Recommendations after surgery of the uterus and appendages. After removal of the uterus and ovaries. How is the operation: types of hysterectomy

If doctors offer a woman to remove the uterus, then she is forced to weigh the pros and cons. In recent years, the need for this operation has been questioned by many medical experts.

As statistics show, most of these operations are performed on women who are not fully aware of all the consequences. The lack of comprehensive information on this topic gives the impression that there are no alternative treatments for women's diseases.

One of the drastic measures is not to take any action, engaging in a change in your lifestyle. This is the longest path, which in some cases is the most correct.

Do you need hysterectomy surgery? Do not rush to agree to the operation. In Israel, they rely on more gentle methods.

* For a full consultation, be prepared to provide medical documentation.

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What happens if you remove the uterus and appendages

Surgical removal of a female organ is a large-scale and complex operation. We must not forget that along with the uterus, the ovaries are often removed.

Hysterectomy is very often accompanied by complications.

In practice, such an intervention is very often accompanied by complications. In addition, many women experience depression. They are dominated by an extremely negative psychological state, they suffer from a sense of loss of femininity.

However, there are also good medical reasons for having surgery:

• muscle tumors that are accompanied by severe bleeding,
• prolapse of the uterus,
• ectopia of the endometrium of the abdominal cavity
• uterine cancer.

The operation is necessary for those women who experience a lot of problems due to the uterus. Although this aspect can be disputed. In any case, the decision to remove the main female organ is made by the patient herself.

Each woman herself comes to the conclusion about the need for surgery. The most controversial issue is the removal of the uterus (hysterectomy) in women of childbearing age. But this operation has never been an absolute necessity.

The exception is severe cases: significant blood loss in the shortest possible time or advanced cancer.

In all other situations, waiting under the supervision of a doctor may be an adequate solution. Do not give in to thoughts that a woman's health improves significantly after a hysterectomy. In reality, the operation only eliminates the external effect. The cause of problems in the female body can be hidden much deeper. Surgery also slightly reduces the risk of ovarian cancer.

To remove the uterus or not? This is up to the woman herself. Even a council of specialists cannot say exactly what processes are taking place in your body. First of all, you should listen to your body.

Some doctors claim that the uterus does not affect the physiological state of the woman, and its removal does not lead to any problems. This can be disputed, since in practice the situation looks a little different.

We list the main consequences of the operation.

The woman is emotionally disturbed. Nervousness, anxiety, suspiciousness, depression are the companions of patients who underwent surgery. To this list, you can add quick fatigue and a quick change of mood. A woman, deep down, worries about what happened and may feel that no one needs her. She has a lot of complexes.

But all this can be overcome. After all, each patient continues to be a woman who wants to love and be loved. The problem is much more complicated if the sexual desire disappears. This is also not uncommon. This effect is associated with hormonal changes that occur as a result of the operation.

2. Loss of fertility

A woman who has lost her uterus and appendages will never be able to get pregnant. After removal, menstruation does not go - menstruation stops forever.

3. Possible health problems

The consequences of the operation are increased risks of:

• osteoporosis;
• pain during intercourse (if the length of the vagina has been surgically shortened);
• prolapse of the vagina.

4. Climax

Hysterectomy of the ovaries and uterus leads to menopause. The reason for this is the cessation of the production of estrogens (female sex hormones). As a result of the operation, a large-scale hormonal failure occurs in the body.

All functions and systems begin to rebuild, since the absence of estrogens in a complex chain of hormonal relationships gives rise to various changes. Tides are a consequence of such transformations. The result is the fall of female sensuality and the loss of sexual desire.

Menopause is rather difficult to tolerate, since the supply of estrogen to the body is interrupted abruptly. Therefore, unpleasant symptoms appear within a few days after surgery. The younger the woman on the day of the hysterectomy, the more severe these symptoms are.

To overcome this side effect, doctors prescribe special drugs that can replace estrogens. They are prescribed immediately after the operation. Taking hormonal drugs, a woman can improve her condition.

For those women who have reached menopause naturally, the loss of appendages is not so tragic. In their body, female sex hormones continue to be produced, but in smaller quantities. The content of androgens (male sex hormones) also decreases.

If only one of their appendages is removed, then the remaining ovary continues to perform its functions.

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Consequences of a hysterectomy

If only the uterus is removed, but the ovaries remain, then they continue to function. However, the production of female hormones in them will stop earlier than the deadline set by nature. The reason is called the fact that the blood flow to the pelvic organs is reduced.

Cons of the operation:

• psychological and physical discomfort;
• seam on the stomach;
• pain in the pelvic area during the rehabilitation period;
• a ban on sexual intercourse during recovery;
• inability to have a child;
• early menopause;
• risk of developing heart disease or osteoporosis.

What are the benefits of a hysterectomy?

• lack of menstruation;
• the impossibility of conception in any case (there is no need for contraception);
• the absence of problems that were present in connection with a female disease (profuse bleeding, pain);
• no need to worry about uterine cancer.

The purpose of the operation is to eliminate the disease of the uterus. If the disease cannot be managed with conservative methods, then doctors recommend a hysterectomy.

However, this operation does not always help to get rid of the disease. For example, in some patients, the consequence of removal of the uterus in endometriosis may be the development of endometriosis of the stump of the cervix. Cultitis is accompanied by pain and discharge. In this case, doctors perform the removal of the stump.

If the uterus was removed, but the ovaries were left

After such an operation, there are no major hormonal changes in the woman's body. After all, the ovaries continue to function, producing sex hormones.

Studies show that the appendages with a removed uterus work in the same mode that is planned at the genetic level. Each individual organism has its own mode.

Thus, after a hysterectomy, estrogens continue to be produced in the appendages. They continue to participate in supporting the woman's hormonal status. Testosterone continues to be produced. As a result, the state of libido remains at a normal level, without decreasing.

Dangerous Consequences

A hysterectomy is a major and complex surgical operation followed by a long recovery period (several weeks or months).

We list the main dangers:

• a large loss of blood, the result of which will be a transfusion;
• infection;
• death - 1 chance in 1000 (due to complications);
• the likelihood of injury to the genitourinary system or intestines.

Feedback on the consequences of the operation

Immediately after a hysterectomy, patients experience pain and slight physical discomfort. Many of them immediately begin to worry about the loss of their femininity. Psychological problems occur in almost everyone. Feelings of inferiority and confusion are the predominant emotions.

