Remove the uterus side effects: The request could not be satisfied
Hysterectomy: Advantages and disadvantages of removing uterus | Columbia Asia Hospital
Hysterectomy is the removal of uterus by surgical method. If the uterus is removed along with the cervix it is called complete hysterectomy. If the uterine body is removed leaving behind the cervix, it is called partial hysterectomy. Sometimes the ovaries, fallopian tubes and other surrounding structures are also removed.
Hysterectomy is a major surgical procedure that has risks and benefits and affects the hormonal balance in the body. For these reasons hysterectomy is only recommended when all other modalities have failed.
What are the types of hysterectomy?
The type of hysterectomy involves the removal of both the uterus and the cervix.
- Radical hysterectomy: This type of hysterectomy involves the complete removal of uterus, cervix, upper vagina and parametrium. Lymph nodes, ovaries and fallopian tubes are also removed in such cases.
- Total hysterectomy: This is a type of hysterectomy, which involves the removal of uterus and cervix. It may or may not involve the removal of ovaries. Ovaries are clearly not of prime concern in total hysterectomy.
- Subtotal hysterectomy: This is a process of removing the uterus, leaving the cervix in situ. Subtotal hysterectomy was introduced with the view to improve sexual functioning after hysterectomy.
Why would you need a hysterectomy?
There are various conditions, where hysterectomy becomes essential and used to treat many women’s health conditions
- When uterine fibroids causes pain, uterine bleeding and other problems, hysterectomy becomes necessary, especially when medical management has failed.
- There are conditions wherein the uterus slides into the vaginal canal and outside. This is known as uterine prolapse.
- Cancer of the uterine, cervix and ovaries.
- Endometriosis, a condition where cells from the lining of uterus appear outside the uterine cavity. It is commonly seen in the reproductive years.
- Intractable bleeding after delivery
What are the advantages of a uterus removal?
The advantages of hysterectomy improves the quality of life and psychological outcome.
- The main reason for women to undergo hysterectomy is abnormal uterine bleeding.
- Hysterectomy relieves abnormal uterine bleeding which is painful and distressing.
- Hysterectomy prevents uterine cancer and is a lifesaver for women who have a family history of cancerous growths in their uterus.
- Hysterectomy for fibroids in the uterus offers great relief to those who have symptoms like bleeding, cramps, urinary problems etc.
What are the disadvantages of a uterus removal?
The disadvantages of Hysterectomy involves risk associated with abdominal hysterectomy surgery.
- Premature menopause associated with long-term health risks which may include premature death, osteoporosis, cardiovascular disease, neurologic disease and so on.
- Removing the ovaries can cause many health problems like higher risk of cardiovascular diseases, bone weakening and arthritis.
- Removal of uterus can cause chronic pelvic problems, that affect the organ, which cause severe pain in pelvic.
Potential Hysterectomy Complications and Side Effects
Hysterectomies are the most common gynecologic procedures performed in the United States and may be performed for a number of reasons, ranging from fibroids to chronic pelvic pain to gynecologic cancer.
Still, many people who are advised to have a hysterectomy are naturally worried about the potential complications and side effects of the surgery, and how their bodies will respond after the removal of their uterus.
Verywell / Laura Porter
As with any surgery, there are certain complications that may arise with a hysterectomy, including:
- Infection and fever
- Blood clots in the leg that can travel to the lung
- Anesthesia-related complications with the lungs or heart
- Nerve or tissue damage
- Bowel obstruction
- Fistula formation
A fistula is an abnormal pathway between two organs, such as the bladder and vagina (called a vesicovaginal fistula).
A person’s medical history may make them more or less prone to developing these complications. For instance, people who are obese are more prone to infection and blood clots than those who are at normal weight.
The reason behind the surgery is another risk factor for developing complications. For example, fistula formation (albeit uncommon) is more likely to occur in people undergoing a hysterectomy for cancer versus people undergoing a hysterectomy for benign gynecological conditions like pelvic organ prolapse.
The type of hysterectomy a person is undergoing also affects their risk. For example, in comparison to a vaginal or laparoscopic hysterectomy, with an abdominal hysterectomy, there is an increased risk for complications like infection, bleeding, blood clots, nerve damage, and bowel obstruction.
An abdominal hysterectomy also usually requires the longest hospital stay and recovery time. With a laparoscopic hysterectomy, there is usually less pain and a lower risk of infection; however, there is an increased risk of injury to the bladder.
There is also an increased risk of a rare, but very serious complication, called vaginal cuff dehiscence, with a laparoscopic hysterectomy.
Vaginal cuff dehiscence refers to the separation of the incision site where the uterus was removed from the upper part of the vagina.
There are several potential side effects that may occur after a hysterectomy.
The physical side effects of undergoing a hysterectomy include pain (usually for a few days) and vaginal bleeding and discharge (often for several weeks). Constipation is also common, and some people experience difficulties with urination or nausea or vomiting.
In addition, if the ovaries are removed, people who have not yet entered menopause will no longer menstruate (called surgical or induced menopause).
As a result, a person may experience a range of menopausal symptoms, such as:
Keep in mind—people whose ovaries are not removed may still experience early menopause if blood flow to the ovaries is compromised.
Emotional side effects may also occur after a hysterectomy. While most people feel satisfied that their symptoms (e.g., pelvic pain or vaginal bleeding) are now gone, some people in their childbearing years may feel anxious or depressed about the loss of fertility.
If you are feeling sad or worried after your hysterectomy, please get in touch with your doctor. You may benefit from talking to a therapist and/or taking a medication for depression or anxiety.
Sexual side effects are also a possibility. Fortunately, research shows that most people who were sexually active before surgery experience the same or better sexual functioning after surgery.
That said, sexual functioning after a hysterectomy is really a complicated topic. Every woman is different, and there are so many factors to consider, such as:
- The reason behind having the surgery (cancer versus a noncancerous condition)
- The level of support provided by a person’s partner
- Mood problems that existed before the surgery
A Word From Verywell
A hysterectomy is a common and generally safe surgical procedure. Complications though, and perhaps unforeseen emotional reactions, do occur. If you are experiencing any new and/or bothersome symptoms, please be sure to contact your doctor.
Hysterectomy (surgical removal of the womb) – InformedHealth.org
A hysterectomy is surgery to completely or partially remove the womb (uterus). This is done to relieve symptoms caused by medical conditions affecting the womb. It is a major surgical procedure that is associated with risks and side effects. So it is usually only considered if other treatments aren’t effective enough. If a woman has uterine or ovarian cancer, though, a hysterectomy may be necessary in order to remove the tumor.
For what reasons is a hysterectomy performed?
The most common reasons for having a hysterectomy include:
Pelvic organ prolapse
Very heavy or painful periods
Uterine (womb), cervical or ovarian cancer
Only rarely does the womb need to be removed immediately. That may need to be done to avoid serious complications due to things like serious injuries, severe infections or uncontrollable bleeding during childbirth.
What types of hysterectomy are there?
There are three types of hysterectomy based on which organs and tissue are removed:
Partial (supracervical) hysterectomy: The main body of the womb is removed. The cervix, fallopian tubes and ovaries remain in place.
Total (complete) hysterectomy: The womb and the cervix are removed. The fallopian tubes and ovaries remain in place.
Radical hysterectomy: A radical hysterectomy involves removing the womb and cervix, the nearby part of the vagina and parts of the supporting tissues – and sometimes also the fallopian tubes, ovaries and pelvic lymph nodes.
What does the procedure involve?
Hysterectomies can be carried out in different ways:
Vaginal hysterectomy: The womb is removed through the vagina. The surgeon doesn’t need to make any incisions (cuts) in the belly.
Laparoscopy (keyhole surgery): The surgeon makes small incisions in the belly and inserts thin tubes with a camera and surgical instruments attached to them. The womb is cut into smaller pieces in the abdominal cavity, and the removed tissue is sucked out.
Abdominal hysterectomy: The womb is removed through an incision across the belly.
Hysterectomies are usually carried out through the vagina or keyhole surgery because they are less invasive than abdominal surgery. If possible, a vaginal hysterectomy is often preferred. It can also be combined with laparoscopy.
The type of procedure that is considered depends on the medical condition and factors such as the woman’s overall health, age and weight. The procedure is done in a hospital because a hysterectomy is a major operation. It’s usually possible to leave the hospital within one week. Depending on the scope of the procedure, it can take 3 to 6 weeks to start pursuing normal, everyday activities again.
When is a hysterectomy a good idea?
The removal of the womb is one of the most common gynecological procedures, but it’s not always necessary. The exact medical condition and the woman’s individual situation will determine how suitable it is. The womb often needs to be removed in women who have uterine or ovarian cancer, to improve the chances of recovery. Symptoms caused by a large number of fibroids can sometimes only be relieved through a hysterectomy. sehr viele lassen sich manchmal nur durch diese Operation lindern.
The symptoms of many other problems can be relieved through other treatments, such as medication or less invasive surgical procedures that do not involve removing the womb. It might also be a good idea to wait until menopause because some symptoms will then improve on their own.
So it’s generally a good idea to think carefully about the pros and cons of the different treatment options before making a decision. If you’re not sure, it might help to get a second opinion from a different doctor.
What are the possible risks and complications of a hysterectomy?
As with all surgical procedures, a hysterectomy may cause injury to blood vessels, nerves or organs, and may result in infections or wound-healing problems. About 5 out of 100 women have these kinds of complications. In the first few days after surgery, women may experience temporary pain, constipation or trouble emptying their bladder. Also, as with any surgery involving the abdominal cavity, scar tissue may form and cause different parts of abdominal tissue to stick to each other. Known as an adhesion, this can lead to pain or digestive problems.
After having a hysterectomy, it’s no longer possible to have children. Menstrual periods stop as well. But if the cervix and the ovaries are left intact, mild bleeding may still occur.
If the ovaries are also removed, menopause starts right after the operation. This may cause problems like hot flashes, mood swings and vaginal dryness.
How the removal of the womb affects the woman’s sex life will depend on what sort of symptoms she had before the procedure. It may improve if pain was a problem before, for instance. But some women experience a decrease in sexual pleasure.
- Robert Koch-Institut (RKI). Hysterektomie. February 06, 2014. (GBE kompakt: Zahlen und Trends aus der Gesundheitsberichterstattung des Bundes).
- U.S. Department of Health and Human Services. Hysterectomy February 15, 2018. (Office on Women’s Health).
IQWiG health information is written with the aim of helping
people understand the advantages and disadvantages of the main treatment options and health
Because IQWiG is a German institute, some of the information provided here is specific to the
German health care system. The suitability of any of the described options in an individual
case can be determined by talking to a doctor. We do not offer individual consultations.
Our information is based on the results of good-quality studies. It is written by a
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Uterine fibroids and hysterectomy Information | Mount Sinai
Hysterectomy is the surgical removal of the uterus. The ovaries may also be removed, although this is not necessary for fibroid treatment. Hysterectomy is a permanent solution for fibroids, and is an option if other treatments have not worked or are not appropriate.
A woman cannot become pregnant after having a hysterectomy. If the ovaries are removed along with the uterus, hysterectomy causes immediate menopause.
Types of Hysterectomies
Once a decision for a hysterectomy has been made, the patient should discuss with her doctor what will be removed. The common choices are:
- Total hysterectomy (removal of uterus and cervix).
- Subtotal, also called supracervical hysterectomy (removal of uterus with preservation of the cervix).
- Oophorectomy (removal of an ovary). Bilateral oophorectomy is the removal of both ovaries. Bilateral salpingo-oophorectomy is the removal of the fallopian tubes and ovaries). These procedures can be performed with either total or supracervical hysterectomy.
Types of Hysterectomy Procedures
Hysterectomy procedures include:
- Abdominal hysterectomy
- Vaginal hysterectomy
- Laparoscopically assisted vaginal hysterectomy (LAVH)
- Total laparoscopic hysterectomy
- Robotic-assisted laparoscopic hysterectomy
Total Abdominal Hysterectomy
Total abdominal hysterectomy (TAH) has been the traditional procedure. It is an invasive procedure that is best suited for women with large fibroids, when the ovaries also need to be removed, or when cancer or pelvic disease is present.
The surgeon makes a 5- to 7-inch incision in the lower part of the belly. The cut may either be vertical, or it may go horizontally across the abdomen, just above the pubic hair (a bikini cut). The bikini cut incision heals faster and is less noticeable than a vertical incision, which is used in more complicated cases or with very large fibroids. The patient may need to remain in the hospital for 3 to 4 days, and recuperation at home takes about 4 to 6 weeks.
