Consequences of surgical removal of the uterus and ovaries. Removal of the uterus - the most common indications, types of operations and recovery rules

Hysterectomy or is a fairly common operation. Most often, it is performed if there are tumors in this organ or if metastases occur after cancer treatment in other tissues of the body.

In extremely rare cases, such an operation is carried out at the request of a woman for contraceptive purposes. Also, the uterus can be removed in some pathologies of pregnancy, when the operation is the only way save the life of mother and child.

The most common reasons for hysterectomy:

Fibrosis or;
Birth infection;
Heavy bleeding during or outside of pregnancy;
Uterine prolapse.

Removal of the uterus is usually performed only in cases where less traumatic treatment options do not exist. However, women are afraid of the consequences of this operation and wonder whether they will be able to live full life after hysterectomy.

Removal of the uterus (hysterectomy): what happens after the operation?

This is enough major surgery, after which the woman has a long wait recovery period. If it is carried out under general anesthesia, then the first hours after waking up a woman may be bothered by nausea. After about 1-2 hours it should feel better and the patient will be able to drink water, and after 3-4 hours eat. But in some cases, the unpleasant sensations drag on.

At first, severe pain and low-grade fever are considered normal. Doctors may also leave a catheter in the bladder to drain urine for 1-2 days.

When will it be possible to get out of bed?

Movement is one of the conditions quick recovery after operation. It allows you to avoid stagnation of blood in the pelvic area, as well as disturbances in intestinal function. After laparoscopy, you can get up after a few hours, and if a full-scale abdominal operation was performed, on the second day.

Pain after surgery

You need to be prepared for the fact that after the anesthesia wears off there will be real pain, both in the area of the sutures and in the abdomen. Pain may also occur during urination due to damage to the urethral mucosa. Therefore, women in the postoperative period, for about 5 days, must be prescribed strong analgesics.

It has been proven that severe pain significantly slows down the healing process, so taking painkillers is mandatory.

Gradually, the wounds will heal and the discomfort will decrease. But slight tingling and pulling sensations may persist for several months. This is due to damage to the nerve endings and will gradually pass.

When will they be discharged from the hospital?

The length of your hospital stay depends on several factors:

How extensive was the surgery?
Reasons for which the operation was performed.
The patient's well-being.
Absence or presence of complications.

In each individual case, based on the available data, the doctor decides when to drink the patient. But even after discharge, the woman must continue treatment; sick leave lasts on average 30-45 days.

How long does it take to recover after hysterectomy?

The duration of the recovery period usually depends on the characteristics of the operation and the presence of complications. Quite quickly, in just 2-4 weeks, health improves if the uterus is removed laparoscopic method- through small incisions on the abdomen. If the organ is removed through the vagina, the recovery period may take 3-4 weeks. After an abdominal hysterectomy, recovery takes at least 4-6 weeks.

Until the end of the recovery period, it is necessary to limit activity; travel and air travel are also prohibited. You can travel no earlier than 4 weeks after laparoscopy and 6 weeks after major surgery surgical intervention.

How long should you not lift weights after hysterectomy?

For the first time after surgery, it is strictly forbidden to load the muscles of the abdominal wall, as well as the pelvic floor, therefore physical exercise and heavy lifting are prohibited. For approximately 4-6 weeks, you must completely stop lifting objects heavier than 1-2 kg. If after this period the woman feels well, you can increase the weight slightly. But if any discomfort arises, you should immediately lower the object.

Many women cannot lift more than 2 kg for a whole year after surgery and more than 5 kg for the rest of their lives.

Under no circumstances should you test your strength by trying to lift weights; this can lead to abdominal pain, bleeding, and even the formation of a hernia, which will subsequently have to be removed surgically.

How long can you not have sex after a hysterectomy?

Sexual activity after hysterectomy is permitted after 4-6 weeks, depending on the complexity of the operation and the speed of recovery of the patient’s body. Sometimes you have to limit your sex life for six months or even a year.

It should also be taken into account that with the simultaneous removal of the ovaries, the woman’s hormonal levels are disrupted, so sexual desire may decrease. It is normalized after the administration of appropriate hormonal drugs.

How long can you not swim after a hysterectomy?

For the first time after the operation, it is forbidden to swim in the pool and especially in open reservoirs due to the questionable quality of the water in them. You can return to your favorite activity no earlier than 6-8 weeks after the hysterectomy.

Diet after surgery to remove the uterus and appendages

Immediately after surgery it is very important to avoid dehydration, so proper drinking regime, i.e. drink at least one and a half liters of water per day. As for nutrition, you need to start eating with small amounts of liquid and semi-liquid dishes, gradually expanding your diet. All food should contain a minimum of salt to prevent fluid retention and swelling.

You need to eat small portions 6-7 times a day. Food should contain fiber to restore normal bowel function and prevent constipation. Calorie intake is increased gradually, introducing new foods with caution. In this case, the food should not be too fatty or spicy.

In the early postoperative period, the consumption of foods that promote development, such as chocolate, pastries, strong coffee and tea, is prohibited. Bloating can cause the stitches to come apart.

After a hysterectomy, patients are often diagnosed with a decrease in hemoglobin levels in the blood. Eating dried apricots, buckwheat, pomegranate juice and lean meat.

It is important to adhere to a gentle diet for the first 2-4 months after surgery, then you can return to your usual diet. But we must remember that after removal of the uterus, many women gain excess weight Therefore, it is important to control calorie intake and physical activity levels.

Suture after hysterectomy

The postoperative suture can be either very small after laparoscopy or quite large after abdominal hysterectomy. In any case, it requires careful care until it heals completely.

If the suture is made using absorbable material, then after about 6 weeks it will disappear on its own. In other cases, the surgeon warns you when to return to the hospital to remove the stitches.

The first time after surgery, the suture must be treated with special means to avoid infection. You can take a shower without fear, but taking a bath is prohibited. The seam is carefully washed with liquid soap and washed off with water.

Gradually, a scar will form at the incision site. Sometimes the skin itches a little, it can be lubricated with a softening cream or lotion. A slight burning sensation or numbness in the scar area is normal and usually goes away after a couple of months.

Brown vaginal discharge after hysterectomy

After a hysterectomy, bloody vaginal discharge is normal. Their hue can be brown, reddish or pink, but the intensity always decreases. After about 4-6 weeks, the discharge stops. Typically, women note that their number increases with active movement.

If there is bleeding after removal of the uterus, it is forbidden to use tampons, only sanitary pads, preferably made of breathable material.

The nature of discharge in different patients can vary greatly, but there are clear boundaries of the norm. The reason for immediately contacting a doctor is:

An increase in the amount of discharge over time;
The appearance of copious bright red discharge (if the pads have to be changed more often than once every hour and a half);
The presence of too large clots may indicate a large-scale internal bleeding;
The appearance of pus in the discharge and an unpleasant odor.

Temperature after hysterectomy

A slight increase in temperature in the first days after surgery is normal. If necessary, the doctor may prescribe antibiotics. After discharge, the temperature may also remain elevated, but not more than 37.5 °C. If it exceeds this mark, you should consult a doctor.

Removal of the uterus and menopause

Many women are afraid of a hysterectomy, believing that menopause will occur immediately after it. But if during the operation only the uterus was removed, but the tubes and ovaries were preserved, then practically no changes in the woman’s hormonal background will occur, the state of health will not change, only menstruation will disappear.

In this case, menopause occurs naturally when the supply of eggs in the body runs out.

There is an opinion that removing the uterus can slightly speed up the onset of menopause, by about 5 years. This is due to a violation of the blood supply to the ovaries, which mostly occurs due to the uterine arteries.

If during hysterectomy the appendages were also removed, surgical menopause begins. Usually it is a little more difficult to tolerate than natural, since during normal menopause the production of sex hormones stops gradually and the body has time to adapt to this, but after surgery it happens suddenly. It is most difficult for women of childbearing age.

