Removal of the uterus together with appendages (panhysterectomy) is a fairly common gynecological surgery. Such a radical surgical intervention is carried out not only according to strict indications, but also, sometimes, at the insistence of the woman herself – if she wishes to prevent female diseases after the onset of menopause.
There is an opinion that the loss of the reproductive organs has a detrimental effect on health and, not least, on the appearance of beautiful women. Fortunately, medicine over the past decade has made great strides forward, and today there are means that help to easily overcome the negative consequences after surgery and make a woman’s life as comfortable as possible.
Indications for removal of the uterus and ovaries
Radical surgery is performed in conditions that threaten the patient’s health, such as:
- malignant process of the body, cervix, ovaries or tubes;
- multiple growing uterine fibroids;
- necrosis of myoma node;
- myoma of the uterus, exceeding the size at 12 weeks of pregnancy;
- benign tumor with a high risk of malignancy (cystadenoma);
- combined pathology: uterine fibroids with multiple polyps or endometriosis, adenomyosis, cystomas and ovarian cysts, inflammatory processes;
- incessant uterine bleeding, with no result after curettage;
- atypical endometrial hyperplasia;
- prolapse of the uterus.
Hello. I’m already 60 years old. But the trouble is, I had to undergo an operation to remove the uterus with the ovary (oncological process). Tell me, how many people live after such an operation? (Lydia, 60 years old)
Hello, Lydia. After removing the uterus and ovaries, people live happily ever after, do not worry so much. The only thing you will need to carefully monitor yourself, because the operation was done about the malignant process. You may need chemotherapy. Also every six months you will need to visit a gynecologist for a mandatory examination. After 60 years, the loss of the genital organs will not affect the general condition of your body.
As a rule, surgery, involving the complete removal of an organ, is performed on women over 40 who do not plan to become pregnant.
From a practical point of view, with a serious pathology, it is better to remove the entire organ, and not its part. Firstly, it is easier for the surgeon to perform such an operation, and secondly, the risk of recurrence is completely eliminated, and hence the chance to get back to the surgical table.
If a woman still hopes to conceive and bear a child (when the patient is less than 45 years old), the uterus and ovaries are removed only in the most extreme cases, and if possible, doctors will fight for every centimeter of healthy tissue.
Good day. I am 35 years old, and my uterus has been removed along with the ovaries due to multiple growing myomas and polycystic ovaries. I have 1 child, my husband and I wanted a second, but, apparently, no luck. The worst thing is that I began to feel hot flashes, but I do not want sex at all. How to live on, what to do? (Lily, 35 years old)
Good afternoon, Lily. Do not despair, in 35 years, life is far from over. What you are describing are the results of a premature menopause caused by a forced operation. However, everything is fixable, do not give up. Contact your doctor and describe in detail all your symptoms. Do not be shy or try to deal with the problem yourself. The specialist will definitely prescribe appropriate drugs that will correct the situation.
How is the operation done to remove the uterus and ovaries?
In terms of volume among all gynecological operations, hysterectomy with the ovaries is the second after cesarean section. In total there are such methods of intervention:
- Laparoscopy. This method is considered the most modern and gentle. The surgeon makes 3 small incisions on the anterior abdominal wall of the patient. Then, the abdominal cavity is filled with a special sterile gas, which allows literally pushing the organs away from each other. The surgeon inserts laparoscopic instruments through the incisions and a small camera on the tube with which he can see everything that is happening on the screen. Modern laparoscopes are equipped with digital matrices, which allow to achieve the most clear images. Surgical intervention lasts from 40 minutes to 1.5 hours – depending on the pathology and the experience of the operating physician. Laparoscopy is famous for a small percentage of complications and a short postoperative period. However, unfortunately, this method is not for everyone. The cuts through which the operation is performed are rather small, and therefore it is impossible, for example, to pull a large cyst through them without the risk of splashing its contents along the abdominal cavity, or myoma of considerable size.
- Laparotomy. The classic type of surgery, in which the surgeon makes 1 large incision on the anterior abdominal wall of the patient. Despite the popularity of laparoscopy, laparotomy in many cases is much more effective. By performing abdominal surgery, the surgeon sees the organs “live”, and not on the screen, which means that the risks of medical error are significantly reduced. In addition, laparotomy is the only method of surgical access to the organs of women who have a large cyst (over 6-7 cm) or uterine myoma. Such an operation usually lasts faster than laparoscopy and takes approximately 40-45 minutes for an experienced surgeon.
The way of operative access is always chosen by doctors individually for each patient, depending on the specific case.
Preparing for surgery
Since extirpation is the most serious operation with the use of general anesthesia, it requires quite serious preparation. Before you designate the day of surgery, the doctor carefully examines the patient’s history, excludes possible contraindications, takes into account all the features of a woman.
Before the upcoming operation, the patient passes:
1. Comprehensive training:
- bimanual examination on the gynecological chair, inspection in the mirrors;
- analysis of vaginal secretions for infections;
- blood test syphilis, HIV, hepatitis;
- general blood and urine analysis;
- blood glucose and its other biochemical parameters;
- blood type and rhesus factor;
- determination of hormone levels;
- MRG, ultrasound of the pelvic organs, ECG, biopsy, if necessary, tonometry, spirography;
- blood clotting test;
- blood test for ovarian tumor markers: CA 125 (standard CA 125 should not exceed 35 U / ml. However, this indicator does not always indicate the development of cancer) and NO4 (a more sensitive tumor marker, which makes it possible to detect changes even at an early stage of the oncological process);
- diagnosis of the nervous, respiratory, cardiovascular, renal systems.