The American College of Obstetricians and Gynecologists (ACOG) recommends vaginal hysterectomy as the first choice, when possible. Vaginal hysterectomy requires only a vaginal incision through which the uterus is removed. The vaginal incision is closed with stitches.
LAVH, and Total Laparoscopic Hysterectomy
Newer minimally invasive procedures have become the preferred methods for hysterectomy. ACOG recommends laparoscopic hysterectomy as the second choice for minimally invasive procedures. Laparoscopic hysterectomies use a laparoscope to help guide and perform the surgery, and allows the ovaries to be easily removed at the same time. The laparoscope is a thin flexible tube through which a tiny video camera and surgical instruments are inserted.
A variation of the vaginal approach is called laparoscopic-assisted vaginal hysterectomy (LAVH). It uses several small abdominal incisions through which the surgeon severs the attachments to the uterus and, if needed, ovaries. In LAVH, part of the procedure is completed vaginally, as in the standard vaginal approach. In total laparoscopic hysterectomy, the entire procedure is performed via laparoscopy, with the uterus either removed through the vagina or placed in a plastic bag and broken up into small pieces so it can be removed via the small laparoscopic incisions. The FDA discourages the use of laparoscopic power morcellation with hysterectomy (see below in “Complications”.)
Vaginal hysterectomy, LAVH, total laparoscopic hysterectomy, and robotic-assisted laparoscopic hysterectomy may have fewer complications, shorter hospital stays, and faster recovery times than abdominal hysterectomy.
Robotic-assisted hysterectomy is a type of laparoscopic hysterectomy, but the surgical instruments are attached to a robot. The surgeon uses a computer console in the operating room to guide the robot’s movements.
The American College of Obstetricians and Gynecologists (ACOG) advises that robotic hysterectomy is best suited for complex hysterectomies. Before choosing robotic hysterectomy, it is important to find a surgeon who has extensive training and experience with this technique.
Minor complications after hysterectomy are very common. Many women develop minor and treatable urinary tract infections. There is usually mild pain and light vaginal bleeding post operation. More serious complications are uncommon but can include infection, blood clots, or injury to adjacent organs.
Laparoscopic power morcellation is a procedure that is sometimes used during laparoscopic hysterectomy or myomectomy. The power morcellator is a rapidly spinning cutting device that breaks up the uterus into smaller fragments that can be removed through small abdominal incisions. It can push many of these small pieces of the uterus throughout the abdominal cavity.
In 2014, the FDA discouraged the use of laparoscopic power morcellation because of evidence that this procedure can spread cancer through the pelvis and abdomen in women who have undetected uterine sarcoma, a type of uterine cancer. As many as 1 in 350 women who undergo hysterectomy or myomectomy for uterine fibroids have this type of cancer. A black box warning was required on all product labels and several of these devices have been withdrawn from the market since. With even more evidence on the risk of spreading cancer, in 2017 the FDA reaffirmed its 2014 decision.
Power morcellators should never be used in women who are peri- or post-menopausal, or in women who have suspected or known uterine cancer. Younger women who are considering a fibroid procedure using power morcellation should discuss with their doctors all possible risks.
Ask a family member or friend to help out for the first few days at home. The following are some of the precautions and tips for postoperative care:
- For 1 to 2 days after surgery, you will be given medications to prevent nausea and painkillers to relieve pain at the incision site.
- As soon as the doctor recommends it, usually within a day of the operation, you should get up and walk in order to help prevent pneumonia, reduce the risk of blood-clot formation, and speed recovery.
- Walking and slow, deep breathing exercises may help to relieve gas pains, which can cause major discomfort for the first few days.
- Coughing can cause pain, which may be reduced by holding a pillow over a surgical abdominal wound or by crossing the legs after vaginal surgery.
- Do not lift heavy objects, douche or take baths, climb stairs or drive for several weeks following surgery.
- Discuss with your surgeon when you will be able to have sex after the procedure. The vaginal incision is the weakest part of the surgery and needs to heal completely before being tested.
Women who have had abdominal hysterectomies should discuss with their doctors when exercise programs more intense than walking can be started. The abdominal muscles are important for supporting the upper body, and recovering strength may take a long time. Even after the wound has healed, the patient may have an on-going feeling of overall weakness, for some time. Some women do not feel completely well for as long as a year while others may recover in only a few weeks.
If a woman has had her cervix removed, she no longer needs annual Pap smears, unless she has had a prior history of abnormal Pap testing, or had cancer found at the surgery. However, women who have had any type of hysterectomy should continue to receive routine pelvic and breast exams, and mammograms.
Premature Menopause after Hysterectomy
Surgical removal of the ovaries causes immediate menopause. If the ovaries are not removed, they will usually continue to secrete hormones until the natural age of menopause (average age 51 to 52 years), even after the uterus is removed.
Because hysterectomy removes the uterus, a woman will no longer experience menstrual periods, even if she has not become menopausal. Studies show that women who have had hysterectomies become menopausal on average 1 to 3 years earlier than would naturally occur.
Your doctor may recommend you take hormone therapy (HT) after your hysterectomy. Women who have had a hysterectomy are given estrogen-only therapy (ET), which may be administered as pills or as a skin patch that releases the hormone into the bloodstream. It can also be given locally to treat specific symptoms such as vaginal dryness (see below). Hot flashes and vaginal dryness are the most common menopausal symptoms. Hot flashes are often more severe after surgical menopause than in menopause that occurs naturally.
Sexuality after Hysterectomy
Sexual intercourse may resume 6 to 12 weeks following surgery. The effect of hysterectomy on sexuality varies among women. Most studies show no negative impact on sexuality after hysterectomy. A small percentage of women notice a negative impact on their sex drive or response. Other women report increased sexual drive and pleasure because they are free from the problems that prompted hysterectomy.
A vaginal lubricant can help reduce vaginal dryness.Vaginal moisturizing agents are available over the counter and may be effective. Dryness may be more of an issue due to loss of the cervical mucus. In studies done on the subject, a low-dose vaginal estrogen treatment applied directly into the vagina is the most effective treatment for vaginal dryness. It will need to be prescribed by your doctor. Topical vaginal estrogen is available in a cream, tablet, or ring that is inserted into the vagina.
Robotic Hysterectomy | Johns Hopkins Medicine
Hysterectomy is the surgical removal of a woman’s uterus. This surgery can be done through small incisions using a thin, lighted scope with a camera on the end (a laparoscope). This is called a laparoscopic hysterectomy.
In robotic-assisted laparoscopic hysterectomy, the surgeon uses a computer to control the surgical instruments. The computer station is in the operating room. The surgeon is able to control the robot’s movements steadily and precisely. This lets him or her get into tiny spaces more easily and have a better view of the operation than with conventional laparoscopic surgery. This procedure continues to be researched to improve the technique.
Why might I need a robotic hysterectomy?
Your surgeon may recommend this surgery if you have a problem with your uterus that has not responded to other treatments. Here are some common reasons why a hysterectomy is recommended:
Non-cancerous fibroid tumors
Uterine prolapse (your uterus has slipped down into your vagina)
Endometriosis (cells from the lining of your uterus grow outside your uterus, causing pain and bleeding)
Other causes of long-term abnormal uterine bleeding
Chronic pelvic pain
Some reasons why robotic-assisted laparoscopic hysterectomy may be recommended:
You will have smaller incisions than in an open type of hysterectomy.
You may have less pain and a shorter hospital stay after surgery.
Your recovery may be easier.
Your risk for complications like bleeding or infection may be less.
What are the risks of a robotic hysterectomy?
Robotic-assisted laparoscopic hysterectomy is a safe procedure, but all surgeries carry some risks. You will need to sign a consent form that explains the risks and benefits of the surgery. You will also want to discuss these risks and benefits with your surgeon. Some potential risks of hysterectomy done by any technique include:
Reaction to the anesthesia
Damage to other organs inside the abdomen
Blood clots that form in your legs and may travel to your lungs
An additional risk of robotic surgery:
There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the procedure.
How do I prepare for a robotic hysterectomy?
Sometime before the day of your surgery you will need a physical exam. Your surgeon may also order tests, such as blood tests, a chest X-ray, or an electrocardiogram (ECG) to check on your general health. Be sure to tell your surgeon about any medications you take at home, including herbal supplements and other over-the-counter medications. You may be told to stop taking aspirin or other medications that thins your blood and may increase bleeding.
Other points to go over:
Tell your healthcare provider if you or someone in your family has any history of reaction to general anesthesia.
If you smoke, you may have to stop smoking well before surgery.
On the day and night before surgery you will be given instructions on when to stop eating and drinking. If you are having general anesthesia, it is common to have nothing to eat or drink after midnight or for at least 8 hours before surgery.
Ask your surgeon if you should take your regular medications with a small sip of water on the morning of the procedure.
What happens during a robotic hysterectomy?
This surgery is usually done under general anesthesia. So, you will be asleep during surgery. Before the procedure:
You will have an intravenous line (IV) started so you can receive fluids and medications to make you relaxed and sleepy.
If you are having general anesthesia, medication may be given through the IV to put you to sleep.
A tube may be inserted in your throat to give you anesthesia and help you breathe while you are asleep.
You may be given antibiotics before surgery.
You may have a catheter tube placed into your bladder to drain urine.
You may have special stockings placed on your legs to help prevent blood clots.
Surgery time may range from 3 to 4 hours.
This is what may happen during the surgery:
Three or 4 small incisions are made near your belly button.
Gas may be pumped into your belly to inflate it and give your surgeon a better view and more room to work.
The laparoscope is inserted into your abdomen. Other surgical instruments are inserted through the other incisions.
Your surgeon attaches the laparoscope and the instruments to the robotic arms of the computer.
Your surgeon moves to the control area to remotely control the surgery.
Your uterus is cut into small pieces that can be removed through the small incisions.
During laparoscopic-assisted vaginal hysterectomy your uterus may be taken out through your vagina.
Depending on the reasons for your hysterectomy, the whole uterus may be removed or just the part above the cervix. The tubes and ovaries attached to the uterus may also be removed.
After surgery, the incisions are closed with 1 or 2 stitches and covered with small dressings.
What happens after a robotic hysterectomy?
After surgery, you will be taken to the recovery room to be watched as you recover from the anesthesia. Most people stay in the hospital for a few days. During your hospital stay this is what may happen:
Expect some pain after this procedure. You may be given pain medicine through your IV.
Your IV will be removed once you can drink fluids and your bowels are starting to pass gas.
You will be given additional pain medicine by mouth or by injection as needed.
Once your IV is removed and you are passing gas, you can start a normal diet.
Your bladder catheter will be removed in 1 or 2 days.
You may have bleeding from your vagina that requires the use of pads.
You will be encouraged to get up and walk as soon as you are able. This helps prevent blood clots from forming in your legs.
You may be given medicine that also helps prevent blood clots.
Caregivers will help you with your bathroom and wound care.
Once you go home, it’s important to follow all of your surgeon’s instructions and keep your follow-up appointments. Take any medications as directed. Some pain during early recovery is normal. Ask your surgeon what medications to take for pain.
Here is what you can expect during recovery at home:
You should be able to gradually return to your normal diet.
Your incision areas should be kept dry for a few days. Follow your surgeon’s instructions on bathing and dressing care. You may need to go back to have your stitches removed.
Keep walking. You should gradually be able to resume normal activities in a few days.
Avoid heavy lifting for a few weeks. Ask your surgeon when you can return to specific activities.
You may continue to have light bleeding from your vagina for several days.
You may be instructed not to put anything into your vagina for up to 6 weeks.
Complete recovery may take anywhere from a few weeks to a few months.
Tell your surgeon about any of the following during recovery:
Increasing pain or pain that is not relieved by medication
Any drainage, bleeding, redness, or swelling from your incision areas
Heavy vaginal bleeding
Pain or swelling in your legs
Chest pain or shortness of breath
In addition to the physical symptoms of recovery, you may have emotional symptoms after this surgery. After hysterectomy you will no longer be able to get pregnant and your periods will stop. Some women experience sadness related to these losses.
If you have had your ovaries removed as part of your surgery, you may notice symptoms of menopause, such as hot flashes and vaginal dryness. Some women may benefit from hormone therapy after hysterectomy. Discuss this with your doctor.
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
The risks and benefits of the test or procedure
When and where you are to have the test or procedure and who will do it
When and how will you get the results
How much will you have to pay for the test or procedure
What kind of hysterectomy is best for you? | UCI Health
Your doctor says you need a hysterectomy. What do you need to know?