How does a woman's life actually change? The answer is simple: "There are no radical changes." The woman continues to lead the same lifestyle as before the intervention. There are no changes in the body and face either.

The correct psychological position minimizes the risk of complications.

The main thing is to keep a positive attitude. Reviews indicate that the correct psychological position guarantees a favorable outcome of the operation and a quick recovery. Here it is important to find a good doctor and enjoy the support of loved ones.

Many women choose to have their hysterectomy done abroad. Clinics in Israel, Spain, Germany, Singapore and many other countries have good reviews.

Israeli doctors take on the most difficult cases, minimizing possible risks. Sheba Medical Center conducts surgeries at government prices.

In terms of its prevalence, hysterectomy is second only to caesarean section. Most of the operations are performed on patients aged 45 years. The uterus is removed in one third of women who have reached the age of 60 years.

Treatment in an Israeli clinic

Oncogynecology in Israel

How to live after the removal of the uterus?

All the nuances of the recovery period are discussed with the attending physician.

• At first, you may be in pain.
• In some women, stitches heal rather slowly.
• Bleeding may occur.
• Many patients develop adhesions.

The recovery period is dangerous for its possible complications. These may be the following:

• fever,
• urination disorder,
• heavy bleeding
• suppuration of the seams,
• venous thrombosis, etc.

To reduce the risk of complications and restore the body after surgery, a number of rehabilitation measures are prescribed:

• Kegel exercises. Total hysterectomy leads to a change in the location of the pelvic organs. This negatively affects the activity of the bladder and intestines. Constipation and urinary incontinence often occur. The pelvic floor muscles weaken, which can lead to vaginal prolapse. Kegel exercises will help prevent this trouble.
• Hormone Replacement Therapy (HRT). To prevent the development of severe symptoms of menopause, you should use the possibilities of HRT. It is prescribed to all patients who have undergone a hysterectomy. The list of mandatory funds includes drugs with estrogens. They may be in the form of tablets, patches or gels. Various combined preparations containing estrogens and gestagens are also used.
• Medications. Women who have undergone hysterectomy are at risk for atherosclerosis and osteoporosis. Medicines help prevent the development of these pathologies.
• Diet. In addition, there is a risk of rapid weight gain, which may be the result of hormonal changes. A proper diet and an active life will help to avoid this.

How to lose weight

If you have gained excess weight after surgery, then you just need to change the principles of nutrition. Excess weight only complicates the situation. Overweight women tolerate menopause much worse.

By adjusting your diet and regimen, you will improve your health, and unpleasant symptoms will become insignificant. The correct lifestyle after the operation is of great importance:

• The main food should be consumed in the morning.
• In the late afternoon, it is recommended to take light foods: fresh fruits, vegetables, cereals.
• Confectionery, fatty, fried and spicy dishes should be excluded from the menu.
• You need to drink clean water, tea, fresh juices. Coffee can be consumed in limited quantities.
• You definitely need to play sports. It can be fitness, swimming, running, walking, etc.

sex life

The issue of intimate life is a cause for concern for most women. Removal of the uterus and sex is the main topic of discussion.

The operation does not affect the quality of sexual life.

However, doctors confirm the fact that the operation does not affect the quality of sexual life. This is also confirmed by those women who have gone through a hysterectomy of the uterus. The main problem lies in the psychological aspects of this operation.

In practice, doctors do not experience sexual problems after a hysterectomy. But a completely different situation occurs in those patients who, along with the uterus, had their appendages removed. Their reviews confirm the fact that the result is hormonal problems and a decrease in libido.

How is sex life changing?

• At first, intimate contacts are prohibited, as the seams must be tightened.
• After the patient feels better, she can return to the usual rhythm of life.

The erogenous zones of a woman are not located in the uterus, but on the external genital organs and the walls of the vagina. Therefore, sex gives the same pleasure as before the operation.

Getting an orgasm is quite real. A lot depends on your partner.

Conclusion: Hysterectomy has more cons than pros. But if the operation is a necessity, then there is no need to despair - this is not a reason to give up the joys of life. With the help of professional doctors you will be able to gain health.

18.05.2017

Myoma is a benign tumor, but due to late diagnosis, it has to be removed. For this, organ-preserving operations and radical ones are used.

The consequences of each of the methods of treatment can be different, it all depends on the health of the woman, the presence of concomitant diseases, the experience and professionalism of the doctor, the type and stage of fibroids.

The ability to have children of their own is directly related in women to the uterus, since it is here that new life is born. Because of this, with the diagnosis of "myoma" and subsequent surgery, many women give up on themselves, considering their body inferior. In addition, there is an opinion that after the removal of the uterus, the consequences are serious - a woman loses the ability to enjoy intimate relationships, the body quickly ages.

In fact, most of these statements have nothing to do with reality. To debunk the myths, you need to learn more about the consequences of the operation. It is better to avoid it, and for this you need to be attentive to your health.

Already at a consultation with a doctor, you can find out in detail how the operation is performed, what is fraught with, how to avoid unpleasant consequences and maintain health in the future.

Complications of the postoperative period

A woman who is about to have an operation needs to stop panicking and think about her own health. Doctors do not prescribe the removal of the uterus for fibroids in every case, there are special reasons for this, and if a woman is scheduled for an operation, then her health and life are in danger, and there is no other way out.

Fibroids are treated both conservatively and sparingly, but the final choice of treatment method depends not on the doctor, but on the circumstances. Therefore, you need to calm down and remember that life does not stop after the operation.

In advance, the doctor will explain the difficulties of the postoperative period so that the woman is not afraid of the symptoms that have arisen. After a hysterectomy (removal of an organ), a woman's body recovers for about 1.5 months, the period may be shorter or longer depending on various factors (the presence of diseases, age, the body's ability to regenerate).

The first days after the operation will be accompanied by symptoms:

• pain in the area of ​​operation. Unpleasant sensations, pulling pains will last only a couple of days. For overly sensitive and impressionable women, doctors prescribe painkillers and sedatives (baralgin, diphenhydramine, ketonal, etc.);
• bloody issues. Usually there is no bleeding after surgery, but there are exceptions. A woman only needs to control the volume of secretions. Small spotting can appear even a month after the operation, but if they suddenly become plentiful, you need to urgently consult a doctor.