Approximately 2-3 weeks after surgery, symptoms of menopause appear, which differ little from the signs of natural menopause - hot flashes, sweating, emotional instability, dry skin and hair, urinary incontinence when coughing and laughing, and vaginal dryness. Timely administration of hormone replacement therapy helps to avoid these problems.

Properly selected medications not only relieve unpleasant symptoms, but also help avoid osteoporosis and reduce the risk of cardiovascular diseases and Alzheimer's disease.

Substitute hormone therapy may not be carried out in all cases. Contraindications to it are:

Oncological diseases;
Kidney and liver diseases;
Meningioma;
Pathologies of the leg veins (thromboembolism, thrombophlebitis).

It should also be remembered that there is no immediate improvement after starting treatment, and you will have to take medications for years until the time of natural menopause comes.

What complications are possible after removal of the uterus?

Although hysterectomy is a complex abdominal operation, complications after it are quite rare. But you need to know them in order to notice them in time and consult a doctor. Complications can occur both immediately after surgery and for several years after it.

In the first weeks or months after a hysterectomy, the patient faces:

Wound inflammation. It manifests itself in the form of swelling, redness, severe pain and pulsation of the skin in the wound area. The temperature can rise to 38 °C or more. Deterioration in health, headaches and nausea are also often recorded.
Bleeding. The opening of some vessels after surgery can lead to heavy bleeding from the vagina. The blood is usually red and there may be clots.
Inflammation of the bladder and/or urethra. It arises due to mechanical damage mucous membranes during catheter insertion. After removing it, they remain painful sensations, which usually go away in 4-5 days. If the pain does not go away or gets worse, you should consult a doctor.
Blockage of blood vessels by blood clots or thromboembolism. This complication most often occurs in patients who move little, so doctors recommend trying to get up and walk as early as possible.

There are a number of complications that arise some time after surgery, perhaps even years later:

Post-variectomy symptoms or premature menopause occur after a hysterectomy with removal of the ovaries. They are characterized by all the symptoms of menopause. Physiotherapy, exercise and hormonal medications are recommended for treatment.
Prolapse of the vaginal walls is one of the most frequent complications. Wearing a vaginal ring and Kegel exercises can partly prevent it. In the most difficult situations surgery is required.
Urinary incontinence has two main causes - weakening of the ligamentous apparatus and a decrease in the level of estrogen in the blood in case of removal of the ovaries. It is eliminated with the help of special exercises and hormonal drugs. No re-operation is required.
Pain due to the development of adhesions requires the use of enzyme preparations. A thorough diagnosis is also necessary, since pain may occur due to incompetent sutures.
The formation of a fistula sometimes occurs when the sutures fail and an infection occurs. The problem can be solved with the help of an additional operation for sanitation and suturing of the tract.

Very often women experience depression, and after surgery they begin to consider themselves inferior. Therefore, doctors try to leave at least one ovary and part of the uterus to maintain normal menstrual cycle. This allows you to avoid depressive moods and maintain normal hormonal levels.

To avoid many problems, it is very important to talk with the patient before the operation, explain to her that the uterus is an organ intended exclusively for bearing offspring and the rest of the time there is no great need for it. After a hysterectomy, her body will not change, the disease, the risk to life and the need for contraception will simply disappear.

Hysterectomy or removal of the uterus is a fairly common operation that is performed for certain indications. According to statistics, approximately a third of women who have crossed the 45-year mark have undergone this operation.

And of course, main question The question that worries patients who have undergone surgery or are preparing for surgery is: “What consequences can there be after removal of the uterus”?

Postoperative period

As you know, the period of time that lasts from the date of surgical intervention to restoration of ability to work and good health is called the postoperative period. Hysterectomy is no exception. The period after surgery is divided into 2 “sub-periods”:

early
late postoperative periods

During the early postoperative period, the patient is in the hospital under the supervision of doctors. Its duration depends on the surgical approach and the general condition of the patient after surgery.

After surgery to remove the uterus and/or appendages which was performed either vaginally or through an incision in the anterior abdominal wall, the patient is in gynecological department 8 – 10 days, it is at the end of the agreed period that the stitches are removed.
After laparoscopic hysterectomy the patient is discharged after 3–5 days.

The first day after surgery

The first postoperative days are especially difficult.

Pain - during this period, the woman feels significant pain both inside the abdomen and in the area of the sutures, which is not surprising, since there is a wound both outside and inside (just remember how painful it is when you accidentally cut your finger). To relieve pain, non-narcotic and narcotic painkillers are prescribed.

Lower limbs remain, as before the operation, in or bandaged elastic bandages(prevention of thrombophlebitis).

Activity - surgeons adhere to active management of the patient after surgery, which means getting out of bed early (after laparoscopy in a few hours, after laparotomy in a day). Physical activity “accelerates the blood” and stimulates intestinal function.

Diet - the first day after a hysterectomy, a gentle diet is prescribed, which contains broths, pureed food and liquids (weak tea, still mineral water, fruit drinks). Such treatment table Gently stimulates intestinal motility and promotes early (1–2 days) spontaneous bowel movement. Independent stool indicates the normalization of intestinal function, which requires a transition to regular food.

Belly after hysterectomy remains painful or sensitive for 3–10 days, which depends on the patient’s pain sensitivity threshold. It should be noted that the more active the patient is after surgery, the faster her condition recovers and the lower the risk of possible complications.

Treatment after surgery

Antibiotics - usually prescribed for prophylactic purposes antibacterial therapy, since the patient’s internal organs came into contact with air during the operation, and therefore with various infectious agents. The course of antibiotics lasts an average of 7 days.
Anticoagulants - also in the first 2 - 3 days, anticoagulants (blood thinning drugs) are prescribed, which are designed to protect against thrombosis and the development of thrombophlebitis.
Intravenous infusions- in the first 24 hours after hysterectomy, infusion therapy (intravenous drip infusion solutions) in order to replenish the volume of circulating blood, since the operation is almost always accompanied by significant blood loss (the volume of blood loss during an uncomplicated hysterectomy is 400 - 500 ml).

The course of the early postoperative period is considered smooth if there are no complications.

Early postoperative complications include:

inflammation of the postoperative scar on the skin (redness, swelling, purulent discharge from the wound and even dehiscence);
problems with urination(pain or pain when urinating) caused by traumatic urethritis (damage to the mucous membrane of the urethra);
bleeding of varying intensity, both external (from the genital tract) and internal, which indicates insufficiently well-performed hemostasis during surgery (discharge may be dark or scarlet, blood clots are present);
thromboembolism pulmonary artery - a dangerous complication that leads to blockage of the branches or the pulmonary artery itself, which can lead to pulmonary hypertension in the future, the development of pneumonia and even death;
peritonitis - inflammation of the peritoneum, which spreads to other internal organs, dangerous for the development of sepsis;
hematomas (bruises) in the area of the sutures.

Bloody discharge after removal of the uterus, like a “daub,” is always observed, especially in the first 10–14 days after the operation. This symptom is explained by the healing of sutures in the area of the uterine stump or in the vaginal area. If a woman’s discharge pattern changes after surgery:

accompanied by an unpleasant, putrid odor
the color resembles meat slop

You should consult a doctor immediately. It is possible that inflammation of the sutures in the vagina has occurred (after hysterectomy or vaginal hysterectomy), which is fraught with the development of peritonitis and sepsis. Bleeding from the genital tract after surgery is a very alarming signal and requires repeat laparotomy.

Suture infection

In case of infection postoperative suture general body temperature rises, usually not higher than 38 degrees. The patient’s condition, as a rule, does not suffer. Prescribed antibiotics and treatment of sutures are quite enough to relieve this complication. The first time the postoperative dressing is changed and the wound is treated the next day after the operation, then the dressing is carried out every other day. It is advisable to treat the sutures with a solution of Curiosin (10 ml, 350-500 rubles), which ensures gentle healing and prevents the formation of a keloid scar.

Peritonitis

The development of peritonitis more often occurs after a hysterectomy performed for emergency reasons, for example, necrosis of a myomatous node.