The first thing you should do, UCI Health gynecologist Dr. Donna Baick says, is to understand the diagnosis and weigh your options, including what kind of procedure is the best for you.
The American Congress of Obstetricians and Gynecologists (ACOG) says the safest, least invasive and most cost-effective way to remove a uterus for non-cancerous reasons is a vaginal hysterectomy, rather than laparoscopic or open surgery.
An estimated 600,000 women a year undergo hysterectomies to treat:
It is the second most common surgery women undergo, after cesarean births.
Open surgery still the norm
Less than a fourth of all hysterectomies are performed vaginally, according to ACOG. About two-thirds of cases are performed with a large abdominal incision, and another 12 percent are performed with special tools called laparoscopes and require a several tiny incisions.
ACOG says the low rate of vaginal hysterectomies is because too few practicing gynecologists have been trained in the technique, and those who have been trained don’t perform them often enough to be comfortable with the procedure.
Baick, who sees patients at UCI Health – Tustin, uses the vaginal approach with her patients whenever she can because there are no external incisions and less bleeding.
“There are also fewer complications, less chance of injury to the patient and less recovery time,” said Baick, who has had many years of experience using the vaginal approach. So do all of her colleagues with UCI Health Gynecology Services.
“I’ve had patients go back to work within two weeks after surgery, compared with four to six weeks for an abdominal or laparoscopic hysterectomy.”
Jill Donahue, 50, of Orange knows first-hand the difference between recovery from a vaginal hysterectomy and a more invasive abdominal procedure.
Donahue underwent a vaginal hysterectomy — Baick removed her uterus, cervix and fallopian tubes — in September 2015. The regional sales manager for a steel parts company was back on the job in less than a week. She was driving again in a week and a half.
In April 2016, Donahue had her gall bladder removed, this time with robot-assisted laparoscopic surgery. More than eight weeks after that surgery, she was still feeling abdominal pain and tenderness. It wasn’t until early July that she could wear jeans without discomfort.
“I love Dr. Baick,” said Donahue, who had suffered for years from heavy and painful menstrual bleeding. “She knows what she’s doing and she’s a got expert skills. She’s also compassionate. She takes time to talk with you about your options and she explains everything.”
Weigh treatment options thoroughly
Baick advises her patients that a hysterectomy is an irreversible surgical procedure, one that should be considered carefully, especially if a woman is still in her childbearing years.
“We don’t take surgery very lightly,” she said. “We try to find out first what is causing the problem.”
Tests usually include a pelvic exam, blood and urine analysis, and possibly ultrasound imaging and an endometrial biopsy.
“If the biopsy confirms that excessive bleeding is due to a fibroid tumor or polyp, and it is benign, we discuss alternatives,” she said.
These can include prescribing medication to control the pain or block the production of estrogen, scraping or suctioning away the uterine lining, or performing a procedure called endometrial ablation.
Before her hysterectomy, Donahue tried nonsurgical treatments. Baick performed a dilation and curettage (commonly known as a D&C) treatment to remove the endometrial lining. A year or so later, she underwent an endometrial ablation procedure to remove the lining with heat therapy. When painful cramps and heavy periods returned yet again in 2015, Donahue and Baick agreed it was time to consider a hysterectomy.
Another patient, Marjan Habibian, 48, met with Baick because she was enduring 25-day menstrual periods that were draining her body of iron, calcium and other critical minerals. Her hair was falling out and she was losing her fingernails. The graphic designer was so fatigued that she would run out of steam by 2 every afternoon.
Baick determined that a benign growth in the lining of Habibian’s uterus was causing the excessive blood flows, a condition known as menorrhagia, and gave her several options, including ablation to remove the uterine lining and the growth.
But the Villa Park mother of two had her heart set on a final solution. She didn’t plan to have more children, and a hysterectomy had given an older friend permanent relief from similarly debilitating menstrual cycles. Baick performed a vaginal hysterectomy on Habibian the day before Thanksgiving 2015, removing her uterus, cervix and fallopian tubes, while preserving the ovaries rather than send her into early menopause.
Habibian went home the next day, expecting to be bedridden and in pain. That didn’t happen. “I didn’t even go to pick up my pain prescription at the pharmacy, and I was back to driving my youngest daughter to school within 10 days,” she said, adding that her hair has grown back in, as have her fingernails, and her energy level is back to normal. “Dr. Baick is an angel.”
Women with scar tissue from a cesarean delivery or other abdominal surgeries, or those with a very large uterus, may not be candidates for a vaginal hysterectomy, Baick said.
Every case needs to be evaluated individually, she said. And patients should consider getting a second opinion. “Women absolutely need to make sure they are making the right choice for themselves,” Baick said.
Types of hysterectomies
Hysterectomies can be partial, complete, include removal of the ovaries, or radical.
- A partial — or supracervical — hysterectomy involves removal of the upper part of the uterus but leaves the cervix intact.
- In a complete hysterectomy, both the uterus and cervix are removed.
- When the ovaries and fallopian tubes are also removed, it is called a hysterectomy with bilateral salpingo-oophorectomy.
- In a radical hysterectomy, the surgeon removes all the reproductive organs as well as the upper vagina, some lymph nodes and surrounding tissue. This type of hysterectomy is usually performed when there is a cancer diagnosis.
Types of surgical procedures
The traditional hysterectomy is performed with an abdominal incision of about five inches, either vertically or along the bikini line to minimize visible scarring. The surgeon can more easily see the uterus and surrounding area, and this may be an advantage when a fibroid tumor is particularly large. With an open surgery, however, there is usually more pain and a longer recovery time.
In a vaginal hysterectomy, a small internal incision is made at the top of the vagina. Through this opening, a surgeon can separate the uterus from connecting tissue and its blood supply then remove the uterus through the vaginal canal. The cervix may also be removed.
In a laparoscopic hysterectomy, special surgical tools are inserted through small abdominal incisions to remove the uterus in pieces. For robot-assisted procedures, the surgeon controls the laparoscopes with robotic arms.
Sometimes a surgeon may also use a laparoscope during a vaginal hysterectomy to get a better view of the uterus and surrounding organs.
What is a hysterectomy?
What it a hysterectomy?
A hysterectomy is a procedure to remove the uterus (1). The word hysterectomy has two parts: hyster-, meaning uterus, and ectomy-, meaning removal.
Not all hysterectomy procedures are the same. There are four main types of hysterectomy procedures:
- A total hysterectomy is the removal of the uterus and cervix.
- A partial (subcervical) hysterectomy is the removal of just the uterus, leaving the cervix in place.
- A total hysterectomy with bilateral salpingo-oophorectomy is the removal of the uterus, cervix, fallopian tubes, and ovaries. Salpingo- refers to the fallopian tubes, and oopho- refers to the ovaries.
- A radical hysterectomy is the removal of the uterus, cervix, fallopian tubes, ovaries, part of the vagina, and other tissue surrounding the uterus (1,2).
Hysterectomies are permanent. A person who has had a hysterectomy can no longer have children (i.e. it causes sterility). Hysterectomies also permanently stop menstrual bleeding, but the hormonal fluctuations of the menstrual cycle will still happen unless a person has had their ovaries removed (1,2).
Reasons for the procedure
A person may choose to have a hysterectomy to treat a reproductive disorder or condition (1-3). Having a hysterectomy is considered major surgery, and coming to this decision should not be taken lightly. Healthcare providers will often try less-invasive alternative therapies and treatments first before a hysterectomy is recommended (2,3).
A hysterectomy is sometimes performed to treat a prolapsed uterus, endometriosis, uterine fibroids, or other bleeding and pain disorders in the lower reproductive system (1-3). They are also performed to treat or prevent reproductive cancers, such as uterine or cervical cancer (1,2). The removal of both ovaries and fallopian tubes during a hysterectomy is sometimes recommended for people with or at high risk of breast cancer (1) or ovarian cancer, as the reproductive hormones released by the ovaries impact cancer risk (4-6). More research is needed in this area.
Transgender men and nonbinary people who were born with a uterus may choose to undergo a hysterectomy with the removal of ovaries and fallopian tubes, as part of gender affirmation surgery (7,8). A total hysterectomy with bilateral salpingo-oophorectomy may be recommended before surgery to construct a penis (7).
Emergency hysterectomies, which usually aren’t chosen, are done to stop life-threatening bleeding during or soon after the delivery of a baby (9). An emergency hysterectomy is typically either a partial hysterectomy or total hysterectomy (9).
Hysterectomies are surgeries and therefore come with risks. Possible complications include infection, hemorrhage, accidental injury to other body parts during the procedure (including the bladder or bowels), and adverse reactions to anesthesia (1,2). Hysterectomies are very effective at treating a variety of disorders and conditions, but it’s important to understand what the alternatives to surgery are, and the risks associated with the procedure.
Reproductive health after the procedure
All types of hysterectomies permanently stop menstrual bleeding. Despite this, people who have not had their ovaries removed will continue to produce reproductive hormones and have hormonal menstrual cycles without periods.
A person who has had both ovaries removed with their hysterectomy will go through surgically-induced menopause (1,2). They will not experience hormonal menstrual cycles or periods. Some healthcare providers may then recommend hormone therapy to help prevent osteoporosis and/or other side effects of menopause (1,2).
People who have had a hysterectomy can no longer carry a pregnancy, as the uterus is the only place in the body where fertilized eggs can develop. Although a person with ovaries could, in theory, experience an ectopic pregnancy (where a fertilized egg begins to develop in the fallopian tube or another part of the reproductive tract), the chance of this is almost zero (10). If you experience extreme abdominal pain or bleeding after your hysterectomy, speak with your healthcare provider immediately.
A person who has had a hysterectomy can still get a sexually transmitted disease, so condoms or another barrier-method should be used during sex with an untested partner.
__Download Clue to track the changes of your menstrual cycle—it’s more than just your menstrual period. __
- Endometriosis is a condition in which tissue like the endometrium (the lining of the uterus) grows outside the uterus, causing pain and / or infertility (1).
- Globally, endometriosis affects approximately 10% (190 million) of women and girls of reproductive age (2).
- Symptoms include severe, interfering pain during menstruation, intercourse, defecation and / or urination, chronic pelvic pain, bloating, nausea, fatigue, and sometimes depression, anxiety, and infertility …
- Due to the variety of symptoms of endometriosis, it is not easy for healthcare professionals to diagnose the condition, and many people who suffer from it know little about it. Therefore, it sometimes takes a long time from the onset of symptoms to the diagnosis (3).
- Currently, there are no generally accepted treatments for endometriosis, and in most cases, treatment is limited to eliminating symptoms (4).
- Access to early diagnosis and effective treatment of endometriosis is important, but is limited in many countries, including low- and middle-income countries.
- There is a need to continue research and raise awareness of the disease worldwide to ensure effective prevention, early diagnosis and more effective treatment (2,5).
Introduction and Definition
Endometriosis is a disease in which tissue like the endometrium (the lining of the uterus) grows outside the uterus (1). This causes a chronic inflammatory response that can
lead to the formation of scar tissue (adhesions, fibrosis) in the pelvis and other parts of the body.Several types of lesions have been described (1,6):
- superficial endometriosis, mainly on the pelvic peritoneum
- endometrioid ovarian cyst (endometrioma)
- deep endometriosis in the rectovaginal septum, urinary bladder and intestines
- in rare cases outside of endometriosis
Symptoms of endometriosis vary and can manifest as a combination of the following conditions:
- painful menstruation
- chronic pelvic pain
- pain during and / or after intercourse
- painful defecation
- painful urination
- depression or anxiety disorder
- bloating and nausea
In addition to the above symptoms, endometriosis can lead to infertility.Infertility occurs due to the possible effects of endometriosis on the pelvic cavity, ovaries, fallopian tubes, or uterus. There is no clear relationship between the degree of damage
endometrium and the severity or duration of symptoms: in some cases, with clearly larger lesions, symptoms may be milder, and in other cases, symptoms may be more severe with smaller lesions. Patient status
often improves after menopause, but painful symptoms may persist in some cases.Chronic pain may be due to the fact that pain centers in the brain become hypersensitive over time (central sensitization), and
pain can appear at any time throughout the course of the disease, including treated, under-treated and untreated endometriosis, and may persist even when the lesions of endometriosis are no longer visible. In some
cases of endometriosis are asymptomatic.
What is the cause of endometriosis?