The listed consequences after removal of the uterus in the first days do not require special control and any measures, pass on their own. It is bad if a woman has swelling and redness of the legs, the temperature rises, there is a feeling of weakness and a problem with urination.

Any of these signs is a reason to consult a surgeon. In order for the recovery after the operation to go well, you need to follow all the doctor's prescriptions regarding lifestyle, physical activity, nutrition, and procedures.

Health problems after hysterectomy

A woman who is being prepared for an operation is told in advance what consequences may arise so that she can imagine how to respond to certain symptoms and not worry in vain.

All the consequences have long been studied by doctors, there is a complex of preventive and therapeutic procedures that can bring a woman's health in order. The consequences associated with a hysterectomy appear immediately after the operation, and several years later.

These are the following states:

• the appearance of depression associated with thoughts of one's own inferiority;
• memory problems;
• various problems with urination;
• weight gain;
• fast fatigue from the usual activities;
• the risk of osteoporosis;
• decreased sexual desire and discomfort during intimate relationships, lack of orgasm.

The genital area is at greatest risk after removal of the uterus - there is a risk of prolapse of the walls of the vagina, and sexual dysfunction. The problems are related to the physical state of health. To return to a normal intimate life, you will need to undergo rehabilitation.

The listed consequences of the removal of the uterus in case of myoma may not appear at all if the doctors during the operation maintained a normal blood supply to the ovaries, preventing a decrease in the level of hormones.

Consequences of removal of the uterus

The above list of complications that may occur rarely or not at all, but there are complications that women often experience after removal of the tumor along with the uterus. The operation is serious, because the body is built harmoniously, and if one of the organs is removed, the others suffer from a loss of connections.

The main consequences: pain during scar healing, discharge, bleeding and increased risk of atherosclerosis. You can prevent such consequences by regular gymnastics and taking vitamins. It is important to avoid overheating during the early postoperative period (sauna, steam bath and hot bath are prohibited).

In addition to the consequences due to the removal of the uterus with fibroids, it is necessary to mention the surgical intervention itself, because this is a serious stress for the body. A woman may experience complications from anesthesia, inflammation may develop, sometimes there is peritonitis, intestinal obstruction, damage to nearby organs.

What is dangerous removal of the uterus and ovaries

If the operation to remove uterine fibroids also involves the removal of the ovaries, the body gets even more stress, because hormones are produced here. If there are no ovaries in the body, it turns out that artificially causes menopause, menopause.

The woman will be prescribed hormones so that synthetic drugs will replace natural progesterone, estrogen. The course of hormone therapy will be very long. If we talk about the consequences of removing the uterus with the ovaries, we can note the following:

• decreased libido due to hormone deficiency;
• the risk of developing diseases of the cardiovascular system;
• depressive state;
• fast fatigue from ordinary activities;
• loss of mineral density in bone tissue is fraught with osteoporosis.

Despite such a list of complications, you need to understand that the operation is not a punishment, but a necessary measure, which is provided only in exceptional circumstances.

What you need to know about hysterectomy surgery

Many women are not so afraid of the consequences as the process of the operation itself, and the reason is ignorance of what will happen. To reduce stress, it is better to know in advance how the removal of uterine fibroids is carried out. The uterus is removed with or without a cervix.

The second option is more preferable, since the cervix plays an important role in the functioning of the pelvic organs. Therefore, an operation in which the neck is also removed is performed only if there is a tumor on it. There are several methods:

• laparotomy or classic surgery with an incision on the abdomen is prescribed for large fibroids and multiple nodes;
• laparoscopy is a small puncture or incision in the abdominal wall through which the uterus is accessed. With this option, the tissues are less damaged, the rehabilitation period is reduced;
• hysteroscopy - access is carried out through the wall of the uterus with a special tool. The abdominal wall is not damaged at all. This technique is appropriate only for small fibroids.

The choice of one of the listed methods depends on the results of the examination, the condition of the woman, her age. After receiving the results of laboratory tests, the doctor presents a complete picture of the disease and can suggest which type of operation will be most effective in a particular situation.

A woman needs to listen to the doctor when he talks about preparing for surgery and the rehabilitation period. It is important to hear the recommendations: it is forbidden to lift weights of more than 3 kg, you must not overheat, you need to visit a gynecologist for preventive examinations.

After the time has passed since the operation, you need to visit a gynecologist and consult on any issues in order to avoid complications. The recovery period lasts about 2 months, and during this time each woman will feel in her own way, although there are common features of the state of health.

The first time after the operation, the woman remains under the supervision of a doctor in the hospital. It is necessary to avoid constipation, for this the diet is adjusted. If there are problems with bowel movements, intra-abdominal pressure may increase, which is bad for healing sutures.

You can not freeze, overheat. Physical activity is prohibited for several months, as are intimate relationships. You need to move after the operation the day after the removal of the fibroids in order to avoid adhesions and blood stasis.

Some women who have undergone surgery later regret that they agreed and frighten other women with stories about their terrible and deplorable condition. Others tolerate the postoperative period well and do not face serious problems.

The fact is that the disease itself exhausts the woman so much that when she gets rid of the symptoms of the pathology, the rest seems to her a trifle. Such different reviews are misleading for those who intend to go to the doctor.

Considering the consequences listed above after the operation to remove the uterus, you need to soberly consider the situation and the options for the development of the disease.

One truth should be immediately clarified - doctors do not prescribe an operation just like that, this is a serious procedure that takes time and effort not only from the patient, but also from the surgeon. Having seriously assessed the prospects, you need to tune in to the best, trust the doctor.

Removal of the uterus after 50 years is recommended for women who have given birth before and subject to the presence of a life-threatening gynecological pathology. This is a common operation in European countries, it is resorted to in order to prevent cancer. In our country, doctors evaluate possible risks and contraindications. In order to carry out a hysterectomy, serious violations of the patient's state of health are required.

Extirpation, hysterectomy - the name of the same gynecological operation, during which the complete removal of the body of the uterus or its parts is performed. Often combined with the removal of the ovaries, part of the vagina and fallopian tubes.

Surgical methods used in gynecology

The choice of technique depends on the state of health of the woman, the severity of gynecological pathology, the presence of concomitant diseases and the prognosis. The decision to choose one or another method is made by the operating doctor.

The size, number, location of tumor nodes, their structure, and damage to nearby pelvic organs are taken into account. Currently, 3 methods of surgical intervention are known, and doctors prefer low-traumatic methods.