The patient's condition deteriorates sharply
The temperature “jumps” to 39 – 40 degrees
Pronounced pain syndrome
Signs of peritoneal irritation are positive
In this situation, massive antibiotic therapy is carried out (prescription of 2–3 drugs) and infusion of saline and colloid solutions
If the effect from conservative treatment no, surgeons perform a relaparotomy, remove the uterine stump (in case of uterine amputation), wash the abdominal cavity with antiseptic solutions and install drainages

The hysterectomy slightly changes the patient’s usual lifestyle. For quick and successful recovery After surgery, doctors give patients a number of specific recommendations. If the early postoperative period proceeded smoothly, then after the woman’s stay in the hospital expires, she should immediately take care of her health and the prevention of long-term consequences.

Bandage

A good help in the late postoperative period is wearing a bandage. It is especially recommended for premenopausal women who have had a history of multiple births or for patients with weakened abdominal muscles. There are several models of such a supportive corset; you should choose the model in which the woman does not feel discomfort. The main condition when choosing a bandage is that its width must exceed the scar by at least 1 cm above and below (if an inferomedial laparotomy was performed).

Sex life, weight lifting

Discharge after surgery continues for 4 to 6 weeks. For one and a half, and preferably two months after a hysterectomy, a woman should not lift weights of more than 3 kg and perform heavy physical work, otherwise this could lead to the rupture of internal sutures and abdominal bleeding. Sexual activity during the specified period is also prohibited.

Special exercises and sports

To strengthen the vaginal muscles and pelvic floor muscles, it is recommended to perform special exercises, using the appropriate simulator (perineal gauge). It is the simulator that creates resistance and ensures the effectiveness of such intimate gymnastics.

The described exercises (Kegel exercises) got their name from a gynecologist and developer of intimate gymnastics. You must perform at least 300 exercises per day. Good tone of the vaginal and pelvic floor muscles prevents prolapse of the vaginal walls, prolapse of the uterine stump in the future, as well as the occurrence of such an unpleasant condition as urinary incontinence, which almost all women in menopause face.

Sports after a hysterectomy are easy physical activity in the form of yoga, Bodyflex, Pilates, shaping, dancing, swimming. You can start classes only 3 months after the operation (if it was successful, without complications). It is important that physical education during the recovery period brings pleasure and does not exhaust the woman.

About baths, saunas, and the use of tampons

For 1.5 months after surgery, it is prohibited to take baths, visit saunas, steam baths and swim in open water. While there is spotting, you should use sanitary pads, but not tampons.

Nutrition, diet

Of no small importance in the postoperative period is proper nutrition. To prevent constipation and gas formation, you should consume more liquid and fiber (vegetables, fruits in any form, wholemeal bread). It is recommended to give up coffee and strong tea, and, of course, alcohol. Food should not only be fortified, but contain the required amount of proteins, fats and carbohydrates. A woman should consume most of her calories in the first half of the day. You will have to give up your favorite fried, fatty and smoked foods.

Sick leave

The total period of incapacity for work (counting the time spent in the hospital) ranges from 30 to 45 days. If any complications arise, the sick leave is naturally extended.

Hysterectomy: what then?

In most cases, women after surgery face psycho-emotional problems. This is due to the existing stereotype: there is no uterus, which means there is no main female distinctive feature, accordingly, I am not a woman.

In reality, this is not the case. After all, it is not only the presence of a uterus that determines a woman’s essence. To prevent the development of depression after surgery, you should study the issue regarding removal of the uterus and life after it as carefully as possible. After the operation, the husband can provide significant support, because outwardly the woman has not changed.

Fears regarding changes in appearance:

increased facial hair growth

decreased sex drive

weight gain

changing voice timbre, etc.

are far-fetched and therefore easily overcome.

Sex after hysterectomy

Sexual intercourse will give the woman the same pleasures as before, since all sensitive areas are located not in the uterus, but in the vagina and external genitalia. If the ovaries are preserved, then they continue to function as before, that is, they secrete the necessary hormones, especially testosterone, which is responsible for sexual desire.

In some cases, women even note an increase in libido, which is facilitated by relief from pain and other problems associated with the uterus, as well as a psychological moment - the fear of unwanted pregnancy disappears. Orgasm will not disappear after amputation of the uterus, and some patients experience it more vividly. But the occurrence of discomfort and even...

This point applies to those women who have had a hysterectomy (a scar in the vagina) or a radical hysterectomy (Wertheim operation), in which part of the vagina is excised. But this problem is completely solvable and depends on the degree of trust and mutual understanding of the partners.

One of the positive aspects of the operation is the absence of menstruation: no uterus - no endometrium - no menstruation. This means goodbye to critical days and the troubles associated with them. But it’s worth mentioning that, rarely, women who have undergone uterine amputation while preserving the ovaries may experience slight spotting on menstruation. Explained this fact simple: after amputation, a uterine stump remains, and therefore a little endometrium. Therefore, you should not be afraid of such discharges.

Loss of fertility

The issue of loss deserves special attention reproductive function. Naturally, since there is no uterus - the place of fruit, pregnancy is impossible. Many women list this fact as a plus for having a hysterectomy, but if the woman is young, this is definitely a minus. Before suggesting removal of the uterus, doctors carefully assess all risk factors, study the medical history (in particular the presence of children) and, if possible, try to preserve the organ.

If the situation allows, the woman either has myomatous nodes excised (conservative myomectomy) or the ovaries are left behind. Even with an absent uterus, but preserved ovaries, a woman can become a mother. IVF and surrogacy are a real way to solve the problem.

Suture after hysterectomy

The suture on the anterior abdominal wall worries women no less than other problems associated with hysterectomy. Laparoscopic surgery or a transverse incision in the lower abdomen will help to avoid this cosmetic defect.

Adhesive process

Any surgical intervention in the abdominal cavity is accompanied by the formation of adhesions. Adhesions are connective tissue cords that form between the peritoneum and internal organs, or between organs. Almost 90% of women suffer from adhesive disease after a hysterectomy.

Forced penetration into the abdominal cavity is accompanied by damage (dissection of the peritoneum), which has fibrinolytic activity and ensures lysis of fibrinous exudate, gluing the edges of the dissected peritoneum.

An attempt to close the area of the peritoneal wound (suturing) disrupts the process of melting of early fibrinous deposits and promotes increased adhesions. The process of formation of adhesions after surgery depends on many factors:

duration of the operation;
volume of surgical intervention (the more traumatic the operation, the higher the risk of adhesions);
blood loss;
internal bleeding, even leakage of blood after surgery (resorption of blood provokes adhesions);
infection (development of infectious complications in the postoperative period);
genetic predisposition (the more the genetically determined enzyme N-acetyltransferase, which dissolves fibrin deposits, is produced, the lower the risk of adhesive disease);
asthenic physique.

pain (constant or intermittent)
urination and defecation disorders
, dyspeptic symptoms.

To prevent the formation of adhesions in the early postoperative period, the following are prescribed:

antibiotics (suppress inflammatory reactions in the abdominal cavity)
anticoagulants (thin the blood and prevent the formation of adhesions)
motor activity already on the first day (turning on its side)
early start of physiotherapy (ultrasound or, Hyaluronidase, and others).

Properly carried out rehabilitation after a hysterectomy will prevent not only the formation of adhesions, but also other consequences of the operation.

Menopause after hysterectomy

One of the long-term consequences of hysterectomy surgery is menopause. Although, of course, any woman sooner or later approaches this milestone. If during the operation only the uterus was removed, but the appendages (tubes with ovaries) were preserved, then the onset of menopause will occur naturally, that is, at the age for which the woman’s body is “programmed” genetically.

However, many doctors are of the opinion that after surgical menopause, menopausal symptoms develop on average 5 years earlier than expected. There are no exact explanations for this phenomenon yet; it is believed that the blood supply to the ovaries after a hysterectomy somewhat deteriorates, which affects their hormonal function.