Endometriosis is a complex disease that affects some women from the beginning of the first menstrual period (menarche) to menopause,
regardless of ethnicity or social status.The exact origin of endometriosis is considered polyetiological (multifactorial), which means that many different factors contribute to its development. Several hypotheses have been put forward,
explaining the origin of endometriosis. It is currently believed that endometriosis occurs for the following reasons.
- Retrograde menstruation is when menstrual blood containing endometrial cells flows back through the fallopian tubes into the pelvic cavity, while blood flows out of the body through the cervix and vagina during menstruation.Retrograde menstruation
can cause endometrial-like cells to be deposited outside the uterus, where they can implant and grow.
- Cell metaplasia, when cells of one type are replaced by cells of another type. Cells outside the uterus turn into endometrial-like cells and begin to grow.
- Stem cells cause disease, which then spreads through the body through the blood and lymph vessels.
Other factors may also contribute to the growth or persistence of ectopic endometrial tissue.For example, endometriosis is known to depend on estrogen, which causes inflammation, swelling, and pain associated with the disease. However, the link between estrogen
and endometriosis is difficult because the absence of estrogen does not always preclude the presence of endometriosis. Several other factors are thought to contribute to the development, growth, and maintenance of lesions in endometriosis. These include modified or weakened
immunity, local complex hormonal influences, genetics and, possibly, substances that pollute the environment (2,7).
Health and socioeconomic benefits of endometriosis control
Endometriosis has major socioeconomic and public health implications. It can reduce quality of life due to severe pain, fatigue, depression, anxiety, and infertility. Some people with
endometriosis experience debilitating pain that prevents them from working or studying (8,9). In these situations, fighting endometriosis can reduce absenteeism or increase a person’s ability to be economically active.Related
with endometriosis, painful sensations during copulation can lead to interruption or avoidance of intercourse and affect the sexual health of people suffering from this disease and / or their partners (9). Fighting Endometriosis Expands Opportunities
affected people, ensuring their right to the highest attainable standard of sexual and reproductive health, quality of life and general well-being.
known methods for the prevention of endometriosis.Raising awareness and early diagnosis and treatment can slow or halt the natural progression of the disease and reduce the long-term burden of its symptoms, including the possible
the risk of sensitization of the central nervous system, however, the disease is currently considered incurable.
A careful history of menstrual symptoms and chronic pelvic pain suggests endometriosis. Although several screening tools and tests have been proposed and tested, none are currently available.
time has not been validated to accurately detect or predict endometriosis in individuals or populations most likely to have the disease.Early suspicion of endometriosis is one of the key factors in early
diagnosis, because endometriosis can often have symptoms that mimic other conditions, making diagnosis difficult. In addition to medical history, referral from primary health care facilities to specialized
institutions for a more detailed survey. For example, ultrasound or magnetic resonance imaging (MRI) is often needed to detect ovarian endometrioma, adhesions, and deep nodular lesions.Histological verification as
usually after surgical / laparoscopic imaging, it may be helpful to confirm the diagnosis, especially in the most characteristic superficial lesions (1,2). The need for histological / laparoscopic verification should not preclude
initiation of empirical treatment.
Treatment is possible with drugs or surgery, depending on the symptoms, the nature of the lesions, the desired result and the patient’s desire
(4).The most common treatments are steroidal contraceptives, nonsteroidal anti-inflammatory drugs, and analgesics (pain relievers). All of these funds must be carefully prescribed and monitored to avoid potential
problematic side effects. Medication for endometriosis aims to either lower estrogen or increase progesterone in order to alter the hormonal environment conducive to endometriosis. These medications include the use of
combined oral contraceptives in the form of pills, progestins and GnRH analogues.However, none of these methods cure the disease, they have side effects, and symptoms of endometriosis can sometimes reappear after stopping therapy.
The choice of treatment depends on the patient’s body characteristics, side effects, long-term safety, cost and availability. Most modern hormonal medications are not suitable for people with endometriosis who want to get pregnant.
as they affect ovulation.
Endometriosis lesions, adhesions and scar tissue can be removed surgically.However, how successfully you manage to relieve pain symptoms and increase the likelihood of pregnancy,
often depends on the degree of the disease. In addition, lesions can recur even after successful removal, and pelvic floor muscle abnormalities can cause chronic pelvic pain. Some people with secondary pelvic changes, including
pelvic floor, and central sensitization can be helped by physical therapy and complementary therapies. Treatment options for infertility caused by endometriosis include laparoscopic surgical removal of endometriosis, ovarian stimulation with
intrauterine insemination (IUI) and in vitro fertilization (IVF), but success rates vary (4).Along with endometriosis, other comorbidities may occur that require diagnosis and treatment. For a multidisciplinary
treatment aimed at various symptoms and overall health improvement has been as effective as possible and should involve not only gynecologists, but also other specialists such as pain specialists, physiotherapists who specialize in
on the pelvic organs, specialists in the field of complementary and alternative medicine, general practitioners and psychologists (2,10).
Problem solving and priorities
In many countries, the general public and most health care workers do not realize that excruciating and disruptive pelvic pain is abnormal, which makes the corresponding symptoms
not given due attention, and diagnoses are made with a significant delay (2,3). Patients who could benefit from symptomatic treatment do not always receive it due to the lack of awareness of endometriosis among primary health care providers.
help.Due to delays in diagnosis, it is often not possible to timely implement available treatments, including nonsteroidal analgesics (pain relievers), oral contraceptives, and progestin-based contraceptives. Due to limited opportunities
access to specialized surgery for those who need it remains suboptimal for health systems in many countries. In addition, there is a shortage of multidisciplinary teams equipped with the appropriate equipment and with a variety of
the skills necessary for the early diagnosis and effective treatment of endometriosis, especially in low- and middle-income countries.Primary care staff have a role to play in screening and basic care
endometriosis, but there are no tools to screen and accurately predict endometriosis among the individuals or populations most likely to have the disease. In addition, there are many knowledge gaps and need
in non-invasive diagnostic methods, as well as in medical treatment that does not prevent pregnancy.
Therefore, some of the priorities that need to be addressed in the fight against endometriosis are as follows.
- Raise awareness of endometriosis among healthcare professionals, women, men, adolescents, teachers and the general population. Local, national and international awareness campaigns should be carried out to educate the public and health
workers about normal and abnormal menstrual hygiene and symptoms.
- Training of all healthcare professionals to improve their qualifications and skills in the screening, diagnosis, treatment or referral of patients with endometriosis.This can take many forms, from basic supplier training to primary
medical and sanitary care methods for recognizing endometriosis to improve the qualifications of specialist surgeons and multidisciplinary teams.
- Ensure that primary health care facilities are involved in screening, detecting and managing endometriosis in situations where gynecologists or highly trained multidisciplinary specialists are not available.
- Promote health policies that provide at least a minimum level of treatment and support for patients with endometriosis.
- Establishment of patient referral and routing systems, including efficiently interacting primary health care centers, as well as secondary (specialized) and tertiary (highly specialized) medical centers
using advanced imaging techniques and pharmacological, surgical, reproductive and multidisciplinary interventions.
- Strengthening the capacity of health systems for the early diagnosis and treatment of endometriosis by making equipment (e.g., ultrasound or magnetic resonance imaging) and medicines (e.g. nonsteroidal) more accessible
analgesics, combined oral contraceptives and progestin-based contraceptives).
- Scaling up research in areas such as pathogenesis, pathophysiology, natural progression, genetic and environmental risk factors, prognosis, disease classification, non-invasive diagnostic biomarkers, individualized
treatment and other treatment paradigms, the role of surgery, new means of targeted therapy, methods of radical treatment and prevention measures for endometriosis (2,5).
- Strengthening collaborative global action to improve women’s access to reproductive health services worldwide, including in low- and middle-income countries.
What WHO does
The World Health Organization (WHO) recognizes the importance of endometriosis and its impact on people’s sexual and reproductive health, quality of life and overall well-being. WHO strives to stimulate and support
developing and implementing effective strategies and interventions to combat endometriosis worldwide, especially in low- and middle-income countries. WHO collaborates with a variety of stakeholders, including academic institutions,
non-governmental actors and other organizations that are actively involved in research to identify effective models for the prevention, diagnosis, treatment of endometriosis and patient care.WHO recognizes the importance of advocacy
activities to raise awareness, disseminate information on policies and services for the prevention and treatment of endometriosis, and in this regard works with civil society and endometriosis patient support groups. WHO
also works with relevant stakeholders to facilitate the collection and analysis of data needed for decision-making on the prevalence of endometriosis in specific countries and regions.
- World Health Organization (WHO). International Classification of Diseases, 11th Revision (ICD-11) Geneva: WHO 2018.
- Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med 2020; 382: 1244-56.
- Agarwal SK, Chapron C, Giudice LC, et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol 2019 (4): 354-64.
- Johnson NP, Hummelshoj L, World Endometriosis Society Montpellier Consortium.Consensus on current management of endometriosis. Hum Reprod 2013; 28 (6): 1552-68.
- Horne AW, Saunders PTK, Abokhrais IM, et al. Top ten endometriosis research priorities in the UK and Ireland. Lancet 2017; 389: 2191-92.
- Johnson NP, Hummelshoj L, Adamson GD, et al. World Endometriosis Society consensus on the classification of endometriosis. Hum Reprod 2017; 32 (2): 315-24.
- Wen X, Xiong Y, Qu X, et al. The risk of endometriosis after exposure to endocrine-disrupting chemicals: a meta-analysis of 30 epidemiology studies.Gynecol Endocrinol 2019; (35): 645-50.
- Nnoaham K, Hummelshoj L, Webster P, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril 2011; 96 (2): 366-73.e8.
- Culley L, Law C, Hudson N, et al. The social and psychological impact of endometriosis on women’s lives: a critical narrative review. Hum Reprod Update 2013; 19 (6): 625-639.
- Carey ET, Till SR, As-Sanie S. Pharmacological management of chronic pelvic pain in women.Drugs 2017; 77: 285-301.
Inflammatory diseases of female genital organs
The problem of inflammatory gynecological diseases occupies an important place in the activities of an obstetrician-gynecologist.
These diseases in gynecological patients occur much more often than other diseases of the genital organs.
The importance of inflammatory diseases is especially great, since it is known that they are often exacerbated, leading patients to disability and even disability.In addition, inflammatory processes of the genital organs often lead to violations of menstrual function, cause infertility, general intoxication of the body with the involvement of the nervous system, liver, kidneys and other vital organs and systems in the pathological process.
The cause of the development of inflammatory diseases of the female genital organs is usually microbial or viral pathogens.
Routes of entry of microbes into the genitals:
- Sexual – active transport of microbes from the vagina to the overlying organs is realized by spermatozoa and Trichomonas.Sperm cells have a negative charge, which is a kind of receptor for microbes.
- Passive transport (independent spread of microbes and viruses through the genitals).
- Hematogenous transport (from other organs with blood flow).
- Lymphogenous (through the lymphatic system), for example, from the intestines with purulent appendicitis.
Factors contributing to the spread of infection (provoking factors):
- Hypothermia, weakening of the general defenses of the body as a result of diseases of other organs and systems.
- Physiological (menstruation, childbirth) or artificial (abortion, intrauterine devices, intrauterine diagnostic and therapeutic interventions, operations on the abdominal organs, IVF, etc.) weakening or damage to the protective (barrier) mechanisms of the cervix.
- Social factors: chronic stressful situations, low standard of living (inadequate and inappropriate nutrition, unfavorable living conditions), chronic alcoholism and drug addiction.
- Behavioral factors: early onset of sexual activity, high frequency of sexual intercourse, a large number and frequent change of sexual partners, while using hormonal rather than barrier contraception, unconventional forms of sexual intercourse (orogenital, anal), sexual intercourse during menstruation, frequent douching and self-medication, improper use of intravaginal tampons, etc.
The onset of the disease is often associated with a change in sexual partner.
Experts classify inflammatory diseases of the female genital organs by the causative agents that caused them, by the place of localization, by the duration and severity of symptoms.
By the type of pathogen diseases in gynecology can be specific and nonspecific:
- Specific inflammations are caused by sexually transmitted infections. These include HIV, gonorrhea, herpes, trichomoniasis, gonococcus, Trichomonas, chlamydia and others.Sometimes several infections can act as pathogens at once.
- Nonspecific inflammation is caused by a woman’s own flora, which is activated if the body malfunctions: Escherichia coli, streptococcus, staphylococcus, etc. In the past few years, viruses and protozoan fungi, which are normally part of the normal microflora of the vagina, have become more and more problematic for women.
As such, there is no difference between specific and non-specific diseases, but there is a general rule – start treatment immediately after the first symptoms appear.