Laparotomy

Amputation of the uterus is carried out by incision along the anterior abdominal wall. This is an abdominal operation, after which complications are possible - adhesive disease, divergence of sutures, bleeding, wound infection, vascular thrombosis. Used by gynecologists in rare cases, if there is a serious pathology:

• extensive malignant lesions of the uterus, ovaries, parametric lymph nodes;
• large size of the uterus;
• peritonitis;
• ovarian rupture;
• ectopic pregnancy;
• purulent fusion of the ovaries and fallopian tubes.

The technique is used in emergency situations when immediate intervention is required. The advantage of the laparotomy method is a good overview of the female genital organs, so that the doctor performs all the necessary manipulations.

Removal of the uterus is done through small incisions or punctures in the abdominal wall using a special tool - an endoscope. This allows you to reduce the risk of complications and save a woman from scars on her stomach. A big plus of laparoscopy is a small loss of blood even with varicose veins of the small pelvis. Currently, progressive clinics use robotics, which ensures high accuracy of movements.

The recovery period for laparoscopic intervention is short, the woman practically does not experience pain, but the cost of manipulation can be quite high.

Vaginal method (transvaginal amputation)

It is used for small myomatous nodes, with prolapse of the uterus and in cases where the organ is not greatly enlarged. The incision is made in the region of the vaginal fornix, while the abdominal wall is not damaged.

Rehabilitation with vaginal access ends quickly, after the intervention there are no scars and adhesions. Pain is practically absent.

Currently, they resort to a combined method of removal, while combining vaginal and laparoscopic methods. This allows amputation to be carried out as accurately as possible and without consequences for the woman's health. In the lower abdomen there are only small traces of a puncture with a tool.

Indications for amputation of the uterus

The main indications for extirpation after 50 years are as follows:

• benign tumors - multiple myomatous nodes, tumors of impressive size (more than 12 weeks), subserous myoma with the threat of torsion of the leg;
• cervical cancer, ovarian cancer, myosarcoma or metastases to nearby organs;
• prolapse and prolapse of the uterus;
• bleeding that is not associated with the monthly cycle or heavy blood loss, as a result of which chronic anemia develops;
• multiple polyps;
• atypical endometrial hyperplasia - proliferation of glandular cells of the inner lining of the uterus, is considered a precancerous condition;
• conservative treatment was ineffective.

Since in adulthood the childbearing functions of a woman completely fade away, doctors resort to a total hysterectomy, then the uterus and ovaries are removed after 60 years.

The consequences can be divided into early, associated with postoperative complications and late, caused by hormonal imbalance and prolapse of the pelvic organs.

In the near future after the operation it is possible:

• Infection and divergence of sutures;
• Pain sensations;
• Violations of the act of defecation;
• The appearance of adhesions in the abdominal cavity;
• Bleeding associated with suture failure or the development of DIC;
• Violation of the emptying of the bladder, pain during urination;
• Development of peritonitis;
• vascular thrombosis.

During the manipulation, the bladder, vessels and intestines are injured, which causes bleeding and causes the development of urinary incontinence and excretion of bowel movements from the vagina.

Consequences of intervention

Depression

After extirpation, many of the fair sex experience a depressive mood; they cannot consider themselves full-fledged women. Tantrums, irritability, mood swings, tearfulness - these problems are faced by the patient's relatives. Husband and loved ones can help to cope with psychological discomfort. However, after 60 years, when menopause has already come naturally, the mood usually does not change.

Impossibility of conception

If a total operation was performed, that is, the uterus was removed along with the ovaries and tubes, menstruation completely stops. Many women who have given birth regard this as a positive thing.

In cases where doctors have decided to keep the ovaries, they are able to perform their function, but fertilization will be impossible. The fertilized egg will have nowhere to attach itself, even modern medical technologies will not help.

Important! The preserved appendages continue to function normally and synthesize estrogens, but menopause develops faster.

Earlier onset of menopause

Removal of the ovaries leads to the onset of menopause, this is due to the cessation of estrogen production and the development of hormonal failure. If the appendages are preserved, menopause begins earlier than the due time.

The reason lies in the fact that during a hysterectomy, the surgeon removes a branch of the uterine artery, as a result of which the blood supply to the ovaries is disturbed. The gonads of women do not receive sufficient nutrition, so dystrophic processes begin to occur in them. The result will be a decrease in estrogen production.

The absence of menstruation is accompanied by unpleasant symptoms:

• tides;
• feeling hot;
• change of mood;
• nausea;
• loss of strength;
• dryness in the vagina.

After a total amputation, menopause occurs abruptly and in record time, so all the symptoms are acute. Hormone replacement therapy will help relieve menopausal disorders, the doctor will recommend the necessary drugs to the woman.

Many women at 50, and even more so at 60, experience a decrease in libido. This is partly due to the fact that due to the lack of natural lubrication and dryness of the vagina, pain appears during sexual intercourse. This problem is solved by joint efforts of partners.

Another reason is a violation of the innervation of the vagina, so some ladies stop having an orgasm and do not see the point in continuing sexual intercourse.

In rare cases, pain during intimacy does not go away within a few months after the intervention, but most often after 1.5-2 months the woman ceases to experience discomfort. Many ladies, on the contrary, become more liberated, as they cease to be afraid of pregnancy.

Erogenous points are not located in the uterus, but in the walls of the vagina and in the clitoris. Therefore, in many women, amputation does not affect the quality of sexual life.

Dysfunction of the pelvic organs

Pathology is a consequence of the removal of the ligaments of the uterus. The result is a displacement of the bladder and intestines. You can suspect the condition by symptoms:

Some women develop lymphedema. Removal of nearby (parametric) lymph nodes causes a violation of the circulation of lymph in the vessels. Symptoms of lymphostasis of the extremities:

• pain and heaviness of the legs;
• swelling of the lower extremities;
• skin redness;
• movements in the joints are difficult, the legs are poorly obeyed.

spikes

Adhesive disease is one of the severe complications of abdominal surgery. Connective tissue strands are formed in the abdominal cavity, which impair the functioning of organs. Patients experience constipation, bloating, difficulty passing urine, persistent or intermittent pain. The pain syndrome can be excruciating and last for several months.