Indeed, if we recall the anatomy of the female reproductive system, the ovaries are mostly supplied with blood from the uterine vessels (and, as is known, they pass quite a lot in the uterus large vessels– uterine arteries).

To understand the problems of menopause after surgery, it is worth defining the medical terms:

natural menopause - cessation of menstruation due to the gradual fading of the hormonal function of the gonads (see)
artificial menopause - cessation of menstruation (surgical - removal of the uterus, medication - suppression of ovarian function with hormonal drugs, radiation)
surgical menopause – removal of both the uterus and ovaries

Women endure surgical menopause more severely than natural menopause, this is due to the fact that when natural menopause occurs, the ovaries do not immediately stop producing hormones; their production decreases gradually, over several years, and eventually stops.

After removal of the uterus and appendages, the body undergoes a sharp hormonal change, since the synthesis of sex hormones suddenly stopped. Therefore, surgical menopause is much more difficult, especially if a woman is of childbearing age.

Symptoms of surgical menopause appear within 2–3 weeks after surgery and are not much different from the signs of natural menopause. Women are concerned about:

tides (see)
sweating ()
emotional lability
Depressive states often occur (see and)
later dryness and aging of the skin occur
brittleness of hair and nails ()
urinary incontinence when coughing or laughing ()
Vaginal dryness and related sexual problems
decreased sex drive

In case of removal of both the uterus and ovaries, hormone replacement therapy is necessary, especially for women under 50 years of age. For this purpose, both gestagens and testosterone are used, which is mostly produced in the ovaries and a decrease in its level leads to a weakening of libido.

If the uterus and appendages were removed due to large myomatous nodes, then the following is prescribed:

continuous estrogen monotherapy, used as oral tablets (Ovestin, Livial, Proginova and others),
products in the form of suppositories and ointments for the treatment of atrophic colpitis (Ovestin),
as well as preparations for external use (Estrogel, Divigel).

If a hysterectomy with adnexa was performed for internal endometriosis:

treatment with estrogens (Kliane, Progynova)
together with gestagens (suppression of the activity of dormant foci of endometriosis)

Hormone replacement therapy should be started as early as possible, 1 to 2 months after the hysterectomy. Hormone treatment significantly reduces the risk of cardiovascular disease, osteoporosis and Alzheimer's disease. However, hormone replacement therapy may not be prescribed in all cases.

Contraindications to treatment with hormones are:

surgery for ;
pathology of the veins of the lower extremities (thrombophlebitis, thromboembolism);
severe pathology of the liver and kidneys;
meningioma.

The duration of treatment ranges from 2 to 5 or more years. You should not expect immediate improvement and disappearance of menopausal symptoms immediately after starting treatment. The longer hormone replacement therapy is carried out, the less pronounced the clinical manifestations are.

Other long-term consequences

One of the long-term consequences of hysterovariectomy is the development of osteoporosis. Men are also susceptible to this disease, but the fairer sex suffers from it more often (see). Related this pathology with a decrease in estrogen production, therefore, in women, osteoporosis is more often diagnosed during pre- and postmenopausal periods (see).

Osteoporosis is chronic disease, prone to progression and is due to such exchange disorder skeleton, as calcium leaching from bones. As a result, the bones become thinner and brittle, which increases the risk of fractures. Osteoporosis is very insidious disease, long time it proceeds hidden and is detected in an advanced stage.

The most common fractures occur in the vertebral bodies. Moreover, if one vertebra is damaged, there is no pain as such; severe pain is typical for simultaneous fractures of several vertebrae. Spinal compression and increased bone fragility lead to spinal curvature, changes in posture and decreased height. Women with osteoporosis are susceptible to traumatic fractures.

The disease is easier to prevent than to treat (see), therefore, after amputation of the uterus and ovaries, hormone replacement therapy is prescribed, which inhibits the leaching of calcium salts from the bones.

Nutrition and exercise

You also need to follow a certain diet. The diet should contain:

dairy products
all varieties of cabbage, nuts, dried fruits (dried apricots, prunes)
legumes, fresh vegetables and fruits, greens
You should limit your salt intake (promotes the excretion of calcium by the kidneys), caffeine (coffee, Coca-Cola, strong tea) and avoid alcoholic beverages.

To prevent osteoporosis, it is useful to exercise. Physical exercise increase muscle tone, increase joint mobility, which reduces the risk of fractures. Vitamin D plays an important role in the prevention of osteoporosis. Consuming fish oil and ultraviolet irradiation. The use of calcium-D3 Nycomed in courses of 4 to 6 weeks replenishes the lack of calcium and vitamin D3 and increases bone density.

Vaginal prolapse

Another long-term consequence of hysterectomy is prolapse of the vagina.

Firstly, prolapse is associated with trauma to the pelvic tissue and supporting (ligament) apparatus of the uterus. Moreover, the wider the scope of the operation, the higher the risk of prolapse of the vaginal walls.
Secondly, prolapse of the vaginal canal is caused by the prolapse of neighboring organs into the freed pelvis, which leads to cystocele (prolapse of the bladder) and rectocele (prolapse of the rectum).

To prevent this complication, women are advised to perform Kegel exercises and limit heavy lifting, especially in the first 2 months after hysterectomy. In advanced cases, surgery is performed (vaginoplasty and its fixation in the pelvis by strengthening the ligamentous apparatus).

Forecast

Hysterectomy not only does not affect life expectancy, but even improves its quality. Having gotten rid of the problems associated with diseases of the uterus and/or appendages, forever forgetting about the issues of contraception, many women literally blossom. More than half of the patients note liberation and increased libido.

Disability after removal of the uterus is not granted, since the operation does not reduce the woman’s ability to work. A disability group is assigned only in cases of severe uterine pathology, when hysterectomy entailed radiation or chemotherapy, which significantly affected not only the ability to work, but also the patient’s health.

Unpleasant sensations are possible with certain types of surgery. For example, if there is a scar in the vagina or when not only the uterus, but also the upper part of the vagina is removed.

Another positive point is that there is no uterus or endometrium, which is shed during menstruation. However, in some cases, on the days of expected menstruation, slight discharge may still be observed. This is due to the fact that in place of the uterus there still remains a stump with a small amount endometrium, which on ordinary days begins to be rejected.

Lack of fertility

It is impossible to express a definite opinion on this issue. For young women of childbearing age, removal of the uterus is, of course, a minus. But since hysterectomy is often performed on women over 40 who have already had children, hysterectomy can be considered a plus since there is no risk of another pregnancy.

It is worth noting that doctors must carefully study the patient’s medical history before recommending complete amputation of the uterus and, if necessary, try to preserve the main reproductive organ. For example, they can remove only myomatous nodes, or amputate the uterus while preserving the ovaries. In the latter case, a woman will be able to become a mother through IVF and surrogacy.

Spikes

Regardless of the type of abdominal surgery, this process accompanied .

Adhesions are connecting cords located between the peritoneal wall and the internal organs. Any violent intervention can only worsen the adhesive process. Provoking factors are also:

The operation takes too long;
The patient’s asthenic constitution;
Severe blood loss during surgery;
Large-scale surgical intervention;
Hereditary predisposition to adhesions;
Infection as a complication of the postoperative period;
Internal bleeding.

The presence of adhesions can be determined by constant or periodic constipation, urination disorders and increased gas production.

To prevent the formation of adhesions, it is necessary to take appropriate measures in the early postoperative period:

Accept antibacterial drugs to prevent inflammation;
Start physiotherapeutic procedures as early as possible;
Start a course of taking anticoagulants to thin the blood;
Early onset of physical activity after surgery.

Early onset of menopause

Despite the fact that the period of curtailment of reproductive function sooner or later occurs in the life of every woman, menopause after removal of the uterus is one of the long-term consequences.

If during the operation only the uterine cavity was removed, preserving the ovaries and appendages, menopause will occur naturally. However, there is an opinion that after such a surgical intervention, menopause occurs five years earlier, which is explained by reduced blood flow to the ovaries.