By the nature of inflammation, can be acute, subacute, chronic and exacerbated:
- The acute course of the process occurs for the first time and is accompanied by vivid clinical manifestations.
- Subacute also worries the woman for the first time, but not so clearly expressed.
- Chronic course lasts more than four weeks. Complaints from the patient during this time, as a rule, are absent and appear only with an exacerbation of the chronic process.Complaints may also be associated with complications of the chronic process that have already occurred (menstrual dysfunction, infertility, dysfunction of other organs and systems).
The course of the inflammatory process depends on the nature of the pathogen and the characteristics of the defenses of the body of women. If the body’s defenses are disrupted, the process may spread (sepsis).
At the site of the lesion female diseases are divided into two types – lesions of the upper and lower genitals.
Lesions of the upper section combine the following diseases: salpingo-oophoritis (inflammation of the ovaries and fallopian tubes), endometritis (inflammation of the mucous membrane of the uterine body), pelvioperitonitis (inflammation of the peritoneum), parametritis (inflammation of the peritoneal tissue), tubo-ovarian abscess (purulent inflammation of the uterine appendages).
The most common inflammatory disease in women is salpingo-oophoritis .
Most often, acute, purulent salpingo-oophoritis begins acutely:
- Fever, sometimes accompanied by chills.The range of temperatures can be different, characterized by an evening rise in temperature with normal or subfebrile readings in the morning.
- Pain in the lower abdomen. They arise sharply. At the onset of the disease, they are usually local in nature, and the patient can clearly indicate the area of the lesion; in the presence of concomitant inflammation of the uterus and surrounding tissues, pain can be widespread and radiate to the lower back, rectum and thigh).
- Abundant purulent (less often serous-purulent) leucorrhoea and cuts during urination.As a rule, they are accompanied by purulent discharge from the urethra, which also leads to the appearance in patients of frequent, small portions, painful urination or severe cuts during urination.
- Subsequently, symptoms of purulent intoxication (weakness, tachycardia, muscle pain, dry mouth), dyspeptic and emotional-neurotic and functional disorders join.
Complete cure, as a rule, does not occur, more often the disease acquires a chronic course with periodic exacerbations.Exacerbation of chronic salpingo-oophoritis can begin under the influence of many external factors: hypothermia, overheating, fatigue, less often associated with reinfection. During the period of exacerbation, the temperature rises, pains in the lower abdomen appear or intensify, and the amount of discharge increases. Usually, the pain intensifies before and during menstruation, sometimes the cycle is disrupted. Up to half of patients note sexual dysfunctions: libido disappears, coitus becomes painful. With a prolonged course and frequent relapses, the urinary, nervous, endocrine, vascular systems are involved in the pathological process, and the disease takes on the character of a polysystemic process.
The acute form of the disease usually develops after undergoing medical and diagnostic interventions on the uterus, operations. Predisposing factors are the leaving of the membranes in the uterus during abortion, blood clots, a large number of pathogenic and opportunistic (Escherichia, Proteus, etc.) microorganisms in the vaginal biocenosis.
The acute form begins with an increase in body temperature, pains appear in the lower abdomen, discharge from the genital tract of a different nature (purulent, bloody-purulent), women complain of weakness, headache.
Without treatment, inflammation can spread to all layers of the uterus and parametrium – the fiber located between the leaves of the wide ligaments of the uterus. The parameter develops. The acute form of parametritis can lead to a parametric abscess, which sometimes spontaneously opens into the rectum, uterus, abdominal cavity or bladder.
With inadequate treatment, development becomes chronic.
Chronic endometritis is characterized by light serous discharge from the genital tract, periodic uterine bleeding outside of menstruation.Sometimes the chronic process proceeds without any external symptoms, but at the same time leads to menstrual irregularities, miscarriage, infertility.
Pelvioperitonitis – inflammation of the pelvic peritoneum. More often it is a complication of the above diseases.
Symptoms: the disease is characterized by acute abdominal pain, nausea, vomiting, bloating, stool and gas retention, fever, increased heart rate. Tongue dry, coated with white bloom.With a modern (erased) course, a small severity of symptoms or the absence of some of them is possible.
Patients need special supervision in connection with the possibility of the transition of pelvioperitonitis to diffuse peritonitis, which requires an emergency operation.
Lesions of the lower section include vulvitis, colpitis (vaginitis), urethritis, bartholinitis and cervicitis (exocervicitis, endocervicitis).
Vulvitis – inflammation of the mucous membrane of the vestibule.Develops mainly in girls. Infection is facilitated by diaper rash, scratching, abrasions, endocrine pathology (IDDM), helminthic infestations, and childhood viral infections. In adults, as a rule, vulvitis is combined with inflammation of the vaginal mucosa.
Clinic: pain, vulvar edema, purulent discharge.
Bartholinitis is an inflammation of the large glands of the vestibule of the vagina. Very often, if the rules of hygiene of the genital organs are not followed, various bacteria and STIs enter it.Its excretory duct is clogged and an inflammatory process occurs in the gland. One-sided lesion of the Bartholin gland is more common.
It manifests itself first by redness around the external opening of the excretory duct, then inflammatory edema can clog the duct of the gland, preventing the release of purulent secretions, which, lingering in the duct, stretches it, forming a false abscess (abscess), which protrudes the inner surface of the labia majora and closes the entrance to vagina.The body temperature may rise, soreness in the perineal region. In rare cases, the inflammatory process can directly capture the tissue of the gland, while a true abscess occurs with strong suppuration and enlargement of the gland. The large and small labia are swollen. The inguinal lymph nodes are enlarged. The body temperature rises. A true abscess differs from a false abscess in constant pain, sharp swelling of the labia, immobility of the skin over the abscess, high temperature.
The abscess can spontaneously open with the outflow of thick yellow-green contents, after which the condition improves.The inflammatory process can subside on its own (without suppuration). In this case, there is a compaction and a slight increase in the gland. However, quite often, after a while, the inflammatory process resumes and becomes more complicated.
Colpitis – inflammation of the vagina (vaginitis).
In the clinical picture there is a triad of symptoms: pain, leucorrhoea, itching.
Colpitis can be caused by gonococci, Trichomonas, chlamydia, as well as opportunistic microorganisms such as staphylococci, streptococci, Candida fungi, Escherichia coli, etc.Allocate acute and persistent vaginitis. In an acute process, women complain of itching in the vaginal vestibule, burning, pressure, heat in the genitals and small pelvis, many note dysuric disorders. Profuse discharge is characteristic – leucorrhoea. The inflammatory process caused by various pathogens has its own characteristics. For example, profuse, frothy, yellowish-green discharge with an unpleasant odor is characteristic of Trichomonas vaginitis; allocation of a white cheesy look – for a fungal.In chronic forms of inflammation, pain is absent, mainly patients complain of discharge, itching, burning, small ulceration in the vestibule vestibule.
Bacterial vaginosis (diagnosed since 1980) Gardner’s disease. Complaints only about increased discharge of leucorrhoea (abundant discharge, foul smelling). There are no symptoms of inflammation. Often women complain of discomfort and burning sensation in the vagina. Recently, bacterial vaginosis is considered as a kind of vaginal dysbacteriosis, which occurs when the number of lactobacilli secreting lactic acid decreases, and the pH of vaginal secretions increases (more than 4.5).This creates conditions for massive reproduction of microorganisms such as gardnerella and obligate anaerobic bacteria. This disease is rare in prepubertal girls and in postmenopausal women, which indicates the great importance of the hormonal component in the occurrence of such an imbalance.
Cervicitis is an inflammation of the cervix, which occurs as a result of penetration into the cervical canal of gonococci, Trichomonas, chlamydia, staphylococci, streptococci and other bacteria, less often viruses.The occurrence is facilitated by ruptures of the cervix during childbirth, prolapse of the genitals, infectious processes in the vagina and, conversely, in the internal genital organs. In an acute process, a woman is worried about weak pain in the lower abdomen, discomfort in the vagina, sometimes itching, mucous or purulent mucous discharge from the vagina, painful sensations during sexual intercourse. In a chronic process, complaints are less pronounced.
Endocervicitis – inflammation of the mucous membrane of the cervical canal.It can occur with the penetration of various bacteria (staphylococci, streptococci, gonococci, intestinal escherichia, etc.). Endocervicitis is often combined with an inflammatory process in other parts of the reproductive apparatus – colpitis, salpingo-oophoritis, erosion of the cervix.
Symptoms: mucopurulent vaginal discharge, no pain. Clinical signs are poorly expressed. In the acute stage, hyperemia around the external pharynx and mucopurulent discharge are determined. In the chronic stage, there is almost no hyperemia, the discharge remains.With a long course of the process, hypertrophy (thickening) of the cervix develops – cervicitis
Genital warts (multiple growths on the surface of the external genitalia and the vaginal opening). Can spread to the perineum, vagina, cervix. The cause of genital warts is a filterable virus (human papillomavirus), the development of the process is facilitated by abundant discharge from the genital tract with colpitis and endocervicitis. Very quickly, genital warts grow during pregnancy.
Symptoms: warts are most often localized on the external genitals, perineum, around the anus. In cases of necrosis of genital warts and the addition of a secondary infection, purulent discharge appears. Vaginal and cervical warts during pregnancy and childbirth can cause bleeding. Diagnosis is by physical examination.
Examination program for pelvic inflammatory disease (PID)
Name of survey
Information that a survey can give
General blood test
Leukocytosis, stab shift to the left, accelerated ESR, lymphopenia in acute and 1 m variant of exacerbation of chronic PID
Increase in the level in acute and 1st variant of exacerbation of chronic PID
Total protein, protein fractions
Decrease in the level of total protein, albumin, increase in the content of globulins in acute and 1st variant of exacerbation of chronic PID
Medium molecules, medium molecular peptides for the assessment of endogenous intoxication
Increase in the level (norm: average molecules -56.8 ± 1.3 U / ml; average molecular peptides -85.4 ± 1.8 μg / ml) in acute and 1st variant of exacerbation of chronic PID
Ultrasound of the pelvic organs
Informative in combination with anamnestic, clinical and clinical laboratory data in the diagnosis of serous and purulent TOVO, abscesses of the small pelvis, pathological changes: the structure of the ovaries, adhesions, infiltrative changes in organs and tissues of the small pelvis, when assessing the results of conservative treatment in dynamics
In acute and exacerbation of a chronic process: an increase in the absolute and relative number of neutrophilic granulocytes in the peripheral blood, as well as their functional activity in the NBT test with a low functional reserve; decrease in phagocytosis indicators; increased IL-1 – producing activity of monocytes; increased serum lysozyme content; increased levels of IgM and IgG in peripheral blood; decrease in the number and functional activity of peripheral blood lymphocytes; an increase in the value of the T4L8 ratio (helpers / suppressors).
Primary microscopy of native material from the vagina, cervical canal, uterine cavity, small pelvis (punctate), fallopian tube (laparoscopy)
Key cells, Trichomonas, fungal flora, leukocytosis.
Gram stained smear from the vagina, cervical canal, uterine cavity, small pelvis (punctate), fallopian tube (laparoscopy)
Diagnostics of gonorrhea, trichomoniasis, bacterial vaginosis, candidiasis; leukocytosis, the degree of functional activity of leukocytes. Assessment of the degree of contamination of the material separately for gram-negative and gram-positive rods, gram-positive cocci, fungi using the following criteria: in large numbers – more than 100 microorganisms in the field of view; in moderation – 20-100 microorganisms in the field of view; in small quantities – 5-20 microorganisms in the field of view; microflora is not determined.To determine the invasiveness (aggressiveness) of the fungal microflora, the presence of budding yeast cells, elements of mycelium and pseudomycelium are noted. The result is obtained within 1 hour.
Culture for aerobic and anaerobic microflora, determination of antibiotic sensitivity of the contents of the vagina, cervical canal, uterine cavity, fallopian tubes and small pelvis
Determination of the nature of the vaginal biocenosis, identification of etiologically significant aerobic and anaerobic microorganisms and their antibiotic sensitivity.
Determination of the pathogen by PCR or quantitative methods (tank culture, Femoflor) in scrapings from the cervical canal, endometrium, fallopian tubes, small pelvis (chlamydia, mycoplasma, ureaplasma, viruses)
Confirmation of the diagnosis of chlamydia, mycoplasmosis, ureaplasmosis, viral infection of the genitals. The result is obtained within 1 day.