To prevent the formation of adhesions, women are not recommended for prolonged bed rest. As early as 1-2 days after the hysterectomy, physical activity should be started. For preventive purposes, physiotherapy is prescribed, course treatment with antibiotics and hormones is carried out.

Activities during the rehabilitation period

1. Diet. Due to changes in hormonal status, many patients gain weight. Eating natural products, avoiding sweets and fatty meats, and a light dinner in the evening will help keep a slim figure.
2. Mandatory wearing of a bandage for 2 months after the operation. This device will help to avoid prolapse of the internal organs and all the accompanying symptoms.
3. Hard physical work, intensive fitness classes are contraindicated. Patients are recommended easy walking. When performing household duties, you should alternate work with rest.
4. You need to wash in the shower, not in the bath.
5. During the recovery period, thermal procedures (bath, sauna), trips to the solarium are prohibited.
6. You should master Kegel exercises to strengthen the muscles of the pelvic floor. They can help prevent vaginal prolapse and urinary incontinence.
7. Medicines must be taken as prescribed by the doctor. All patients after a total hysterectomy are prescribed hormonal drugs. They will relieve the symptoms of menopause and improve the well-being of a woman.
8. Vaginal tampons are not recommended for vaginal discharge unless prescribed by a doctor for medicinal purposes.
9. Do not lift heavy objects weighing more than 4 kg.

The duration of rehabilitation depends on the type of intervention performed. With abdominal surgery, recovery lasts 2-3 months. After laparoscopy and vaginal amputation, rehabilitation takes 2-4 weeks.

I'm due for a hysterectomy. Tell me how I can live after her, can I be a full-fledged woman? I heard that this is a very difficult operation, after which you have to lie down for almost a month, that after the removal of the uterus, women age quickly, the skin sags, they immediately gain excess weight, that big problems begin - many generally cease to experience the pleasure of sexual life. I’m only forty years old, I have a young husband (five years younger than me), somehow I don’t want to believe that only joyless old age lies ahead ...

Galina B., Moscow

According to the Scientific Center for Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences, hysterectomy ranges from 32 to 38.2% of all gynecological operations.

We asked Elena Nikolaevna ANDREEVA, Doctor of Medical Sciences, to tell us about this operation.

A hysterectomy is a surgery to remove the uterus. It can be total (when the body and cervix are removed) and subtotal (when only the body of the uterus is removed). Panhysterectomy is an operation to remove not only the uterus, but also appendages - the ovaries and fallopian tubes.

In what cases is such an operation necessary?

Hysterectomy is most often done for uterine fibroids. But, of course, not in every case of fibroids, but only when large uterine fibroids are found. Because of this, the functions of neighboring organs - the bladder and rectum, may be disturbed, the woman is worried about pain, and urination is difficult. The indication for surgery is uterine fibroids and in cases where it rapidly increases in size during the year.

Often the question of surgery arises when a woman suffers from endometriosis.

With endometriosis, menstrual irregularities often occur - menstruation itself can be very heavy, sometimes turning into bleeding, which can lead to a decrease in hemoglobin in the blood. Menstruation is preceded by "smearing" spotting, which often persists even after the menstruation itself seems to have ended. Pain in the lower abdomen can radiate to the legs, to the lower back, to the rectum. During intercourse, a woman feels discomfort, pain, so she practically cannot live a sexual life. In this case, the operation to remove the uterus allows the woman to return to normal health and the possibility of a full life.

An unconditional indication for surgery is malignant neoplasms of the genital organs.

Subtotal hysterectomy, which preserves the cervix, is now done less and less often because it is often insufficient. The body of the uterus affected by endometriosis is removed, leaving the cervix, on which at the time of the operation there are no visible changes, however, over time, the cervix may also be affected by the same disease. As a result, you have to do another operation and remove the cervix.

All these problems can occur in women of any age. Except, perhaps, prolapse and prolapse of the uterus, which is more common in older women. If at the same time a woman does not have severe chronic diseases, for example, the cardiovascular system, then it is better to really go for a radical operation to remove the uterus, during which plastic surgery is also done to strengthen the muscles of the pelvic floor. Moreover, as a rule, by that time a woman no longer plans to have children anymore.

And if a woman is young and she is told that her uterus will be removed because of a fibroid, does she lose the opportunity to give birth to a child?

In such cases, we try our best to avoid this operation. For example, with uterine fibroids, in most cases, it is possible to perform a conservative myomectomy operation - to remove the fibroids, while preserving the uterus. Even if there are changes in the ovary, you can not completely remove it, but make a resection (remove only a part) and prescribe hormonal treatment in order to save the young woman the opportunity to have a child in the future. Another thing is that such operations are not performed in every hospital. But, probably, for the sake of this it is worth contacting the leading medical centers.

Moreover, such a most sparing approach to surgical intervention is justified not only when it comes to women of reproductive age (up to 35 years). There are cases when women at the age of 40 (and older) still plan to have children, for example, in a new marriage.

But if we are talking about saving a woman's life, then it is already impossible to take into account age, there is no choice left.

That is, it turns out: if a woman no longer plans to give birth to children, then most likely, if all these problems arise, her uterus will be removed? How will this affect her overall health?

The uterus is a muscular organ, its main function is to bear a child during pregnancy. This organ is not vital.

In addition, it must be borne in mind that this organ is removed only if there are serious health problems. The operation of hysterectomy is a radical one in gynecology, that is, it leads to a cure for a woman and an improvement in her quality of life. Please note that the indications for surgery are quite serious - if they are, and a woman objects to the operation, her life cannot be called normal - pain, bleeding, dysfunction of other organs and problems in sexual life ...

Anesthesia can affect the general condition of the body, but this is inevitable with any surgical intervention. Of course, it is important that anesthesia is chosen adequately, taking into account the state of the heart and blood vessels, the nervous system, kidney function, etc.

Is it true that if a woman's uterus is removed after forty, the ovaries must also be removed at the same time?

If a woman does not have any changes in the ovaries, then why remove them? Age in this case does not matter.

Removal of both the uterus and the ovaries at the same time - panhysterectomy - is done only in cases of a combination of pathological changes in both the uterus and the ovaries.

But even if a cyst is found on the ovary, then this is also not a reason to remove the entire organ - you can limit yourself to resection (removal of part) of the ovary. Another thing is if a formation similar to a cystoma (benign tumor) is found on the ovary. In this case, the "suspicious" tissue must be excised and urgently, right during the operation, examined in the histology laboratory. Depending on the result of the study, the ovary may be removed completely or partially. Panhysterectomy is done for oncological diseases of the uterus, ovaries or if they are suspected.