There are several definitions of menopause:

Natural occurs after a decrease in the functioning of the gonads;
Artificial is provoked by taking certain medications or performing surgery on the genitals;
Surgical occurs after removal of the uterus and ovaries.

Surgical menopause is much more difficult to endure than natural menopause, since the body abruptly stops producing hormones (whereas with natural menopause this process lasts several years). Women of childbearing age feel the especially severe consequences of surgical menopause. It is worth noting that the first signs of decline in reproductive function appear within a few weeks after the operation and include:

Increased sweating and;
Decreased libido;
Increased emotionality;
The vagina becomes dry and intimate problems with a partner appear;
Depression (see);
Urinary incontinence (when laughing, coughing);
The skin becomes dry and flabby, and hair and nails become brittle (see).

Osteoporosis is a chronic, progressive disease in which calcium is gradually lost from the bones, they become more fragile and the patient suffers from frequent fractures. The danger of the disease also lies in the fact that most often it is asymptomatic, and signs begin to appear only when the pathology is neglected.

Often, with osteoporosis, the vertebrae are injured, and if just one is damaged, the patient will not even feel pain. Bone fragility leads to subsidence of the vertebrae, posture changes and height decreases. To prevent the development of this serious disease, all patients after removal of the uterus must take hormone replacement drugs so that calcium salts are removed from the bones more slowly.

Vaginal prolapse

To prevent complications after surgery, you need to do Kegel exercises, limit weight lifting, and avoid sexual intercourse for the first time. If there is no effect, carry out plastic surgery to strengthen the pelvic ligaments.

Features of diet and exercise

Patients after hysterectomy must adhere to certain nutritional principles. The diet must include dried fruits, cabbage, nuts, dairy products, fresh fruits, vegetables, herbs and legumes. However, you need to minimize salt intake (to prevent calcium from being removed from the bones), avoid coffee, strong tea and alcohol.

Moderate physical activity also serves effective means prevention of osteoporosis and other complications. Thanks to gymnastics, muscle tone increases and the risk of fractures decreases. Vitamin D intake will also help strengthen the body (you can take fish fat, take specialized vitamins or drink special vitamins).

Despite the seriousness of hysterectomy surgery, many women successfully go through the recovery period and literally begin to live again. Firstly, removing the uterus permanently solves the issue of contraception. Secondly, removing the problematic uterus eliminates pain, and many women even experience an increase in libido.

In addition, the consequences of the operation do not lead to disability, since they practically do not affect the ability to work. Disability can only appear if the removal of the uterus was accompanied by chemotherapy and radiation therapy, which in itself has serious consequences for the body.

Surgeries to remove the uterus and appendages are always stressful for a woman. Perhaps not so much physiological as psychological. This depends primarily on the patient’s age and her plans for the future. The younger the woman, the more often the question arises: what will happen next? How to live after surgery? Are there any chances for a normal sex life?

There are answers to these questions. And both gynecologists and psychotherapists answer them, trying to find a compromise between the need to preserve the life and health of a woman and her future relationship with her husband or loved one.

The problem lies both in the personal attitude of the girl or woman to the extirpation procedure, and in the long-term consequences of organ amputation, which in any case will appear after some time:

hormonal deficiency;
early onset of menopause;
loss of libido function and inability to experience orgasm.

The last point is especially important for psychological health women because it allows them to express sensuality and sexuality, which means success with the opposite sex.

Although questions about hysterectomy are often reviewed, there are cases when removal surgery is necessary. Mostly these are life-threatening diseases. also in gynecological practice There are examples when the uterus has to be removed urgently to save the patient’s life - unsuccessful abortions, problems during childbirth.

If the operation does take place, then you need to know what consequences it causes, what to expect in the future and how to maintain health and intimate relationships.

Recovery period

The postoperative period lasts on average up to two months. During this time, the woman's internal seams, she is recovering from blood loss and undergoing psychological adaptation. There is no need to think about starting sexual activity in the near future. The main thing after surgery is the support of loved ones and the absence of complications.

As time passes, the question of starting sexual activity becomes more relevant. At 35–45 years old, a woman is at the peak of her sexuality, but habitual activities often turn out to be painful due to surgery.

We have to reconsider sex positions, time, pace. In a word - everything. At this moment, the attitude and understanding of the man is very important, who should be interested in the woman recovering and feeling good, and also experiencing an orgasm. The mood and desire to have sex often depends on its understanding.

If a woman maintains a positive attitude and her sex life is restored within a short time after the operation, then it should be understood that hysterectomy affects hormonal levels. After removal of the uterus, the level of estrogen in the body decreases faster than nature programmed. A decrease in the amount of estrogen entails a decrease in libido, and therefore the desire for intimacy may appear less often and not be as bright as before; longer sexual intercourse may be required to achieve orgasm.

This phenomenon is natural and should be taken into account. For this purpose, hormone replacement therapy is available in the form of tablets, patches or gels. Such drugs help cope with fading sexual function, as well as problems that are a consequence of hormonal imbalance:

osteoporosis;
early menopause;
problems with the cardiovascular system.

The lack of estrogen in the body can cause vaginal dryness and discomfort during sex. To eliminate them, use a special lubricant. It is sold in a sex shop or pharmacy. If sex with a partner occurs using a condom, then some varieties already have such a lubricant.

When the body of the uterus is removed, the cervix can perform its functions in intimate life along with the clitoris. Therefore, a full sexual life should be restored after the operation. But this is more a question of a woman’s psychological mood - the absence of depression and imaginary problems.

Complete removal of the uterus and cervix also affects the woman’s condition and is stressful for the body. The cause is most often (CC). After such an operation, major changes in hormonal levels, the onset of menopausal hot flashes, and deterioration in the functioning of other organs and systems are possible. In particular, the digestive tract and urinary system.

There is a medical ban on starting genital sexual relations until complete recovery. If desired, you can use alternative types of sex - oral, anal. But only on condition that they are acceptable to both partners and do not cause... This is especially true for anal sex, since the rectum is in close proximity to the operated organ and can cause bleeding, which will require urgent hospitalization and repeated surgery.

It’s good if a woman still has a desire for intimacy after surgery to remove her reproductive organs, but she should still be careful and listen to the doctor’s advice. The quality of sexual life is restored over time, especially if you use hormonal drugs. If you have ovaries that continue to produce hormones, medications may not be needed immediately, but after some time.

According to psychologists, such an operation is a kind of catalyst for relationships. If a woman’s intimate relationships between her partners were excellent before the operation, they will remain so after the operation. But if sex was “a stretch”, a woman rarely had an orgasm, then, sad as it is, sexual relations will become even worse. In this case, the initiator will be the woman, and the main argument will be the operation and poor health.

Conservative treatment of the uterus and appendages is not always successful. To save a woman, you have to sacrifice organs, and sometimes the whole system. The main cause is subtotal malignant lesions of the female genital area or from other organs.

After total removal of the uterus and ovaries, complete restoration of sexual functions is also possible. The main condition is complete recovery and the absence of negative thoughts.

You can consult a psychotherapist. It is advisable that a man and a woman come to the appointment together.

The first time after surgery - usually up to one year - there is pain in the pelvic area. As an option, change your usual positions and use lubricant for greater comfort.

When the ovaries are removed, early menopause and all the problems associated with it inevitably occur. But this is not a reason to give up intimate life, especially when the connection with your partner is constant and the relationship is trusting. The most common mistake women make in such cases is not wanting to discuss their problem with their partner and getting hung up on their thoughts. The partner perceives this as a loss of interest in himself and the relationship worsens.

To quickly restore the uterus, you should use laser equipment. The procedure for laser removal of polyps is carried out within one day without being in the hospital. This method helps fast healing wounds and, therefore, will allow you to continue a full sexual life. Rehabilitation after polyp removal is a minimum of 3 weeks. After this time, it is allowed to begin sexual relations if they do not cause pain and bloody discharge from the vagina.

conclusions

Regardless of the severity of the situation, everything possible should be done to restore the female reproductive function, if the operation is performed in at a young age and the woman plans to have children. It is also worth using all available methods to restore normal sex life, which is an integral part of a happy family.

