4. Livial contains additional androgens. Prevents the production of gonadotropins, which stimulate the synthesis of sex hormones, reduces bone loss, and increases libido. Take the drug strictly one tablet at a time, moving according to the arrows.

Treatment is continued for 3-6 months until the symptoms of hysterectomy disappear. After this, the ovary begins to work. In severe forms of hysterectomy syndrome, long-term HRT is required, which is stopped one year before the age of natural onset of menopause. This age is approximately after 50 years, the period is set individually by the doctor.

Additionally, osteoporosis is prevented by taking calcium supplements. To treat anemia, iron is used - Totema, Sorbifer, Maltofer, Ferronal.

Life without an organ

In the first time after surgery, pain is possible, which is eliminated by taking analgesics. In the future, persistence of pain may indicate the development of adhesions. Psychological trauma after organ removal, especially at a young age, leads to the development of neuroses, which is aggravated by hormonal imbalance. In such cases, the help of a psychotherapist is sometimes required.

If a woman did not plan to have more children, then a hysterectomy makes it possible not to worry about contraception. Sex life does not suffer.

But metabolic, neurovegetative and emotional disorders develop regardless of a woman’s desire.

How does this happen

Removal of the uterus entails a decrease in blood supply to the ovaries and their ischemia. Restoration of blood flow to an adequate level occurs within a year. Until this happens, atrophy develops, ovulation does not occur, and hormone production decreases.

Estrogen receptors are located in the vaginal mucosa, skin, bones, intestines and adipose tissue. Therefore, they are the ones who suffer from the lack of:

• the skin becomes dry and flabby, wrinkles appear;
• vaginal dryness;
• osteoporosis develops in the bones;
• the intestines are subject to the development of constipation;
• the mass of adipose tissue increases.

Through a feedback mechanism, gonadotropic hormones continue to intensely stimulate the ovaries, but they are unable to produce the required amount of estrogen. At the same time, the production of neurotransmitters, which affect the function of blood vessels, the respiratory system, and the psycho-emotional background, decreases.

Mood instability and tearfulness appear. Vascular reactions manifest themselves in the form of hot flashes, redness of the facial skin, sweating, and chills. Sometimes I suffer from shortness of breath and palpitations.

Health problems

1. Arterial hypertension develops under the influence of a decrease in dopamine in the hypothalamus and impaired vascular reactions. For treatment, antihypertensive drugs are taken for life, which are selected individually. It is also important to follow a diet.
2. Hyperthermia occurs after spasm of blood vessels in the hypothalamic structures. Prevention - contrast shower.
3. Obesity develops due to a lack of estrogen. Treatment is HRT, a low-calorie diet and physical activity.
4. Neuropsychiatric disorders, depression, decreased mood as a consequence of impaired blood supply to the hypothalamic structures and the production of dopamine. It is corrected by psychotherapy methods, taking motherwort tincture, valerian extract, and in severe cases, antidepressants.

The solution to health problems depends on hormonal levels. Replacing the lack of your own estrogens eliminates most pathological disorders.

On the first day after surgery, follow a light diet so as not to burden the intestines. Cereal soups, liquid porridges, and omelettes are preferred. Give jelly, tea or compote to drink. For 2-3 days you can steamed lean meat and fish, vegetables. They eat small meals every 2-3 hours.

From 5-6 days they switch to a dietary diet that excludes hard-to-digest foods, smoked foods, and spicy foods. For bowel function, it is important to consume at least 1.5 liters of fluid.

Approximately 2 weeks after surgery, you return to your normal diet. But hormonal changes after removal of the uterus contribute to excess weight gain. Therefore, you need to carefully monitor the calorie content of your food and not overeat.

Products to be consumed:

• vegetables and fruits;
• lean meats and fish;
• dairy products;
• cereals;
• wholemeal bread;
• vegetable oil;
• to loosen stools - beets and prunes;

Limit or completely eliminate:

• salt;
• sugar;
• baked goods, flour products;
• smoked, spicy;
• sweet drinks.

Uterine fibroids are a neoplasm that grows in the myometrium (muscle layer) and consists of connective tissue and veins. A woman who has been diagnosed with one or more myomatous nodes, first of all asks the attending physician whether it is necessary to remove the organ.

The main causes of fibroids are:

• hormonal imbalance;
• disruptions in immunity;
• heredity.

There are three types of myomatous nodes:

• sumbucous (growing into the organ);
• subserous (“come out” in the peritoneum);
• interligamentous.

The average size of a node is 5 cm, sometimes it reaches 10 cm; large fibroids are rare.

The main symptoms of fibroids (especially multiple or large ones) fall into three categories:

• disruption of menstrual bleeding;
• pain in the lower abdomen;
• infertility (sometimes miscarriages or premature births, as a result of which the child rarely survives).