Is hysterectomy really a difficult operation?

The fact that this operation requires a long recovery period, on the one hand, is true, on the other hand, it is not entirely true. It all depends on how the operation was done.

Today there are three of them - laparoscopy, laparotomy and vaginal surgery. Each has its own advantages and features.

In leading medical centers, laparoscopy is most often performed today, as it is the most sparing and highly effective. During laparoscopy, it is possible to simultaneously perform plastic surgery and tighten the ligaments that hold the internal organs in order to avoid their omission. However, this operation requires a highly skilled surgeon and appropriate equipment in the operating room. Therefore, unfortunately, today it is not carried out in all hospitals.

Laparotomy is resorted to in cases where, for example, the patient, due to other (non-gynecological) diseases, cannot tolerate the conditions of anesthesia used in laparoscopic operations. If the fibroid is large and the uterus is significantly enlarged, then practically the only way to remove it is to resort to a laparotomy operation. Vaginal surgery is done mainly in cases of prolapse or prolapse of the uterus.

Where there is no special equipment, the laparotomy remains the most common operation.

First days

The POSTOPERATIVE period differs significantly depending on which access the operation was performed with.

After laparoscopy, the patient gets out of bed the next day, and is discharged home on the 5-6th day. The advantages of this operation include a high cosmetic effect - a woman "remembers" 3-4 small "holes" with a diameter of only 0.5 cm, which after a while are practically invisible on the stomach.

After a laparotomy, a woman is allowed to get up on the 2nd-3rd day after the operation, and she is usually discharged from the hospital after 8-12 days. After the operation, a seam remains on the abdomen, but now doctors are trying to make it as cosmetic as possible, which soon becomes hardly noticeable. In addition, located transversely above the pubis, such a seam is not noticeable even in a bikini.

During vaginal surgery, there is simply no seam on the abdomen, since the only visible seam is on the perineum, all other incisions are made inside, through the vagina, the uterus and removed.

Nutrition - what should it be immediately after the operation?

As for the postoperative diet, after laparotomy and laparoscopy, the first one or two days are a zero table, that is, practically nothing is allowed except water and liquid porridge.

Then the usual nutrition is gradually restored, but how quickly - it already depends on the recommendation of the attending physician.

After vaginal surgery, the diet should be observed more strictly and for a longer time - at least 7 days. In addition, after such an operation, you can only stand or lie down for the whole month, you are not allowed to sit, so only a buffet ...

After operation

Is it TRUE that the inevitable consequence of such an operation is constant fatigue and weakness?

This is an operation of a fairly large volume, so the recovery period after it can last two to three months (in some cases up to six months). At this time, a woman has every right to experience both increased fatigue and weakness. After laparoscopy, as a rule, a woman recovers within a month.

Are there any restrictions, contraindications to physical activity?

Of course, in the first month after the operation, physical activity is excluded so that all the sutures heal. From the first postoperative days, only breathing exercises of physiotherapy exercises are recommended. For another three months, physical activity is limited, and after six months, all restrictions are removed. A woman can engage in any sport except weight lifting. After the operation, you should not lift more than 3 kg. But we believe that it is absolutely harmful for healthy women, for everyone, to lift heavy (more than 5 kg)!

The first is to lead a healthy lifestyle and feel like a healthy, active, full, sexy woman.

But at the same time, do not forget in a month and in six months to come for a consultation with a doctor and do a control ultrasound examination of the pelvic organs.

It is advisable to contact a gynecologist-endocrinologist to resolve the issue of hormone replacement therapy, if necessary. And if the ovaries are removed, then a visit to the endocrinologist is required.

Hysterectomy is an operation aimed at the surgical removal of the uterus and its appendages. Amputation of an organ is a serious surgical intervention, which is performed for the purpose of therapy and prevention of serious diseases, most often oncology. Ovarian resection is also practiced in breast cancer, since the functioning of these organs is closely related. The larger the removed area, the longer and more laborious will be the recovery of the patient after his lost natural function. The uterus and ovaries are organs that are directly related to the conception, bearing and birth of a child. Their removal can be performed in case of some gynecological diseases, as well as the development of potentially dangerous tumors, leading to malignancy, or malignant degeneration of cells. The main consequences of the removal of the uterus and ovaries are fatal infertility and the absence of physiological uterine bleeding (menstruation). At the same time, the hormonal background works as usual: estrogens have a beneficial effect on the cardiovascular system and bone tissue, testosterone maintains the quality of sexual relations and awakens libido.

In general, life after the removal of the uterus does not end, on the contrary, it acquires peculiar advantages. So, if you are tormented by PMS and painful periods, this will not happen after amputation of the organ. There will be a neutralization of the symptoms that entail adhesions. Doctors call uterine hysterectomy "surgical menopause", but, unlike the natural onset of menopause, the operation does not disrupt the hormonal background. It is a completely different matter if the ovaries were eliminated along with the uterus. In this case, a woman whose menopause has not yet come will acutely feel all its symptoms: hot flashes, weight gain, decreased skin turgor, osteoporosis, etc. Therefore, hysterectomy of the uterus and appendages is relatively dangerous and uncomfortable for women of reproductive age. If menopause has already begun, 1.5-2 months after the operation, you will completely stop noticing any changes in the body. The conclusion follows from this: the real menopause after removal of the uterus, with all its consequences, can be noted only if the patient is relatively young, and the ovaries are removed along with the muscular organ. At the same time, HRT is prescribed to support the body.

Even if the operation went well, and the patient does not feel any pathological signs, life after removal of the uterus is overshadowed by a purely psychological aspect. She rightly feels inferior, because from now on she is completely devoid of reproductive function. In addition, now the patient does not have her period, which also adds to the mental difference with the course of a healthy woman's life.

