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Removal of the uterus is a serious operation involving the removal of appendages from a woman’s body, which are responsible not only for fertility, but also for the production of hormones important for the entire body. One of the first symptoms after a hysterectomy is symptoms usually associated with menopause.
When a woman decides to have her uterus removed, she is often anxious. Especially when he hears opinions of friends saying that after the procedure they do not feel like women anymore. It is also for this reason that he is concerned about the relationship with his partner. On the other hand, she is aware that such an operation will improve her health and, in the case of oncological changes, it will save her life.
To reassure, it is worth adding that this type of treatment is not performed automatically. A woman’s age is of great importance (most often it is the period of menopause), whether she gave birth, and the diseases she is struggling with. The presence of vaginal bleeding, endometriosis, fibroids, and adnexal tumors qualifies for the procedure of removing the uterus. The operation may include the removal of the uterus itself or the uterus and the appendages (body, cervix, ovaries and fallopian tubes).
Removal of the uterus – causes
The first and most common symptom to worry about is abnormal vaginal bleeding. This situation should always be diagnosed. Bleeding can cause fibroids, endometrial diseases (abnormal growths), but also cervical and endometrial cancers (considered a disease mainly in women over 50). However, removal of the uterus is not always necessary. Doctors may perform endometrial resection, i.e. endoscopic removal of the lining of the uterus.
One of the symptoms of fibroids is heavy, prolonged periods, which can lead to iron deficiency anemia. This ailment, as well as the rapid growth of fibroids or pressure on adjacent organs (rectum or bladder), are generally indications for treatment. Myomas are detected during gynecological examination and ultrasound.
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Removal of the uterus – diagnosis
Ovarian tumors are also an indication for the removal of the uterus. Unfortunately, it is not always possible to diagnose them early. – This is especially true of ovarian cancer, which is revealed very late, only when it is spread within the abdominal cavity and ascites. A woman may widen the waist of her clothes, thinking she is putting on weight. Meanwhile, this is how the advanced stage of cancer manifests itself – says oncologist Roman Czarnecki from the Provincial Specialist Hospital in Wrocław.
That is why prevention is so important. The basic tests related to the detection of neoplasms of the reproductive organs are: gynecological, cytological, colposcopic, histopathological, CA-125 marker, ultrasound, computed tomography.
Larger fibroids also qualify for the removal of the uterus, especially if they grow rapidly, as this may suggest malignant changes. It could be like in the case of 49-year-old Maria: – It started with two hemorrhages in a short time. The latter was abundant and scared me. The gynecologist suggested surgery as soon as possible, said that myomas, with which nothing happened for a long time, now began to grow rapidly.
However, in the case of fibroids, surgery to remove the uterus is not the only option. An alternative may be embolization. It consists in destroying the myoma inside the body. Its downside is the inability to perform a histopathological examination. The procedure is usually performed on women who have not yet given birth.
Due to the frequency of cancer, it is worth carrying out regular genetic tests of the most common mutations responsible for breast cancer and ovarian cancer.
Only the silly one is not afraid
Often times, a woman who hears about a hysterectomy becomes confused and scared. If the reason is “harmless” fibroids, why is it necessary? Maybe the gynecologist doesn’t say everything and it’s actually cancer? It is worth talking to your doctor and asking them to explain what is happening in the body to find out how the surgery will affect its functioning later. In such a situation, the support of close people is important. If they cannot be counted on, it is worth seeing a psychologist and telling about your thoughts and fears.
– It is good to be aware of the “gains and losses” of such a procedure – says psychologist Tatiana Ostaszewska-Mosak from the Center for Counseling and Therapy in Warsaw. – This is not a trivial operation, but it will be easier for us to prepare for it if we realize that its purpose is to improve health or even save a life. It is supposed to help us, not to harm us. Thanks to it, the troublesome bleeding, which is so troublesome in the climacteric period, will stop, she adds.