Aspiration biopsy of the endometrium
Assessment of the functional capabilities of the ovaries and the reception of the endometrium by histological changes in the uterine mucosa, diagnostics of the nature of the inflammatory process in the endometrium, histobacterioscopic characteristics of the pathogen, obtaining ideas about the state of local immunity (immunomorphological reactions) and protective capabilities of the mucus-forming apparatus of the uterus (lectinohistochemical studies).
It is carried out with chronic PID for: identifying the most altered areas of the endometrium; targeted biopsy of the endometrium for histological, histochemical studies and identification of the pathogen; detection of concomitant pathology.
Laparoscopy – the “gold” standard for diagnostics of acute PID
Establishing the nature of inflammation, the degree of changes in the fallopian tubes, the presence of complicated PID.Differential diagnosis. Biopsy of material for bacteriological and histological (immunomorphological, lectinohistochemical) studies. Therapeutic measures.
Treatment of inflammatory diseases of female genital organs
Important to remember !!!
It is a serious mistake to choose a method of treatment on your own, based on the experience of friends, relatives or information in the media, literature. Only contacting an obstetrician-gynecologist immediately when the first symptoms appear will help to avoid serious complications and the transition of the inflammatory process to a chronic one.Since there are no two identical people, the treatment regimen is always prescribed individually, taking into account the characteristics of the body, examination indicators, the presence of diseases of other organs in a woman, etc. In this case, the doctor pays attention to possible allergic reactions, the state of immunity.
Also, do not forget that chronic diseases are very difficult to treat and you can get rid of them only with the help of a highly qualified specialist. Otherwise, relapses and complications are inevitable, which are often more dangerous than the disease itself.
Chronic gynecological diseases are often the root cause of an unstable emotional state and a decrease in the quality of sexual life. It is worth remembering about the real danger of dysfunction of the reproductive system, that is, the inability to conceive and give birth to a child. Whatever the consequences of illness, they always change a woman’s life for the worse.
The general principles of successful treatment are:
- Timely and accurate diagnostics, including control after a course of treatment
- Timely start of treatment
- Individual, comprehensive and competent approach
- Simultaneous treatment of sexual partners
- Compliance with diet during treatment
- Prevention of complications and exacerbations
!!!! Treatment of inflammatory diseases of the female genital organs should be complex, that is, to influence all the mechanisms of the development of the disease !!!!
So, in the arsenal of gynecologists the following methods of treatment:
- In acute inflammation, exacerbation of chronic, antibacterial antiviral drugs are prescribed, which are designed to fight the pathogen.
- In parallel, the correction of immune disorders is carried out.
- To reduce the body’s response to the destruction of microbes, desensitizing therapy is performed.
- To remove toxic substances from the body, detoxification therapy is prescribed
- If necessary, during the course of treatment, treatment of accompanying complaints and symptoms is prescribed (for example, drugs against itching, pain, etc.)
- For the prevention of the negative effects of drugs on other organs, as well as for the prescribed drugs to “work” with more complete efficiency, enzyme preparations and probiotics are prescribed.*
* Preparations for the above methods can be prescribed both in tablet form for oral administration, and in the form of various injections. Injections of drugs must be carried out in a medical institution under the supervision of medical personnel (usually in a treatment room)
- Local treatment (douching, baths, tampons with drugs, treatments, applications, irrigation, etc.) are used to enhance the effect of antibacterial and antiviral therapy, as well as as an independent type of treatment for certain diseases.It is carried out in a treatment room or at home. For local treatment, various drugs are used, the action of which is aimed at combating the pathogen, relieving the symptoms of inflammation, removing the decay products of microbes, etc.
- Phytotherapy – treatment with herbal preparations. It can be used in combination with other methods and independently. For general treatment as well as for local treatment.
- Drug-free treatment combines a large number of methods:
- Surgical (usually used when conservative treatment is ineffective or to remove pathological formations in the “cold period”, that is, after the acute inflammation subsides).It is carried out in a hospital setting.
- Acupuncture – impact on biologically active points (mesotherapy, electrical stimulation of active points, finger massage, acupuncture)
- Physiotherapy exercises
- Diet food
- Spa treatment
- Physiotherapy is one of the methods of treatment in which not chemical factors (drugs) are used, but physical ones: currents, magnetic fields, laser, ultrasound, etc.
Physiotherapy (in gynecology in particular) in medicine and, like drug therapy, is selected individually depending on many, many characteristics of a person and his illness.The beauty of physical therapy is that it helps and complements the treatment of conditions that do not always respond well to conventional therapy.
The use of physical factors is traditionally an important component in the prevention and treatment of obstetric and gynecological pathology. Physical factors can be the main or auxiliary method in the complex of therapeutic measures. Physiotherapy is especially relevant in the treatment of acute inflammatory processes and in the treatment of chronic ones.For example, in a number of chronic diseases of the female genital area, blood flow to the pelvic organs can be impeded due to changes in tissues and blood vessels. In this case, the drug effect is ineffective, since the active substance with the blood flow does not enter the organ or tissue in the proper volume, while exerting a general, often negative effect on the woman’s body as a whole. The combination of the same medicine with physiotherapy, an integrated approach to the treatment of the disease can improve the condition and quality of life of a woman with minimal drug load.
For some diseases physiotherapy is often the only treatment . For example, chronic pelvic pain as a result of adhesions and neuralgia of the pelvic nerves after inflammatory diseases, surgical interventions exhaust patients physically and mentally, disrupting the normal lifestyle and harmony of sexual relations. The carried out physiotherapeutic treatment helps not only to shorten the length of the recovery period, but also prevents the formation of adhesions.The latter fact is especially important for women with infertility. Thus, during the physiotherapy treatment , a number of positive effects are observed:
- reduction of treatment time
- mild painless healing effects
- prevention of complications and relapses
- no side effects typical of drug treatment
- reduction of drug load or, in some cases, refusal from them
The following hardware physical factors are most commonly used today in gynecology:
- Electric and magnetic fields. The active factor of the electromagnetic field can be mainly its electric or magnetic component. Magnetotherapy is mainly characterized by an anti-inflammatory effect, which is associated with the anti-edema effect of the factor. This makes it possible to widely use the magnetic field in gynecology in the early postoperative period after surgical interventions.
- Electrotherapy (use of electric current). It is possible to use direct current (galvanization, drug electrophoresis), pulse currents (interference therapy, electrical stimulation, etc.)). Treatment with pulsed currents relieves spasm of blood vessels and smooth muscles, which improves blood supply to tissues, and has an analgesic effect.
- Action of mechanical factors (ultrasound therapy). Ultrasonic (US) influences carry out a kind of micromassage of cells and tissues, accompanied by the appearance of heat, and provide an analgesic effect, “softening adhesions”, improve the blood supply to tissues and increase the hormonal activity of the ovaries.
- Phototherapy. Light therapy – the use of ultraviolet (UV rays), infrared and visible rays. Short-wave UV rays, for example, with direct contact with pathogenic microorganisms located directly on the skin or mucous membrane, cause a pronounced bactericidal effect and are used in the treatment of inflammation of the mucous membrane of the external genital organs and vagina. Phototherapy also includes the use of laser radiation. Low-intensity laser radiation is included in the treatment of endocervicitis (inflammation of the cervical canal), colpitis (inflammation of the vaginal mucosa) and inflammatory diseases of the pelvic organs.
In inflammatory diseases of the female genital area, the following physical influences are more often used:
- Induction therapy
- Electrophoresis of drugs, phonophoresis
- Low frequency impulse currents
- Paraffin therapy
- Mud therapy
Non-traditional methods of treatment are also used, such as hirudotherapy (treatment with leeches), apitherapy (treatment with bees and bee products).
Prevention of inflammatory diseases in women
He who is forewarned is armed, therefore experts strongly recommend that girls and women follow a number of simple rules that will help avoid serious health problems.
- Eat as many citrus fruits and legumes as possible, fish and potato dishes, and fermented milk products (especially those containing bifidobacteria). This will avoid dysbacteriosis of the external genital organs.
- During menstruation, use tampons during the day and pads at night. Remember that super absorbent tampons, or tampons that remain in the vagina for six hours or more, promote the growth of microorganisms.
- Do not purchase specific intimate hygiene products: colored tampons and toilet paper, perfumed soap and sprays – this can cause irritation of the mucous membranes and the development of dysbiosis and inflammation.
- After swimming or swimming in the sea, try not to walk for a long time in a wet swimsuit, as this is fraught with the danger of hypothermia of the pelvic organs and the activation of microbial and viral flora in these organs.Plus, you unwittingly create ideal greenhouse conditions for germs.
- Give preference to underwear made from natural fabrics – synthetic fabrics hardly absorb moisture and do not provide enough good air circulation in the genital area. Cotton underwear does not allow the formation of an alkaline environment on the vaginal mucosa.
- Limit high sugar foods in your diet. According to many well-known doctors, refined sugar has properties sufficient to maintain chronic candidiasis.
- Pay attention to even minor discomfort when urinating – it can be a harbinger of serious discomfort.
- Do not eat too much bread and mushrooms, do not abuse alcohol, especially beer – all of these foods favor the occurrence of chronic fungal infections.
- Practice good hygiene and use only your own shaving razors and other toiletries.
- During hygienic procedures of the genital and perianal area, your movements should be directed towards the anus in order to avoid the introduction of intestinal diseases into the genitals from the anus.
- If your partner has any infection, you should also see a gynecologist – most likely, the microbial flora will bother you too.
- Avoid casual sex. If there was unprotected contact with a casual sexual partner, you need to contact the clinic as soon as possible to carry out preventive measures to prevent infection with urinary infections.
Intrauterine device. The whole truth about the pros and cons! MC “Orange”
One of the most effective methods of contraception is the installation of a spiral into the uterine cavity.The popularity of this method is determined not only by its high efficiency, but also by its ease of use. Since the IUD is installed in the uterus and during the entire period does not require any additional manipulations from the woman.
Do you already have children and want reliable contraception? Consult a gynecologist at the Orange Medical Center. If you have no contraindications, the doctor will select and install a spiral. To make an appointment, call +7 (495) 646-80-03 .
Contraceptive effect of the IUD
Modern intrauterine devices are made of inert plastic. To increase the efficiency and prolong the life of the IUD, the plastic base is wrapped with the finest wire, usually copper. To reduce the likelihood of developing inflammatory diseases after the introduction of the spiral into the uterus, gold, silver, etc. are added to it. To enhance the contraceptive effect, you can choose a spiral that contains hormones.
The contraceptive effect of intrauterine contraceptives consists of two factors:
- Obstacle to the advancement of sperm to the egg.
- Prevention of implantation of a fertilized egg.
Installation of an IUD allows you to forget about the problems of unwanted pregnancy for several years. Modern spirals are installed for a period of 3-5 years. The effectiveness of the method reaches 98%, which today can be considered the best indicator. Only sterilization can provide a degree of reliability of 100%, but in contrast to it, intrauterine contraceptives are a reversible method. When you are planning a pregnancy, your doctor will remove the coil and give you advice.The fully reproductive system will recover within 3 months.
The use of intrauterine devices is suitable for women who have given birth and are completely healthy. The method has many relative and absolute contraindications:
- Allergy to spiral materials (most often to copper).
- Inflammatory gynecological diseases and genital infections.
- Injuries after childbirth, instrumental abortion, diagnostic procedures.
- Diseases of the cervix.
- Menstrual irregularities.
- Diseases of the circulatory system.
Before putting on a spiral from pregnancy, be sure to consult your doctor. The fact is that intrauterine devices have side effects, and these risks need to be assessed with your gynecologist. Side effects of the IUD include:
- Risk of developing endometritis. This is due to the fact that a foreign body is in the uterine cavity for a long time.Even after the spiral is removed, the changes persist for a fairly long period. In case of infection with sexually transmitted infections, serious complications can develop, up to miscarriage or infertility.
- Risk of developing an ectopic pregnancy. The spiral induces the fallopian tubes to contract antiperistaltic, as a result of which their normal function may be impaired.
- Installation of an intrauterine device does not provide a 100% guarantee. Conception can occur, but results in a spontaneous abortion.
Installation and Removal
The intrauterine device is inserted into the uterine cavity. On the one hand, such manipulation is not difficult for an experienced doctor, but there is always a risk of uterine perforation. This condition will definitely require treatment. Don’t risk your health. An experienced doctor should install the intrauterine device in a clinic.
Attention! Before installing the spiral, the doctor will definitely prescribe additional examinations for you.They are needed to assess the state of health and the possibility of using intrauterine contraceptives.