Doctor of Medical Sciences, Professor Afanasyev Maxim Stanislavovich, oncologist, surgeon, oncogynecologist, expert in the treatment of dysplasia and cervical cancer

Historically, medicine has established the opinion that the uterus is needed only for bearing a child. Therefore, if a woman does not plan to give birth, she can safely resort to surgery.

Is this really true or not? Why, for example, in March 2015, Angelina Jolie had both ovaries removed from her fallopian tubes, but left an “unnecessary” uterus? Let's find out together whether hysterectomy is dangerous. And if it’s dangerous, then with what.

From a surgeon's point of view, radical surgery solves the issue “at its root”: no organ – no problem. But in fact, surgeons’ recommendations cannot always be perceived as objective. They often do not follow up with patients after discharge, do not conduct examinations six months, a year, 2 years after removal of the uterus, and do not record complaints. Surgeons only operate and rarely face the consequences of the operation, so they often have a false idea about the safety of this operation.

Meanwhile, scientists different countries independently conducted a series of observations. They found that within five years after hysterectomy, most women developed:

1. (previously absent) pelvic pain of varying intensity,

2. problems with the intestines,

3. urinary incontinence,

4. vaginal prolapse and prolapse,

5. depression and depression, up to serious disorders psyche,

6. emotional and physiological problems in relationships with your spouse,

7. Some women who were operated on for severe dysplasia or in situ cancer experienced a recurrence of the disease - damage to the stump area and vaginal vault.

8. fatigue,

9. steady increase blood pressure and other serious cardiovascular problems.

The problem is not invented, because according to the data Science Center Obstetrics, gynecology and perinatology of the Russian Academy of Medical Sciences, various operations to remove the uterus account for from 32 to 38.2% of all abdominal gynecological operations. In Russia, this is about 1,000,000 uterus removed annually!

The problem also has another side. Since all of these complications develop gradually, over the course of a year or several years after surgery, women do not associate the deterioration in their quality of life with the previous operation.

I am writing this material so that you can evaluate for yourselfall the pros and cons of the operation, weigh the pros and cons,and make your choice consciously.

My practice shows that there are no extra organs. Even in older women, removal of the uterus carries Negative consequences for health, and in the second part of the article I will dwell on them in detail.

Diagnoses that are no longer indications for hysterectomy

Thanks to the introduction of high-tech methods, some of the indications for genital removal have ceased to exist. absolute indications. Here is a list of diagnoses for which removal of the uterus in women can be replaced by other treatment methods and the organ can be saved.

1. Symptomatic, enlarged, rapidly growing uterine fibroids are today treated by embolization of the uterine arteries: the vessels feeding the fibroids are blocked. Subsequently, the fibroid gradually resolves.

2. Adenomyosis, or internal endometriosis, can be eliminated using a therapeutic method (PDT).

Endometriosis causes cell proliferation inner shell uterus in atypical places. PDT specifically destroys these cells without affecting healthy tissue.

Photodynamic therapy is an organ-preserving treatment method that is included in the federal standard of care (see).

3. Precancerous condition of the endometrium -, – are also treatable using PDT. To date, I have successfully treated 2 patients with this pathology.

In cases where hyperplasia is predominantly viral in nature, treatment with PDT can eliminate the cause of the disease. In the treatment of cervical pathologies, the complete destruction of the human papillomavirus after one PDT session is confirmed in 94% of patients, and in 100% of patients after a second PDT session.

4. Precancerous conditions and oncological formations in the cervix. , and even microinvasive cancer can be completely cured using photodynamic therapy in 1 or 2 sessions.

The PDT method eliminates not only the disease itself, but also its cause – the human papillomavirus.

That's why correctly and completely Photodynamic therapy performed is the only method that ensures lifelong recovery and minimal risk of relapse (reinfection is possible only in case of re-infection with HPV).

There is one more good news. Previously, a combination of age and several gynecological diagnoses was a compelling reason for organ removal. For example, a combination of cervical condylomas and uterine fibroids, or cervical dysplasia with adenomyosis against the background of a completed labor function.

To justify the removal of an organ, the surgeon usually does not give rational arguments, but refers to his own experience or established opinion. But today (even if the attending physician tells you otherwise) a combination of several diagnoses is no longer a direct indication for removal of the uterus. Modern medicine considers each diagnosis as independent, and for each treatment tactics is determined individually.

For example, dysplasia and adenomyosis regress after photodynamic therapy. And the availability multiple fibroids is not a reason for oncological alertness. Numerous observations recent years show that fibroids are in no way associated with cancer, do not degenerate into a cancerous tumor, and are not even a risk factor.

There is a concept of risks in surgery therapeutic effects. The task of a good doctor is to minimize risks. When a doctor decides on treatment tactics, he is obliged to evaluate the indications, weigh the possible negative consequences of different treatment methods, and choose the most gentle and effective one.

By law, doctors must inform everyone possible methods treatment, but in practice this does not happen. Therefore, against the backdrop of the surgeon’s urgent recommendations for organ removal, I strongly advise you to consult several specialists or write me to evaluate the feasibility of breast-conserving treatment that is right for you.

Unfortunately, not all diseases of the uterus can be treated with minimally invasive and therapeutic methods, and in some cases it is still better to remove the uterus. Such indications for removal are called absolute - that is, not requiring discussion.

Absolute indications for hysterectomy

1. Uterine fibroids with necrotic changes in the node. Preservation of an organ with such a diagnosis poses a threat to life.

2. Prolonged uterine bleeding that cannot be stopped by any other means. This condition is fraught with the loss of a large volume of blood and poses a serious danger to life.

3. Combination of large uterine fibroids and cicatricial deformation of the cervix.

4. Uterine prolapse.

5. Cancer, starting from stage I.

6. Giant size of tumors.

Depending on the indications, operations on the uterus are performed different methods and in different volumes. First, we will get acquainted with the types of surgical interventions. Then I will dwell in detail on the consequences that every woman will experience to one degree or another after the removal of this organ.

Types of hysterectomy operations

IN medical practice abdominal and endoscopic removal uterus.

Abdominal surgery (laparotomy) is performed through an incision on the anterior abdominal wall.
The method is considered traumatic, but it provides great access and in some cases there is simply no alternative. For example, if the uterus has reached a large size due to fibroids.
The second method is endoscopic surgery (laparoscopy). In this case, the surgeon removes the uterus through punctures in the anterior abdominal wall. Laparoscopic hysterectomy is much less traumatic and allows for faster recovery after surgery.
Vaginal hysterectomy is the removal of the uterus through the vagina.

Consequences after abdominal hysterectomy surgery

Abdominal surgery to remove the uterus through a large incision is one of the most traumatic procedures. In addition to the complications caused directly by the removal of the uterus, such an operation has other negative consequences.

1. After the operation, a noticeable scar remains.

2. High probability of hernia formation in the scar area.

3. Open surgery usually leads to the development of extensive adhesions in the pelvic area.

4. Rehabilitation and restoration (including performance) requires a lot of time, in some cases up to 45 days.

Removal of the uterus without the cervix. Consequences of supravaginal amputation of the uterus without appendages

Whether the cervix is left or removed during a hysterectomy depends on the condition of the cervix and the risks associated with retaining it.

If the cervix is left, this is the most favorable situation possible.

On the one hand, due to the preserved ovaries, the hormonal system continues to function more or less normally. But why do they leave the cervix when removing the uterus? Preserving the cervix allows you to maintain the length of the vagina, and after restoration the woman will be able to lead a full sex life.

Removal of the uterus without ovaries. Consequences of hysterectomy without appendages

Removal of the uterus without appendages, but with the cervix, is a more traumatic operation.