The main types of hysterectomy in surgical practice

Laparoscopic intervention is considered the optimal and sparing method of amputation, but it is not appropriate for all patients. With regard to the location of the removed organs, there are several types of operations:

Supravaginal amputation of the uterus. It is a local removal of an organ, in which the cervix remains in its "legitimate" place in the small pelvis. Appendages (fallopian tubes and ovaries) are not affected. Supravaginal amputation of the uterus is performed using an optical laparoscope, which is inserted into a miniature incision in the lower abdominal part. The operation is indicated for patients with a small size of the uterus, as well as with its prolapse. It does not entail the formation of rough scars on the body. Supravaginal amputation of the uterus is different in that it has a rapid recovery, in contrast to rehabilitation after removal by another method. Extirpation of the uterus without appendages requires a phased separation of the cavity from the neck of the organ. It is performed using specific surgical instruments. Supravaginal amputation of the uterus is the easiest and most gentle variant of hysterectomy.

A total hysterectomy is the amputation of the cervix and its body, while preserving the tubes and ovaries. It is practiced with extensive lesions of organs and in cases where their partial preservation is impossible. Indicated in carcinoma.

Radical hysterectomy involves the complete removal of the organs of the female reproductive system. Amputation of the cervix and organ cavity is associated with surgical removal of the fallopian tubes and ovaries. Additionally, local (inguinal and pelvic) lymph nodes are excised, as well as the upper part of the vagina. Such an intervention is indicated for extensive lesions of the internal genital organs, especially for endometrial cancer, which spreads to the cervix.

Supravaginal amputation of the uterus without appendages, as the simplest variant of hysterectomy, is relevant in cases of the formation of volumetric fibroids, with severe pelvic pain and heavy uterine bleeding of unknown origin. Until the patient reaches the age of forty, doctors try to do everything possible to preserve the integrity and health of the organs of the reproductive system (not with low-grade cancer). If the patient's age exceeds 40 years, preference is given to radical methods. Amputation of the cervix, its cavity and appendages, becomes a kind of guarantor of protection from the spread of the disease, its metastasis (in cancer) and relapses. After surgery, maintenance therapy and HRT are necessary.

Preventive amputation of the cervix and its body is practiced by many US gynecologists to protect against the development of oncology. On average, a hysterectomy reduces the risk of ovarian cancer from 1:85 to 1:300. Disease prevention often includes a radical mastectomy - the removal of the breast, especially in women at risk. Remember - breast cancer is closely related to the functioning of the reproductive organs! In advanced cases, simultaneous removal of the mammary gland and uterus with appendages can be performed. This is especially true for women with a hereditary threat of breast cancer.

Access to organs

Amputation of the cervix, its cavity and appendages can be performed in several ways of surgical access:

• Laparoscopic, which involves the application of small punctures in the peritoneum, through which a laparoscope is inserted into the cavity - an optical device that transmits an image to a special monitor. The operation is carried out with the help of several thin instruments, after it there are no scars, and the rehabilitation is quick and painless.
• Laparotomy, based on the principle of standard abdominal surgery. In this case, a sufficiently long incision is made on the lower abdominal part, which can be transverse and longitudinal. Through it, the doctor gets access to all the organs of the small pelvis. Today, this access technique is outdated, and is practiced only with extensive lesions affecting several organs at the same time. The operation is also performed if there are adhesions in the body of the uterus that prevent its simplified removal from the peritoneum. Laparotomy access is used for emergency interventions.

Who needs surgery: direct indications

Amputation of the cervix and body of the organ can be carried out for a number of reasons:

• multiple uterine fibroids associated with cicatricial deformities and hypertrophy, or single large fibroids, or developing during premenopause;
• precancerous lesions of the organ cavity;
• death and torsion of the myomatous node;
• growth of the endometrium in the thickness of the uterus (adenomyosis);
• malignant tumors of the endometrium in the first stage;
• prolapse and prolapse of the uterus;
• polyposis and endometrial hyperplasia (atypical and recurrent);
• benign tumors of the uterus and appendages, prone to malignancy;
• violation of menstrual function against the background of modification of the endometrial tissue;
• chronic pain localized in the lower abdomen (also includes the pelvis and lower back);
• uterine bleeding of unknown origin, leading to hemoglobin deficiency;
• multiple pelvic adhesions.

Preventive surgery can be performed for breast cancer, since this organ is closely related to the functioning of the ovaries. Metastasis of a breast tumor almost always extends to this appendage. In the United States, such interventions are practiced quite often. The well-known Hollywood diva Angelina Jolie performed a radical bilateral mastectomy (complete removal of the breast) in order to protect against cancer, being extremely genetically susceptible to it. According to the actress, the next step in her preventive measures will be the removal of the ovaries. It should be noted that the results of her tumor markers after the removal of the mammary gland shocked the entire world community: the risk of developing a malignant tumor decreased from 78% to 3%.

If the doctor during the operation suspects the involvement of neighboring organs in the pathological process, amputation of the cervix and its cavity will be urgently supplemented by the elimination of the appendages.

Regardless of the method of access and the type of operation, it is very traumatic for the female body. Therefore, it requires careful preparation and rehabilitation. If the intervention was an emergency, it is important to strictly comply with all the rules and regulations indicated by the attending physician.

Absolute and relative contraindications for surgery

Hysterectomy itself has no absolute contraindications. However, certain types of intervention and access are not recommended for a number of pathologies.

Laparoscopy is not performed when:

1. large dimensions of the uterus;
2. voluminous ovarian cysts;
3. uterine prolapse.

An operation involving vaginal access is not performed when:

1. poorly differentiated cancer, when it is impossible to exclude its penetration into adjacent organs of the small pelvis;
2. too large volume of the body of the uterus;
3. cases, if previously there was a delivery by caesarean section;
4. processes that form adhesions in the organ (adhesions may interfere with the normal conduct of a hysterectomy);
5. inflammatory processes of internal organs.

Planned hysterectomy is not performed for diseases that cause an increase in body temperature, exacerbation of chronic disorders, menstrual bleeding.

The intervention is carried out with caution in breast cancer, especially if there is a suspicion of metastasis to the reproductive organs. To exclude direct contraindications, specific tests are prescribed - tumor markers.

Preparation for the operation and stages of its implementation

It should be emphasized that during surgical manipulations, unexpected pathologies may be detected, the presence of which it is desirable to exclude even on the eve of the operation.

Hysterectomy is performed after the doctor has studied the results of such studies:

1. vaginal smear;
2. assessment of vaginal mucus by the cultural method (bakposev);
3. TORCH complex;
4. PCR diagnostics;
5. general and biochemical blood/urine tests.