For fibroids that are not dangerous, conservative treatment is indicated. But, unfortunately, in most cases it turns out to be ineffective and surgery is recommended for the patient.

Is it possible to do without surgery?

Basically, it is necessary to remove the uterus after the age of 40, when the woman does not plan to have any more children and the organ is no longer needed. In this case, doctors are required to monitor the condition of the tumor(s) in advance, find out how much they are progressing, and whether it is worth intervening surgically. The main indication for surgery is the patient’s age after 40 years and the size of the myomatous nodes exceeding the gestation period of 12 weeks and growing rapidly over time (more than 4 weeks per year). It is also necessary to remove the organ if doctors suspect that uterine fibroids have begun to degenerate into a malignant cancerous tumor (sarcoma). Then, hysterectomy is allowed in young women (under 40 years old) who have not had children in order to save their lives.

There are many cases where, after 40 years, uterine fibroids themselves begin to decrease with the onset of menopause (due to a lack of female hormones in the body) and disappear after some time altogether. This usually takes several years. In this case, the operation to remove the organ can be postponed or even canceled - it will not be needed.

If one or more myomatous nodes are detected, it is necessary to undergo a full examination so that the doctor, having a complete picture of the patient’s health condition, makes a decision on the advisability of surgery. In women under the age of 40, surgeons try to remove fibroids while preserving the organ or most of it.

After 40 years, doctors agree that the best option during menopause would be complete removal of the uterus to avoid relapses (recurrence of fibroids) and cancer.

Indications for surgical intervention

The following describes situations when it is worth performing an operation to remove fibroids or the organ as a whole (regardless of how old the woman is):

• If the size of the myomatous node corresponds to the period of pregnancy after the 12th week;
• If uterine fibroids increase catastrophically quickly (for 4 or more weeks of pregnancy);
• When myomatous nodes manifest themselves with frequent and heavy bleeding (both menstrual and intermenstrual), the patient develops general anemia due to blood loss, accompanied by pallor of the skin, poor health and fainting;
• If fibroids cause severe pain (severe cramps during menstrual bleeding, abdominal pain due to tumor compression of neighboring organs and nerve endings in the spine);
• If an ultrasound examination reveals irreversible changes in the myomatous node (its necrosis, rupture, infection);
• When the patient has uterine fibroids of a subserous or sumbucous type, growing on a long stalk, through which it connects to the organ. There is a high probability of torsion of the leg, which may result in severe uterine bleeding (if the fibroid is submucosal) or peritonitis (if the node is peritoneal);
• If the fibroid is located in the cervical area;
• If the myomatous node is located submucosally on a thin long stalk and is visible in the lumen of the cervix, it begins to “be born”, it can be removed surgically by twisting the stalk;
• In preparation for IVF;
• If the patient is diagnosed with infertility associated with a myomatous node, its size or location;
• When fibroids cause miscarriages or miscarriages.

If disturbances in the functioning of neighboring vital organs are diagnosed:

• Urination is impaired, urine stagnates in the bladder, which can cause inflammation or the formation of sand and stones;
• The back wall of the bladder is compressed, urine is thrown back into the ureter, which can provoke pyelonephritis and other inflammatory diseases, cause dilation of the renal pelvis (hydronephrosis);
• The process of defecation is disrupted (the rectum is pinched), which is why the patient experiences prolonged constipation, threatening poisoning of the body;
• Compression of the nerve endings near the rectum occurs, which causes radiculitis (severe lower back pain) and pain in the heart and lower extremities.

Surgical treatment of myomatous nodes

The choice of method and extent of surgical intervention directly depends on several factors:

Patient's age.

Rehabilitation after removal of uterine fibroids

Uterine fibroids are currently the most common gynecological disease. The cause of this disease is not fully understood. But according to one theory, fibroids are formed due to the active growth of the myometrium under the influence of various factors. It is also believed that hormonal imbalance plays an important role in the development of the disease. Despite the cause of the disease, uterine fibroids require diagnosis and further treatment.

Services table

Service name	Price
Promotion! Initial consultation with a fertility specialist and ultrasound	0 rub.
Repeated consultation with a fertility specialist	1,900 rub.
Initial consultation with a reproductologist, Ph.D. Osina E.A.	10,000 rub.
Hysteroscopy	RUB 22,550
Ultrasound gynecological expert	RUB 3,080
Therapeutic and diagnostic laparoscopy (difficulty category 1)	65,500 rub.
Therapeutic and diagnostic laparoscopy (difficulty category 2)	RUB 82,200
Program "Women's Health after 40"	RUB 31,770

Uterine fibroids. Delete. Consequences. Reviews

When uterine fibroids are diagnosed in the early stages and the myomatous node is small, conservative therapy is prescribed. But, unfortunately, women come in with advanced variants of uterine fibroids. And in such cases, surgical removal of the nodes is necessary. Surgical treatment of uterine fibroids can be carried out in different ways. Depending on the technology of the operation, the recovery period takes place differently.