By leaving the ovaries, the surgeon allows the woman to maintain normal hormonal levels. If the operation is performed at a young age, the ovaries can avoid menopause and all associated health consequences.

But even after removal of the uterus without appendages, the anatomical relationship of the organs is disrupted. As a result, their function is impaired.

In addition, complete removal of the uterus, even with preservation of the ovaries, leads to shortening of the vagina. In many cases, this is not critical for sex life. But the anatomy of the organ is different for everyone, and not all women manage to adapt.

Removal of the uterus with appendages

This is the most traumatic operation that requires a lot of recovery time.

She needs serious hormonal correction and usually causes all the most severe consequences, especially if performed at the age of 40-50 years - that is, before the onset of natural menopause.

I will tell you more about the most common consequences of hysterectomy below. The most unpleasant thing is that all these consequences are irreversible and practically impossible to correct.

Meanwhile, a series of recent scientific studies in this area indicate the opposite. Even if the ovaries are preserved, removal of the uterus is an operation with a high risk of endocrine disorders.

The reason is simple. The uterus is connected to the ovaries and tubes by a system of ligaments, nerve fibers And blood vessels. Any operation on the uterus leads to serious disruption of the blood supply to the ovaries, up to partial necrosis. Needless to say, in literally suffocating ovaries, the production of hormones is disrupted.

Hormonal imbalances manifest themselves in a whole string of unpleasant symptoms, the most harmless of which is a decrease in libido.

In the vast majority of cases, the ovaries are not able to completely restore or compensate for normal blood supply. Accordingly, the hormonal balance of the female body is not restored.

Consequence 2. Ovarian cysts after removal of the uterus

This is a fairly common complication in cases where the ovaries are preserved after removal of the uterus. This is how it manifests itself bad influence the operation itself.

To understand the nature of the cyst, you must first understand how the ovaries work.

In fact, the cyst is natural process, which occurs every month in the ovary under the influence of hormones and is called a follicular cyst. If the egg is not fertilized, the cyst bursts and menstruation begins.

Now let's see what happens to the ovaries after removal of the uterus.

The uterus itself does not produce hormones. And many surgeons assure that after its removal the hormonal levels will not change. But they forget to say how closely the uterus is connected to other organs. When separating the ovaries from the uterus, the surgeon inevitably disrupts the blood supply and injures them. As a result, the functioning of the ovaries is disrupted, and their hormonal activity decreases.

Unlike the uterus, the ovaries produce hormones. Disturbances in the functioning of the ovaries lead to disruption of hormonal levels and the process of follicle maturation. The cyst does not resolve, but continues to grow.

It takes about 6 months to restore the full functioning of the ovaries and level out hormonal levels. But not always everything ends well, and the enlarged cyst resolves. Often, repeated surgery is required to remove an overgrown cyst - if large sizes formation there is a risk of rupture and bleeding.

If, several months after removal of the uterus, pain appears in the lower abdomen, which increases over time, you should visit a gynecologist. The most probable cause, why does the ovary hurt, it’s an overgrown cyst.

The likelihood of developing this complication is only 50% dependent on the skill of the surgeon. Every woman's anatomy is unique. It is not possible to predict the location of the ovaries and their behavior before surgery, so no one can predict the development of a cyst after removal of the uterus.

Consequence 3. Adhesions after hysterectomy

Extensive adhesions after removal of the uterus often lead to the development of chronic pelvic pain. Characteristic symptoms these pains - they intensify with bloating, indigestion, peristalsis, sudden movements, long walking.

Adhesions after surgery to remove the uterus form gradually. Accordingly, pain appears only after some time.

On initial stage postoperative adhesions in the small pelvis are treated conservatively; if ineffective, they resort to laparoscopic excision of adhesions.

Consequence 4. Weight after hysterectomy

Body weight after surgery can behave differently: some women gain weight, sometimes even gain weight, while others manage to lose weight.

The most common scenario after removal of reproductive organs is rapid weight gain, or a woman’s belly grows.

1. One of the reasons why women gain weight is due to metabolic disorders and the resulting fluid retention in the body. Therefore, strictly monitor how much water you drink and how much you excrete.

2. After removal of the uterus and ovaries, the hormonal levels change, which leads to a slowdown in the breakdown of fat, and the woman begins to gain excess weight.

In this case, a gentle diet will help to remove the belly. Meals should be fractional, small portions 6-7 times a day.

Should you worry if you have lost weight after having your hysterectomy? If the reason for the operation was a giant tumor or fibroid, there is no need to worry, you lost weight after removing the uterus.

If there was no mass formation, but you are losing weight, most likely it is a hormonal imbalance. To return your weight to normal, you will need hormone therapy.

Consequence 5. Sex after hysterectomy

Women who have undergone vaginal hysterectomy should remain in sexual rest for at least 2 months until the internal sutures heal. In all other cases, sex can be had 1-1.5 months after the operation.

Sex life after removal of the uterus undergoes changes.

In general, women are concerned about vaginal dryness, burning after intercourse, discomfort, and pain. This occurs due to a drop in estrogen levels, which causes the genital mucosa to become thinner and begin to produce less lubricant. Hormonal imbalance reduces libido and interest in sexual life decreases.

Removal of the uterus and appendages most strongly affects the intimate side of life, since the absence female hormones leads to frigidity.
Removal of the uterine body has little effect on intimate life. Vaginal dryness and decreased libido may occur.
Removal of the uterus and cervix leads to shortening of the vagina, which makes sex difficult after surgery.

Consequence 6. Orgasm after hysterectomy

Does a woman have an orgasm after a hysterectomy?

On the one hand, all sensitive points - the G-spot and the clitoris - are preserved, and theoretically a woman retains the ability to experience orgasm even after removal of the organ.

But in reality, not every woman gets an orgasm after surgery.

Thus, when the ovaries are removed, the content of sex hormones in the body drops sharply, and many develop sexual coldness. A decrease in the production of sex hormones occurs even if the ovaries are preserved - for many reasons, after surgery, their activity is disrupted.

The best prognosis for orgasms is for those who still have a cervix.

The consequences after removal of the uterus and cervix are manifested in a shortening of the vagina by about a third. Full sexual intercourse often becomes impossible. Studies carried out in this area have shown that the cervix has great value in achieving vaginal orgasms, and when the cervix is removed, its achievement becomes extremely difficult.

Consequence 7. Pain after hysterectomy

Pain is one of the main complaints after surgery.

1. In the postoperative period, pain in the lower abdomen may indicate a problem in the suture area or inflammation. In the first case, the stomach hurts along the seam. In the second case, the main symptom is joined heat.

2. If the lower abdomen hurts and swelling appears, you can suspect a hernia - a defect through which the peritoneum and intestinal loops extend under the skin.

3. Severe pain after surgery to remove the uterus, high temperature and poor health indicate pelvioperitonitis, hematoma or bleeding. Repeat surgery may be required to resolve the situation.

4. Pain in the heart indicates the possibility of developing cardiovascular diseases.

A large Swedish study of 180,000 women found that hysterectomy significantly increases the risk of cardiovascular disease. coronary disease and stroke. Removing the ovaries further aggravates the situation.

5. If you are concerned about swelling of the legs or an increase in local skin temperature, you need to rule out thrombophlebitis of the veins of the pelvis or lower extremities.

6. Pain in the back, lower back, right side or left can be a symptom of adhesive disease, cyst on the ovary and much more - it is better to consult a doctor.

Consequence 8. Prolapse after hysterectomy

After removal of the uterus, the anatomical location of organs is disrupted, muscles, nerves and blood vessels are injured, and the blood supply to the pelvic area is disrupted. The frame that supports the organs in a certain position ceases to perform its functions.

All this leads to displacement and omission internal organs– primarily the intestines and bladder. Extensive adhesions aggravate the problem.

This is manifested by numerous increasing problems with the intestines and urinary incontinence with physical activity, coughing.

Consequence 9. Prolapse after hysterectomy

The same mechanisms cause the so-called genital prolapse - drooping of the vaginal walls and even their loss.