It is important to exclude or preliminarily cure phlebological and cardiological diseases. In some cases, pre-treatment of existing pathologies is necessary. For example, with rapidly growing fibroids, HRT is prescribed.

You must also provide the doctor with your blood type and Rh factor. He will without fail produce the necessary supply of biological fluid for emergency transfusion. You have to pick up and purchase a special bandage for yourself.

A special diet is recommended two days before the operation. At this time, it is worth giving preference to liquid and grated food, as well as fermented milk products. Meat should be excluded altogether, you can use only weak non-concentrated broths. Temporary paresis of the intestine, characteristic of recovery after surgery, provokes constipation. To exclude them in the postoperative period, in the evening before the day of surgery, it is worth putting an enema. The hysterectomy itself is traditionally performed on an empty stomach, and the diet is maintained for several days after the procedure. If the patient has varicose veins in the lower extremities, she needs to put on a bandage (tightening stockings), and this must be done on the day of the operation, without getting out of bed in the morning. Sedative premedication is applied just before the hysterectomy. But if the anxious mood does not leave the woman in preparation for the operation, it can be prescribed the day before.

Hysterectomy is performed under general anesthesia or combined spinal (epidural) anesthesia. Postoperative measures are partly aimed at detoxification after pain relief.

Any type of surgery is performed with the patient in the supine position. The treated area is pre-disinfected with concentrated antiseptics (alcohol and iodine). A puncture or incision is made along the white line of the abdomen. Then there is a layer-by-layer cutting of all tissues, and then, under the control of vision, the removal of the uterus and appendages from the cavity. In the case of the laparoscopic method, a special optical device is inserted into the peritoneum, and all manipulations are monitored on the operating monitor. With the help of thin instruments, the body of the uterus is removed, and then the vessels and ligaments are carefully tied up. The postoperative bandage, as a rule, is put on the patient in the operating room.

Postoperative rehabilitation

Before you get out of bed for the first time, it is recommended to put on the leg brace (compression stockings) again. Your abdominal area will also be protected by a bandage. His choice should be taken as carefully and responsibly as possible. Here it is important to take into account the recommendations of the doctor. The support bandage should be made from natural materials and have a breathable texture so that your wounds heal faster. The bandage should fit you in size. Despite the slimming property, it should not hamper movements and frankly put pressure on the injured areas. In addition, the postoperative bandage must be strong and reliable. You can not unfasten and remove it until the permission of the operating doctor. Antiseptic treatment is carried out directly in the hospital, where you will have to stay for 3-5 days. You can remove the bandage no earlier than 2 weeks after the intervention. It is possible to wash only partially, it is not recommended to take a shower and a bath. After the bandage is removed, the doctor will remove the stitches from the incisions. From now on, you will need to periodically treat the wounds and closely monitor their "behavior".

Painkillers are given by injection during your stay in the clinic. The doctor then switches the woman to their oral regimen, if necessary, and the treated area is still sore.

If you have had a traditional hysterectomy, for 6 weeks you should refrain from:

• lifting weights (more than 5 kg);
• intense physical activity;
• sexual contacts;
• swimming in open water;
• taking a bath.

After laparoscopy, all of the above restrictions are relevant for 2 weeks.

Bloody discharge after removal of the uterus is the norm. They may appear within 2 months. Discharge after removal of the uterus by surgery has a creamy texture and a brown tint. If the discharge has become scarlet, and clots have appeared in them, and the stomach hurts more intensely than during menstruation, you should immediately consult a doctor. As for hygiene products, you should opt for pads and stop using tampons. After the completion of physiological bleeding, menstruation will no longer bother you.

After the operation, it is recommended to start physical activity as soon as possible. If you feel too bad, do light exercises while lying down. You will be given anticoagulation therapy to prevent blood clots.

Nutrition after removal of the uterus implies a soft rationalization of nutrition, in which it is worth abandoning any products that irritate the mucous membrane. The diet involves the rejection of flour, sweet, smoked, cottage cheese and strong drinks (tea and coffee). Of course, the diet requires the complete exclusion of alcohol.

Physical activity can be started no earlier than 2-3 months after the hysterectomy. Sex is allowed only 6 weeks after the intervention. Since periods no longer come, contraception is not necessary if the partner is permanent.

The doctor will definitely prescribe you HRT and radiation, if necessary.

Additional prevention of oncology: radiation

If you have a small, dormant tumor, you may be given radiation therapy after surgery. It involves external or internal irradiation of organs with X-rays or other powerful particles. For more severe forms of cancer, external beam radiation therapy is combined with chemotherapy. In this case, irradiation is supplemented by a drop infusion of special preparations, selected individually. Radiation therapy does not have serious side effects, but it can be complicated by severe stool disorder, especially if adhesions are concentrated in the pelvis. After completion of the course, spikes, on the contrary, will appear less brightly. Radiation therapy is often prescribed to relieve pain in advanced cancers. X-ray irradiation is the most gentle therapy for cancer at an early stage.

Possible complications and consequences of hysterectomy

After surgery, you may experience the following complications:

• hematomas and swelling of the treated area;
• bleeding of varying intensity;
• pain in the breast area;
• urination disorders;
• injuries to nearby tissues and organs (in particular, intestinal adhesions);
• wound infection;
• venous thrombosis;
• genital prolapse;
• endometriosis on the stump of the uterus.

The onset of menopause follows after the removal of the ovaries. In this case, the patient is prescribed HRT drugs to maintain health, as with the onset of early menopause. HRT is necessary for the active prevention of atherosclerosis, osteoporosis and cardiovascular pathologies. HRT also helps prevent premature aging. HRT can also be prescribed to mature women if indicated.

After any type of hysterectomy, infertility occurs and menstruation ends.

If there are additional adhesions on the background of the operation, it is recommended to turn to laser treatment.

Quality of life after amputation of the uterus

Most women who have undergone surgery, 2 months after it, begin to feel much better than before the operation. Menstruation stops, nothing hurts in PMS, libido increases, the need to use contraception is eliminated. Some endure the condition extremely hard due to the psychological aspect. Young women clearly understand that they can no longer have children, and plunge into depression. In this case, the full support and help of a qualified psychotherapist is necessary. Despite everything, a certain degree of risk of oncology after a hysterectomy remains, therefore it is recommended to be examined in a timely manner and regularly take tests.

Hysterectomy is a complex and traumatic operation that can save lives. Try not to despair and get some benefit from it. Be healthy!