When there are no contraindications, you will be assigned an appointment time and will give you recommendations on how to prepare for the procedure. The installation of the female spiral is performed on the 5-9th day of the menstrual cycle.
The procedure is performed without anesthesia. In order to exclude the likelihood of uterine perforation and ensure the accuracy of the introduction of the spiral, the manipulation is carried out under the control of ultrasound. After the procedure, the doctor will set a date for the next appointment, it is necessary to control the IUD.Normally, such an examination is carried out after 1-1.5 months, but if after installation you feel unwell, your temperature rises, bloody discharge appears, you need to go to the doctor immediately.
IUD is not recommended for use for more than 5 years. Removal of the intrauterine device is also done only by a gynecologist in a clinic. The procedure is very simple, but you cannot do it yourself, since it is easy to break the structure without experience. To prevent possible risks during removal, this procedure in our clinic is also carried out under ultrasound control.After the procedure, an examination by a gynecologist is required.
Remember, all existing methods of contraception have their advantages and disadvantages. The intrauterine device is no exception to this rule. The choice of contraception should be a joint decision of the doctor and his patient.
Intrauterine contraceptives are one of the most affordable methods. The cost of the IUD itself depends on various factors – the material of manufacture, additives, etc.e. You can see the price of the installation procedure in the price list or ask the registry. Even if you choose an expensive product, given that you will be using it for several years, contraception will be cheaper than other methods.
Treatment of endometrial polyp in the uterus
We will gently help you to cure an endometrial polyp in the CTA!
The basic principle that all doctors in our center adhere to is do no harm. The main difference between the treatment of an endometrial polyp in our Center is that we do not immediately hospitalize for curettage, but observe it.
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Endometrial polyp is a “+ tissue” formation. In the classical medical approach, detection of a polyp in the endometrium (cervical canal) is an indication for curettage. Is it always justified and effective? Not always. Sometimes these are errors of an ultrasound examination, and a shadow, a fold, etc. is taken for a polyp. (then, according to the results of histology, to which the removed tissue must be sent, the polyp is not detected).Sometimes a removed polyp grows back in the same place a year later – and this can be repeated not one, not two, but many times.
Health Territory Approach
Having found a suspicion of a polyp, we do a control ultrasound in 1 month – in the first phase of the cycle, on the 5-6th day. We make a “pipe-test”, which is absolutely safe and painless, without anesthesia, will allow us to obtain the mucous membrane (endometrium) of the uterine cavity and make its histological examination. If, indeed, the endometrial polyp is confirmed, then we observe it for another 3 months (for the dynamics of growth).
With active growth of the polyp, the presence of a “clinic” (abnormal bleeding, smearing spotting before and after menstruation, menstrual irregularities) – we send for separate diagnostic curettage under the control of hysteroscopy (examination of the uterine cavity using a special optical device) – this is necessary to see the mucous membrane of the uterine cavity with your own eyes, if there is a polyp, remove it, coagulate its bed. Only then is there a guarantee that the polyp will not grow back.
“Very often, according to the classical treatment of the endometrial polyp, after removal, hormonal therapy is recommended, and we recommend … pregnancy (a natural way to turn off the ovaries, change the functional processes in the endometrium). Polyps are dangerous because they can be reborn – malignant. Therefore, any doctor with such a diagnosis in a patient has cancer alertness. But if, upon careful observation of a polyp, its growth is not detected, tumor markers are not elevated, and there is no clinical picture, then most likely it will not have to be touched, ”G.V. Ovsyannikova, Head of the Obstetric and Gynecological Department of the Territory of Health.
Treatment of uterine polyps with homeopathy
Removing the polyp helps to forget about the problem for a while. Often, neoplasms in the uterus appear again, since surgical treatment eliminates only the external manifestations of the disease, and not its cause. Treatment of uterine polyps with homeopathy helps to avoid recurrence of the disease. This technique has a complex effect on the body, eliminating the main cause – hormone imbalance.
If you are unable to cope with the disease using traditional medicine, consult a homeopathic doctor in our clinic.
Why homeopathic treatment of uterine polyps is effective
A competent specialist selects a therapy regimen individually, taking into account the patient’s complaints and the results of examinations. Due to the natural composition of the preparations, side effects are practically excluded. In case of individual intolerance to any components, the doctor adjusts the treatment. The therapy program is selected so as to simultaneously affect the following aspects of the disease:
- Improvement of hormonal levels, disruptions of which are a common cause of neoplasms.
- Reduction and prevention of inflammatory processes, which can also lead to the appearance of a polyp.
- Restoration of mental state, reduction of nervousness. Constant stress and intense experiences have a destructive effect on women’s health.
The main advantage of the technique is that it does not poison the body with chemistry, but helps the immune forces to cope with the disease on their own. By restoring systems and organs in a natural way, homeopathy not only gets rid of polyps without surgery, but also prevents their occurrence in the future.
How to treat cervical erosion
Many women who have been diagnosed with cervical erosion are in no hurry to be treated or, even worse, self-medicate. Both the one and the other option are potentially dangerous to the health, and sometimes the life of a woman. What kind of disease is this and how to treat it – you will learn from our article.
What is erosion.
According to the medical dictionary, the term “erosion” means a defect in the mucous membrane of the cervix.It would seem that simple. But, unfortunately, it only seems to be. This defect spoils sleep and nerves for many women and requires immediate treatment. But first things first.
If you have been diagnosed with congenital erosion of (which is quite rare), you are very lucky. In this case, the delicate and vulnerable tissue from the cervical canal (columnar epithelium) due to hormonal disorders (most often in adolescents) “settled” on the outer surface of the cervix. This situation goes away by itself after childbirth or another hormonal surge.But, despite this, it requires constant supervision of a specialist.
There is also true erosion of (when a wound appears on the epithelium), which is also not common. This wound usually heals on its own in a few weeks.
But the most common is false or pseudo-erosion. It appears in the same way as congenital, only it does not heal itself. The delicate tissue of the cervical canal (columnar epithelium), which by nature is not endowed with protective functions, lends itself to the destructive influence of an aggressive environment and various infections.It can end in disaster. In this case, of course, treatment is necessary.
Causes of occurrence.
According to medical research, no one can say for sure what causes this defect in the tissues of the cervix, but the list of reasons for its occurrence is approximately as follows:
First, , erosion can be triggered by hormonal disorders. This is exactly what happens in girls over the age of 13. Hormonal formation, age-related changes in the body can cause erosion.
The second reason is the early onset of sexual activity. For the immature mucous membrane of the cervix, getting any infection, even the most seemingly harmless, can be fatal and in 99% of cases causes erosion. Infections are exacerbated especially against the background of lowered immunity, so you have to deal with a whole chain of diseases.
The third reason is inflammation of the female genital organs. This is why treatment usually begins with treating inflammation.
The fourth reason is mechanical damage.Most often it means childbirth, abortion, and just trauma during sex. Due to the resulting ruptures or cracks in the tissues of the cervix, erosion occurs.
Symptoms of cervical erosion.
We are accustomed to the fact that the disease manifests itself as pain. In fact, pain for many is the very push after which we force ourselves to go to the doctor. Erosion is most often painless. It is difficult to diagnose by symptoms, since they accompany many more diseases.Erosion is diagnosed by a gynecologist only on examination. But still, I would like to list the symptoms of the course of the disease. I hope their appearance will alert women and speed up the visit to the gynecologist. So, any spotting, especially after intercourse, is the first sign of erosion. Such discharge is also a sign of a pregnancy failure or a precancerous condition of the genitals, so hurry to the doctor. Despite the fact that most often women who have erosion feel absolutely healthy, they still have periodically pulling pains in the lower abdomen, pain during intercourse, and abundant whitish discharge.Symptoms include menstrual irregularities.
I would like to once again emphasize the need to visit a gynecologist as soon as possible in case of any of the above symptoms. And do not be afraid, everything that is diagnosed in the early stages is treated!
To treat or not to treat?
Lovely girls and women, erosion is not a runny nose and does not go away by itself! This is a fact proven by many years of medical practice. Moreover, improper treatment (including self-medication “as a friend told me”), or a complete lack of treatment can sooner or later end badly – erosion will develop into a malignant tumor or other equally terrible diseases.The only case after which erosion will disappear without treatment is childbirth (again in the case of congenital erosion). After childbirth, all tissues of the uterus and cervix are renewed. And even here there is no 100% guarantee of cure.
Today there are several methods of treatment. Each of them has its pros and cons, so it’s up to you and your healthcare provider to choose.
Before prescribing treatment, the doctor needs to reliably study what he is dealing with.Therefore, you will have to pass some tests. First of all, this is a doctor’s examination, a colposcopy (examination of erosion in magnifying devices), smears for the composition of the flora, examination for infections, blood tests for syphilis, HIV are mandatory. The list of necessary ones will be determined by the doctor. Before treating erosion, you need to eliminate the apparent cause, if any, based on the test results. For example, to heal the inflammation that has arisen against the background of sexually transmitted infections, and directly these infections themselves.And after that, the doctor will select the best method for you to influence directly on erosion.
Methods of influencing erosion are as follows:
In common people, cauterization of erosion with an electric current, resulting in a burn, and then a scar on the cervix. Its variety is diathermoconization, in which the tissue is not only cauterized, but also completely removed from the erosion zone. Back in the 18th century, healers used something like a soldering iron for cauterization.Until now, little has changed. Diathermocoagulation is the most common method of treatment, in terms of the fact that there is a moxibustion apparatus in almost any antenatal clinic. And it is relatively inexpensive to carry out such a procedure. This is where the advantages of electric moxibustion end. The procedure is clearly not pleasant. Although they say that moxibustion is not very painful, and rumors of unbearable torment are spread by suspicious women, do not believe it. The process lasts up to 20 minutes and with each discharge of the current the uterus contracts very strongly.This reminds of the strongest labor pains, there is a heat in the place of touch. And the smell in the air resembles the smell of burnt meat.
After the procedure, for about a month, there are very abundant transparent, and sometimes bloody discharge, the lower back often aches, and weakness torments.
This is how it goes. But that’s not all. From the first time, erosion may not disappear and the procedure will need to be repeated. In addition, complications are possible: problems with bearing children, infertility, exacerbation of inflammation, bleeding, hematomas.I think very few people would like to experience diathermocoagulation on themselves. Moreover, now this method is gradually being abandoned, and abroad, only diathermoconization is occasionally used for the treatment of cancer.
Complete healing in 6-7 weeks.
Use in nulliparous: prohibited.
The essence of this method is that the tissues of the area affected by erosion are destroyed by the flow of liquid nitrogen from a special cryoprobe. The site is selected extremely accurately and healthy tissues are practically not damaged, a scar on the cervix does not form.The procedure takes about 10 minutes. It is painless, you only feel that something is happening inside, the stomach pulls a little. No smell. This method is bloodless and very gentle. But it is not always applicable in cases of deep erosion. Repeated cryotherapy may often be necessary.
Complete healing in 4-6 weeks.
Use in nulliparous: possible.
3. Laser therapy
New modern method. The only non-contact method.It is considered effective and least dangerous. The essence of the procedure is that the area of erosion is amenable to targeted action by a laser beam, the depth of destruction is fully controlled. No scars remain.
Complete healing for a month.
Use in nulliparous: Recommended.
4. Radio wave surgery
The impact occurs with a radio wave. It stimulates the internal energy of the cell, which in turn destroys and vaporizes the cell. The method is quick and painless.The scar does not appear, however, blood discharge is possible.
Complete healing for a month.
Use in nulliparous: Recommended.
5. Chemical coagulation It is used only for insignificant amounts of erosion (less than 2 kopeck coins). In fact, this is the treatment of erosion with special preparations (such as solkovagin), which destroy the columnar epithelium. Several (up to five) procedures are required.
Does not guarantee complete healing.
Complete healing is individual.
The attending physician selects the optimal treatment method based on your individual data.
You can make an appointment with a gynecologist in the “Appointment” section or by phone: 8 (3412) 65-51-51.
In addition, you can sign up for Online consultation of a gynecologist and get a full doctor’s consultation without leaving your home.
Cervical cyst: description of the disease, causes, symptoms, cost of treatment in Moscow
A cervical cyst is a pathological disease caused by rounded neoplasms, a cavity inside filled with liquid secretion.Usually, the cyst itself does not pose a threat to the health and life of a woman. A cyst located on the cervix can cause infection. This can lead to infertility and ectopic pregnancy. Most often, pathology occurs in women of reproductive age. About 15% of women have cystic neoplasms.