If in the postoperative period a woman begins to lift weights without waiting for full recovery, the situation worsens. Intra-abdominal pressure increases, the walls of the vagina are “pushed” out. For this reason, lifting weights is contraindicated even for healthy women.

When lowered, the woman experiences a sensation of a foreign object in the perineal area. Pain bothers me. Sex life becomes painful.

To reduce the symptoms of prolapse of the vaginal walls after removal of the uterus, special gymnastics are indicated. For example, Kegel exercises. Constipation also increases intra-abdominal pressure, so to prevent the process you will have to learn to monitor your intestinal function: bowel movements should be daily and stool should be soft.

Unfortunately, vaginal prolapse after hysterectomy cannot be treated.

Consequence 10. Intestines after hysterectomy

Intestinal problems after surgery are affected not only by the changed anatomy of the pelvis, but also by a massive adhesive process.

Intestinal function is disrupted, constipation, flatulence, various defecation disorders, and pain in the lower abdomen occur. To avoid intestinal problems, you must follow a diet.

You will have to learn to eat often, 6 - 8 times a day, in small portions.

What can you eat? Everything except heavy food, products, causing bloating abdomen, stool retention.

Improves the condition of the pelvic organs and regular exercise.

Consequence 12. Urinary incontinence after hysterectomy

This syndrome develops in almost 100% of cases as a consequence of a violation of the integrity of the ligamentous and muscular framework during surgery. The bladder prolapses and the woman loses control of urination.

To restore bladder function, doctors recommend performing Kegel exercises, but even with exercise, the condition usually progresses.

Consequence 13. Relapse after hysterectomy

Uterine surgery is performed for various indications.

Unfortunately, the operation does not protect against relapse if the uterus was removed due to one of those diseases that are caused by the human papillomavirus, namely:

leukoplakia of the cervix,
stage 1A cervical or uterine cancer
microinvasive cervical cancer, etc.

Regardless of the technique, surgery does not guarantee 100% recovery; it only removes the lesion. Traces of the human papillomavirus, which is the cause of all these diseases, remain in the vaginal mucosa. Once activated, the virus causes a relapse.

Of course, if there is no organ, then a relapse of the disease cannot occur either in the uterus or in its cervix. The cervical stump and the mucous membrane of the vaginal vault are subject to relapses - dysplasia of the vaginal stump develops.

Unfortunately, relapses are very difficult to treat with classical methods. Medicine can only offer such patients traumatic methods. Removing the vagina is an extremely complex and traumatic operation, and the risks of radiation therapy are comparable to the risks of the disease itself.

According to various sources, relapses after surgery occur in 30 - 70% of cases. That is why, for the purpose of prevention, the Herzen Institute recommends performing photodynamic therapy of the vagina and cervical stump even after surgical removal of the uterus. Only eliminating the papilloma virus protects against the return of the disease.

This is the story of my patient Natalya, who faced a relapse of cancer of the vaginal stump after removal of the uterus.

“Well, I’ll start in order sad story, with a happy ending. After giving birth at 38 years old and my daughter turning 1.5 years old, I had to go to work and I decided to see a gynecologist. In September 2012, there was no sign of sadness, but the tests were not reassuring - stage 1 cervical cancer. It was of course shock, panic, tears, sleepless nights. In oncology I passed all the tests, where the human papillomavirus genotype 16.18 was discovered.

The only thing our doctors offered me was expiration of the cervix and uterus, but I asked to leave the ovaries.

The postoperative period was very difficult both physically and mentally. In general, a vaginal stump remained, no matter how sad it may sound. In 2014, after 2 years, tests again show a not very good picture - then after six months, grade 2. They treated her with everything - all kinds of suppositories, antivirals, ointments.

In short, a lot of money was spent, and after a year and a half of treatment for this dysplasia, it went into the third stage and again cancer. What did our doctors offer me this time: photodynamics.

After reading about her, I was delighted and gave myself into their hands. So what do you think was the result of their innovative technologies? And nothing has changed! Everything remained in its place. But I read so much about this method, studied various articles, I was especially attracted to the photodynamic method of Dr. Afanasyev M.S., and having compared the method and technology of treatment, I was surprised that everything that this doctor writes and tells was significantly different from how they did it me in our clinic. Starting from the ratio medicinal product per kilogram of my weight, the methodology itself, the questions they asked me. After photodynamics, I was forced to wear glasses for almost a month, sit at home with the curtains closed, and not lean out into the street. I had no doubt that they simply did not know how to do this procedure! I contacted Dr. Afanasyev M.S., bombarded him with questions, told my story and he offered his help. I thought and doubted for a long time.

My doctor suggested me radiation therapy, but knowing its consequences and the quality of life after this therapy, I still chose photodynamics again, but that Maxim Stanislavovich would give it to me.

Having gathered new strength, I flew to Moscow. The first impression of the clinic was, of course, pleasant, you feel like a person whom everyone cares about, attentiveness and responsiveness are the main qualities of these employees.

About the PDT procedure and recovery

The procedure itself took place under anesthesia, went away quickly, and in the evening I went to see my sister who was staying with me. I only wore glasses for three days. After 40 days I went for an initial examination to my clinic, but I had an eroded spot, apparently the healing was slow, but despite all this, the tests were good! The doctor prescribed healing suppositories. And when I came back after 3 weeks, the doctor gave me…….., everything healed, and I was very surprised - how did that happen! After all, during the entire practice of conducting photodynamics using their technology, there was not a single positive result! Now I will go for another examination in April. I am sure that everything will always be fine for me now!

This is my story. And I’m telling it to you so that you don’t give up, and during treatment choose the most gentle method of treatment, and not remove everything at once, apparently this is easier for our doctors. If I had found out about Maxim Stanislavovich earlier, I would have avoided these tears, a terrible operation, the consequences of which will strain my whole life! So think about it! No amount of money is worth our health! And most importantly, if you have the human papillomavirus of this particular genotype, which provokes cervical cancer under certain circumstances, you need to remove this cause. This is exactly what photodynamics does, but the technology and the doctor who does it must be masters of their craft. Who have extensive experience, scientific works and positive results in this area. And I think the only doctor who observes all this is Maxim Stanislavovich. Thank you very much Maxim Stanislavovich!!!”

The consequences described above after removal of the uterus concern different women to varying degrees. Young women of childbearing age have the hardest time undergoing hysterectomy.

Consequences of hysterectomy after 50 years

Surgery during menopause also does not greatly affect the health and well-being of a woman.

And if the operation was performed according to indications, then you made the right choice.

Consequences of hysterectomy after 40 years

If a woman did not have menopause before the operation, then during the recovery period it will be very difficult for her. The consequences of surgery during active childbearing years are experienced much more acutely than at the age of natural menopause.

If the operation was caused by a huge fibroid or bleeding, removal of the uterus provides significant relief. Unfortunately, over time, almost all the long-term consequences that we discussed above develop.

In medical language, this condition is called post-hysterectomy and post-variectomy syndrome. It manifests itself as mood swings, hot flashes, arrhythmia, dizziness, weakness, and headache. The woman does not tolerate stress well and begins to get tired.

Within just a few months, sexual desire decreases and pain develops in the pelvic area. Suffering skeletal system– the level drops minerals, osteoporosis develops.

If hormonal levels are not corrected, aging will begin immediately after surgery: 5 years after hysterectomy, 55–69% of women operated on at the age of 39–46 years have a hormonal profile consistent with the postmenopausal one.

Surgery to remove uterine cancer is not necessary in its early stages

Uterine cancer is adenocarcinoma and carcinoma is a malignant process. The choice of treatment method and extent of intervention depends on the stage of the disease.

Earlier initial stages cancer (, microinvasive cancer) and precancerous diseases (,) were indications for removal of the uterus. Unfortunately, oncological surgery does not eliminate the cause of the disease - the human papillomavirus - and therefore has high percent relapses.