Removal of the uterus – course
The operation is performed under general anesthesia. Most often, the abdominal wall is cut transversely (pubic symphysis line) or longitudinally (navel – pubic symphysis), about 15-20 cm. The procedure can also be performed vaginally or laparoscopically – the surgeon makes three 2-3 cm incisions, inserts instruments and operates to remove organs through the vagina. If the cause is fibroids, in both cases it is possible to reduce them pharmacologically earlier in order to facilitate the procedure. The doctor decides which method to choose, taking into account the type of disease, anatomy and age of the woman.
The patient has smaller wounds after laparoscopy, but the healing process is similar. On the second day after surgery, doctors recommend getting out of bed to prevent the formation of blood clots and adhesions. A woman should stay on a strict diet for 2 days and under medical supervision for 3 to 7 days, and up to 2 weeks – if the surgery was oncological in nature. During this time, complications may occur: infection, hemorrhage, thromboembolic complications, urinary incontinence or postoperative intestinal obstruction.
If all goes well, the patient is discharged from the hospital with one month off work. After this time, it is checked with the result of histopathology. The next tests should be performed as standard – once a year. Different rules apply to a woman after oncological surgery – she must undergo a diagnosis 2-3 times a year and see a doctor every 4-6 months. After the operation, she should not lift or play sports, but it is advisable to follow an easily digestible diet. As after any surgical intervention, a gradual return to physical activity is recommended. If the instructions are not followed, a hernia, bleeding or intestinal complications may result.
Removal of the uterus and hormone replacement therapy
Hormones (estrogens and progestins) are produced in the ovaries. It is the shortage of the former that is responsible for the unpleasant symptoms of menopause, which is why they are supplemented pharmacologically. Women who do not have their womb removed should undergo combination hormone therapy (estrogen and progestin) to protect the uterine lining. In this case, the administration of estrogen alone may lead to neoplastic changes.
However, if an operation to remove the uterus with appendages was performed, only estrogen is administered. It turned out that this method is much safer after several years of use than complex therapy, although after 5-7 years of treatment, a slight increase in the risk of breast cancer was observed.
It happens, however, that women refuse to take hormones. They say it is harmful therapy, and there are also those who believe nature should not be interfered with. So what are the facts and myths about HRT? – Women who do not choose hormone therapy are at greater risk of osteoporosis and atherosclerosis. After the menopause, bone loss occurs, and with age, the risk of fractures increases. Hormones slow down the process of osteoporosis, but also have a cardioprotective effect. They protect against the development of ischemic heart disease, provided that HRT is introduced at the right time, preferably in the transitional period, before menopause, says gynecologist Agnieszka Antczak-Judycka from the Damian Medical Center in Warsaw.
Estrogen therapy reduces hot flashes, night sweats, trouble sleeping, but also relieves senile vaginitis and vaginal dryness, cystitis and delays the aging process of the skin that appears after menopause. Hormones can be taken in various forms – patches, creams or gels on the skin, tablets or injections, vaginal pessaries or creams. It should also be remembered that the effect of hormone therapy is not immediate, its effect can be assessed only after 3-4 months.
Life after the removal of the uterus
How a woman feels after surgery largely depends on herself. First of all, she should accept the result and explain what she gained
– after all the ailments that caused fear and pain have disappeared. For some, it may be important to know that there are no more fibroids in the abdomen, which could have turned into a malignant tumor over time.
Women are also concerned about intimate relationships with their partner. Abstinence is recommended for a month after the procedure, but it all depends on your well-being and the results of the medical check-up. Often the fears are unfounded, and women say sex is more rewarding than before. However, they sometimes complain of vaginal dryness emerging.
Consultation: lek. med. Roman Czarnecki, surgeon-oncologist, Provincial Specialist Hospital H. Kamiński in Wrocław, Department of Oncological Surgery and Clinical Oncology; Agnieszka Antczak-Judycka, MD, PhD, gynecologist, Damian Medical Center in Warsaw.
Source: Let’s live longer
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