One of the most common gynecological diseases is the cervical cyst. Closed glands appear in the neck, in which fluid accumulates. The inflammatory process originates in the vagina or in the uterine canal.The inflammation goes to the excretory ducts. The glands enlarge and fill with the fluid produced. They resemble a drop in shape, the size can be from 1 mm to 3 cm. Internal mucus is usually white or yellow in color.
Types of cystic neoplasms
These voids can form in various tissues. There are two types of cystic formations:
Nabotovs. These cysts of the cervix appear in the course of pathological abnormalities of the nabotal glands.The epithelial tissue of the cervix changes.
Endometrioid. If an endometrial cell enters the inner uterine surface, then into the neck, it grows to the wall. A blood-filled cyst forms. Bleeding occurs before the onset of the menstrual cycle. The glands have a bluish tinge. This process of cyst formation occurs during childbirth, abortion and the insertion of gynecological spirals. This type of cyst is formed in women over the age of 30.Genetic predisposition may also be the cause.
To protect parts of the uterus from mechanical stress, it is lined with layers of epithelium. Some epithelial cells are flat and scaly in shape. They are located at the entrance to the vagina. The latter are similar to cylinders. These cells excrete mucus through themselves, which is formed in the parasitic glands. The mucus provides protection from bacteria in the uterus. Through these cylinders, it enters the cervical canal, the inner part of the neck.
When the glands become clogged, mucus excretion is impaired, a nabot cyst is formed. The mucus has no outlet and begins to accumulate. The glands swell and voids are formed. Changes in the work of the glands themselves are the cause of nabotovaya cysts. Mucus can independently change its consistency, and block the passage from the gland. Pseudo-erosion can contribute to this process of occurrence. Sometimes, squamous epithelium grows and covers the area of cylindrical tissue, thereby blocking the exit.
The emergence of these pathologies due to a number of reasons. These can be inflammatory diseases, reproductive disorders, hormonal disruptions. If, as a result of blockage, the recirculation canal was damaged, a single cyst occurs. Violation of multiple exits forms multiple cysts. They are common. Cysts can become self-healing from cervical ectopia.
Development of cysts
The cervix is located in the vagina.It is the communication of the uterus with the vagina. The external cervical os is in contact with the vagina, and the internal with the uterine cavity. In appearance, it resembles a tunnel between the genitals. The secretion in the cervical canal destroys bacteria and infection without entering the uterus. The content of the channel changes depending on the menstrual cycle, age and characteristics of the woman’s body. Violations in the cervix occur as a result of a modification of the epithelium. First, a woman’s immunity decreases, inflammation begins, then the glands become clogged, cysts appear.
The onset of blockage of the glands and the formation of multiple and single cysts, the following factors may be:
Hormone imbalance strongly affects the female body. Changes can trigger various reactions.
Infection. The early transferred disease was not cured to the end. Discontinuation of therapy for infection ahead of time.
Late term surgical abortion.Can cause blockage, especially in cases of failed procedure.
Difficult childbirth. Bearing a large fetus or giving birth to twins, triplets.
Traumatic effects in the groin or lower abdomen.
Erosion. Severe mucosal disorders.
Menopause. At this time, the glands become thin and not elastic, they lose their shape.The uterine walls are sensitive, the stimulation of the glands is disturbed.
Any chronic abnormalities in the reproductive system can cause blockages. There are single, multiple and endometrioid cysts. They differ in appearance, cause and location. Treatment of cysts is not difficult. Timely gynecological examination and colposcopy will be effective.
Symptoms of cyst formation are most often absent.During the course of the disease, a woman may not feel any kind of discomfort. The clinical picture is absent before changes in the size of the cystic outgrowth. But if the disease develops rapidly, and there is no visit to the examination room for a long time, some signs of a cervical cyst appear. Bleeding between periods. The cervix changes its shape, the structure of the epithelial tissue is disrupted. Sexual intercourse is painful. The nature of vaginal discharge changes.They appear in various quantities and consistencies, regardless of sexual arousal. Severe pain in the perineum and appendages.
A large cyst can put pressure on the cervical canal. Such influence sometimes becomes a factor of infertility. In most cases, during gestation, single and multiple cysts do not have any negative effect. Pregnancy proceeds without complications. Childbirth is also within normal limits. Treatment of a cervical cyst is carried out only after the woman has stopped postpartum discharge.It usually takes about 40 days. The introduction of a spiral in the presence of this pathology is not prohibited. A woman can safely use this intrauterine device to prevent unwanted pregnancy.
It should be understood that the contents of the cervix are a favorable environment for the development of bacteria and infection. The virus can develop and affect the uterus, vagina, ovaries, fallopian tubes. Inflammation is a common cause of infertility and ectopic pregnancies.Large cysts with a diameter of 1 cm become the reason for the obstruction of conception.
Complications of this pathology are rare. Cervical or cervical infertility as a result of the formation of a mucous plug in the passage of the uterus. Contents may cause suppuration. An abscess develops. The threat of miscarriage due to a large number of cysts or one large one, which irritates the cervix.
In gynecological practice, a cyst is considered a normal condition for the female body.Therefore, the approach and method of treatment are considered only after a thorough diagnosis. Against the background of an imbalance of hormones, endometrioid cysts appear. For the treatment of pathologies, drugs are used that increase the level of estrogen in the blood. Hormone treatments are usually combined with several ingredients.
Progestin and estrogen are combined oral contraceptives. Choose well-chosen single-phase drugs with a minimum dose of estradiol. The combination of these drugs has a synergistic effect.This technique has a number of advantages, the components enhance each other’s properties.
The use of these funds reduces the risk of developing a cervical cyst, and also reduces their size if the patient has this disease. Over time, under the influence of COCs, cysts can dissolve.
Hormonal drugs reduce the increased bleeding during the menstrual cycle. Functional cysts regress. The risk of developing benign neoplasms in the female breast is reduced.Malignant tumors in the ovaries do not develop.
Hormonal treatment is used only as directed by a doctor. The course of COC treatment is prescribed individually. To do this, each patient must undergo a series of examinations. The appearance of a malignant tumor is excluded, the level of hormones in the blood is established. Only after these procedures, the specialist will be able to choose the reception of a particular drug and its dosage.
The use of agonists is very effective.A group of these hormones quickly helps to cope with cervical cysts. After taking them for about 14 days, it suppresses the synthesis of estrogen. Between monthly bleeding disappears. Sometimes, there is a temporary cessation of the cycle, this is within the normal range. The body is put into a state like before menopause.
Drying of the mucous membranes appears. There is irritability and insomnia, depression, fatigue. These drugs are used only if other drugs are not effective, since they have a number of side effects.Cysts begin to dissolve and shrink after about 1.5 months of admission.
Operation methods and recovery period
When the cyst reaches a large size and medications do not bring results, the doctor decides to remove it. The procedure is not complicated, is easily tolerated by patients, and has a short rehabilitation period. Women often postpone surgery, but doctors strongly recommend following medical instructions on time and without a doubt.
The operation takes place in an outpatient clinic, within a few hours. After the client comes to her senses, she can be free and leave the hospital. The operation is painless and complications are rare. After removal of the cervical cyst, thick bloody discharge appears. Also, yellow discharge will come out of the vagina. Over time, they will disappear completely, it takes several weeks.
There are several effective methods for removing a cyst surgically.Indications for the use of removal or conization of the cervix are:
The beginning of the inflammatory process. This can lead to the development of an abscess. Lumps may develop in the small pelvis, which will become painful over time.
If urgent histological examination is required. For example, the form of a cyst has an unusual shape, histology is carried out to exclude cancer.
Pregnancy does not occur for a long time when a cyst interferes with the flow of the cervical canal.
The large size of the neoplasm interferes with the gynecological examination of other organs of the genitourinary system.
Preparation for a surgical operation proceeds as follows:
1. The woman passes all the prescribed tests
2. Undergoes consultation with a gynecologist, surgeon and therapist.
3. Various types of ultrasound are performed without fail.
5. Optional CT or MRI.
The surgeon makes two punctures in the pelvic part and sucks out the contents of the cystic formation through them. Through the second puncture, a special drug is injected, which promotes its resorption. The operation takes place within a couple of minutes. The process does not bring pain to the woman, there are no nerve endings on the cervix that transmit pain.
If the cyst is multiple, conization is used.This method is more traumatic, but the treatment of the cyst is thorough. The affected area is removed from the circulatory canal. The operation is performed with a surgical scalpel. Has a number of complications. Bleeding may open, scars and perforations may form. This method is rarely used due to the risks of complications. But this operation surpasses the quality of the research material, beam and laser methods.
Laser treatment. Laser removal is most often used for nulliparous women.Removal with a laser beam completely eliminates infection, due to the absence of contact with the mucous membrane. This is the main advantage of this type of treatment. Complete healing takes about 30 days. After the intervention, no scar is formed, there is no bleeding. That is why this technique is performed for patients suffering from diabetes mellitus. The bloodless execution of the process does not damage the vessels.
Electric shock treatment. The coagulation method is the burning of a cyst using electric waves.The operation is painful and is performed under anesthesia. Bleeding is possible. After the intervention, scars and ulcers remain. During childbirth, the formed scars on the cervix prevent it from stretching, therefore this method is used for women who have given birth or have left reproductive age.
Healing occurs within 60 days. In the process of rehabilitation, a woman may be prescribed anti-inflammatory and pain relievers. Wound healing medications contribute to rapid healing.Not recommended for women in the postmenopausal period, and with the presence of a pronounced altered shape of the cervix.
Cryodestruction. Affected tissues are exposed to low temperature nitrogen. The cyst is frozen and blood circulation in it stops. Ice crystals destroy the cyst tissue from the inside. There is no pain, the use of an antiseptic is replaced by a low temperature.
The rehabilitation period depends on the state of the body before the operation, the chosen method of treatment, age, individual characteristics of the patient’s body.By following the instructions of the doctors, the recovery period will be faster. A woman should exclude weight lifting, do not visit saunas, baths or swimming pools. Abstaining from sexual intercourse for at least 2 weeks, after surgery 1 month.
The doctor prescribes complex therapy, possibly douching. Gynecological control is about a month. Various discharge and pulling pain are normal signs of rehabilitation. Do not overextend the abdominal muscles to avoid the appearance of a postoperative hernia.
Treatment of cervical erosion and cysts in Novosibirsk | reviews, sign up, price
Erosion or ectopia of the cervix is a violation of the integrity of the mucous membrane of the vaginal part of the cervix, ulceration or defect on it.
Many women face this diagnosis, and, of course, they care about how dangerous it is, how it can threaten and how it is treated.
There are several types of this disease:
- True erosion.
This mucosal lesion looks like a bright red wound. Damaged tissues often show signs of inflammation, can bleed when examined by a gynecologist and during sexual intercourse. The inflammatory process does not last long – about two weeks, after which the true erosion usually turns into ectopia – the so-called pseudo-erosion.
- Pseudo-erosion (ectopia).
May develop asymptomatically for a long time. It manifests itself as ulcers and wounds on the mucous membrane of the cervix.Over time, ectopia grows, penetrating deep into the cervix and forming hollow passages that are filled with secretions, resulting in the formation of cysts.
The main danger of ectopia is that atypical cells can grow against its background, which in some cases leads to the development of an oncological process. That is why it is not recommended to take this diagnosis lightly.
- Congenital erosion.
As the name implies, erosion appears even during intrauterine development. In the future, it is asymptomatic. As a rule, no treatment is required, just observation by a doctor is enough. Congenital erosion usually goes away with age.
Among the symptoms of cervical erosion are:
- pulling pains in the lower abdomen,
- spotting after sexual intercourse,
- pain during intercourse,
- increase in the volume of normal discharge,
- violation of the menstrual cycle.
Most often, cervical erosion is asymptomatic, and only a gynecologist on examination can detect its presence.
There are several treatments available. The doctor can offer drug therapy, as well as the impact on erosion with liquid nitrogen (cryodestruction), laser radiation, radio wave treatment, in some cases, surgery may be required.
In each case, the specialist selects the treatment regimen individually, depending on the type of erosion, the state of the cervical mucosa, concomitant diseases and the general condition of the woman.
A cervical cyst appears as a result of blockage or enlargement of the glands. The excretory ducts that produce mucus are closed due to the inflammatory process. The gland is enlarged as a result.
Also, erosion of the cervix can lead to the appearance of a cyst. Small seals form on it, they gradually grow, and a cyst develops.
Other causes of cyst development:
- hormonal disruption,
- tumor processes,
- the influence of the vital activity of parasitic organisms,
- congenital individual developmental characteristics.