After surgery to remove uterine fibroids using laparoscopic and hysteroscopic methods, the recovery period is less painful and easy. The same cannot be said about the laparotomy method. This method is traumatic and entails some health risks; therefore, the recovery period lasts longer and is accompanied by pain.

How long does it take to recover after removal of uterine fibroids?

The rehabilitation period after removal of uterine fibroids depends on the technique of the operation. So, with the laparoscopic method of removing uterine fibroids, the recovery period is the shortest. The body recovers within a month, sometimes within a month and a half.

Postoperative period after removal of uterine fibroids

The early postoperative period lasts 3-4 days and, as a rule, proceeds without any special features. At the same time, menstrual function in women of reproductive age will not be impaired. Generally accepted recommendations should be followed, thanks to which the late postoperative period is painless and easy. The recovery period after removal of uterine fibroids by laparoscopy is uneventful and quite easy. A hospital stay is necessary only in the first days, then, if there are no complications, the patient is discharged for outpatient treatment. After removal of uterine fibroids using the laparoscopic method, it provides the opportunity to return to a full life in the shortest possible time.

Recovery after abdominal surgery to remove uterine fibroids

After uterine fibroids have been removed by laparotomy, the postoperative period lasts longer. With this approach, a large incision is made on the anterior abdominal wall. This involves prolonged healing of the suture, pain after removal of uterine fibroids in the incision area. In this case, hospital stay is mandatory. During the recovery period after this method of treatment, it is necessary to take antibacterial drugs, as well as antispasmodics. In the first days after surgery, patients experience pain. This is explained by the fact that when performed in this way, a large area of ​​tissue is injured.

Reviews after removal of the uterus for fibroids.

In some cases, it is necessary to remove fibroids along with the uterus. The reason for choosing such a radical method is the presence of multiple uterine fibroids, effects on neighboring organs, and uterine bleeding. Having a hysterectomy entails more serious consequences, and therefore the recovery period takes longer. It will take at least six months for a woman’s body to fully recover after removal of the uterus. During this time, the patient’s sutures, both external and internal, heal. In addition, after removal of the uterus and ovaries, hormone production is disrupted. This is one of the consequences after removal of the uterus with fibroids. Reviews from women indicate that after the operation they showed signs of postmenopause. The woman is worried about depression and insomnia. In addition, such women are susceptible to frequent fractures. This condition is explained by characteristic changes in a woman’s body after the cessation of estrogen production.

If you do not carry out the necessary treatment after surgery, a relapse is possible after removal of uterine fibroids.

In order to avoid such manifestations of posthysterectomy syndrome, it is necessary, together with the attending physician, to decide on the prescription of hormone replacement therapy.

After removal of uterine fibroids, you cannot

During the recovery period, there are some prohibitions and restrictions. This suggests that the patient will be able to return to her usual lifestyle only after some time. During the rehabilitation period, you should absolutely refuse:

• visits to steam rooms (saunas, baths and other establishments),
• sunbathing, as well as from the solarium,
• bad habits, alcohol and smoking slow down the recovery process,
• visiting the pool, due to possible infection of the sutures.

• physical exercise. For normal healing and prevention of suture dehiscence, it is not recommended to visit the gym. Lifting weights no more than 3-4 kg. In the postoperative period, gymnastics is also contraindicated after removal of uterine fibroids.
• ingestion of foods that cause gas formation. In the postoperative period, it is important that bowel movements occur freely and regularly, and bloating should be avoided. Since distended intestinal loops affect the sutures.

Surgery to remove uterine fibroids: consequences, reviews

Among the consequences after removal of uterine fibroids, one can only note an increase in body temperature in the first days after the operation and pain. According to reviews from many women, the possible consequences depend not only on specialists, but also on the woman herself. If you follow all recommendations, you can avoid consequences.

Sex after uterine fibroid removal

As for sexual life in women after treatment for uterine fibroids, this is a purely individual question. Thus, the beginning of intimate life after myomectomy depends on the decision of the attending physician. We can say that with laparoscopic removal of nodes, intimate relationships can begin within 7-10 days. But do not forget that before making this decision, an examination by a gynecologist is necessary. In addition, it is worth noting that after removal of fibroids, you should protect yourself with condoms. This will ensure the prevention of suture infection, as well as the onset of unwanted pregnancy. After all, after a myomectomy, you should plan a pregnancy no earlier than a year later.

If a radical operation was performed to remove fibroids and the uterus was removed during the operation, it is recommended to abstain for at least 60-90 days. Even though the uterus has been removed, protection with condoms is also recommended.