2. Bowel preparation:
- compliance with the standard three-day diet with complete elimination of fiber;
- a few days before the manipulation of the exclusion from the diet of beans and bread;
- fasting for 12-14 hours before the operation, reduction of water intake (no more than 1-2 sips with extreme need);
- bowel cleansing with an enema immediately before surgery.
3. Drug preparation involves the use of antibacterial agents designed to maintain the patient’s condition, with such diseases as:
- endocrine pathologies (diabetes mellitus);
- varicose veins, thrombophlebitis;
- severe diseases of the cardiovascular, respiratory, renal systems;
- viral infections (common cold);
- neurological diseases.
4. Preparation of veins. Before a panhysterectomy, it is very important to properly prepare women suffering from venous pathologies (which is not uncommon after the age of 50). The fact is that immediately after surgery, blood stasis can occur, which threatens with various complications, among which the most difficult is the separation of a blood clot. To prevent negative consequences, elastic bandages are used with which the patient’s limbs are tightly wrapped. Bandaging prescribed by a vascular surgeon before surgery.
5. Psychological support. Full complete removal of the reproductive organs of a woman very often causes real stress, which is not at all surprising. Many are frightened and even refuse to visit the surgeon at the last moment, even if they themselves know that it is impossible to do without an operation. Therefore, about 90% of patients, doctors recommend visiting a psychologist to mentally prepare for the upcoming intervention.
After surgery to remove the uterus and ovaries, the woman is in the hospital under the continuous supervision of doctors for at least 3-5 days. The recovery period (early) lasts about 2-3 weeks, and the body completely returns to normal in a few months.
The patient may experience painful sensations for the first 2-3 days, but this is a variant of the norm, and in case of severe pain syndrome, the doctors prescribe painkillers. In addition to painkillers, doctors prescribe antibacterial drugs and fortifying substances to their wards. In the first days after the manipulation, the seams are processed every few hours.
All patients after hysterectomy of the uterus and ovaries appear bloody from the vagina (they may be brown, reddish or even pink). Although these secretions are very similar to menstruation, they have little in common with them and are only a consequence of the work of the surgeon, and are often accompanied by aching pain in the groin. Allocations can remain up to 1,5 months, plentiful – the first 2 weeks, and then more scanty. During this period, women are advised to use pads, but by no means tampons.
Important tasks in the first weeks of rehabilitation are:
- Proper nutrition with elevated levels of iron. The doctor must prescribe a diet, because in the early recovery period, you can eat, not all.
- Minimal exercise, bed rest the first days after surgery. However, after 2-3 days, the patient must get up and walk a certain amount of time per day, otherwise there is a risk of thrombosis.
- Regulation of the bowel. If the patient cannot go to the toilet by herself, on the third day after the surgery she is given an enema.
- Provide pain relief. A woman who has undergone removal of the uterus and ovaries should not tolerate severe pain. In addition to significant discomfort, pain slows down the process of tissue regeneration itself.
And yet, amputation of the uterus with appendages can not pass without a trace for the female body. Patients undergoing radical surgery must adhere to strict rules:
- Monitor your diet, do not allow a large weight gain. The everyday menu should include cereals, fruits, vegetables, dairy products, soups, rye bread.
- Do not use saunas, baths, tanning beds, if possible – do not sunbathe during the hours of the most active sun (from 11 to 14).
- Visit the gynecologist at least 2 times a year for examination.
- Refrain from sexual activity for 2 months after extirpation.
- To do sports only after complete healing of the stitches – with the permission of the attending physician.
- Do not allow hypothermia.
If you strictly adhere to the recommendations of the doctor, the recovery period will pass quickly enough. You should not engage in self-treatment, with the slightest discomfort, you should immediately contact a qualified specialist.
Hello. Can you please tell me if I can get pregnant if I have one ovary with a tube? Uterus and second ovary saved. (Daria, 38 years old)
Hello Daria. Of course, you can get pregnant if the second ovary functions well, because eggs continue to be produced in it. Consult with your doctor, do an ultrasound, take tests for hormones. If the state of the body and the remaining reproductive organs are normal, you can safely begin planning pregnancy.
Possible consequences after removal of the uterus with ovaries
The fears of many women that, after the uterus and ovaries are removed, the quality of life, appearance and ability to have sex will change for the worse, is unfounded. In fact, after the postoperative period, patients taking drugs prescribed by a doctor lead a full life without pain.
And yet the operation to remove the reproductive organs is a serious manipulation that does not go completely without a trace. The consequences of surgery, which often occur in patients undergoing surgery:
- Loss of childbearing function. It’s no secret that without the uterus and ovaries it will be impossible to get pregnant. This is grief for a woman who finds herself in such a situation at a young age, but for older women who already have children is not so significant. In addition, in patients, menstruation stops forever.
- Changes in the emotional background. The patient may experience anxiety, depression, excessive mistrust. In addition, rapid fatigue and mood swings are not uncommon. All these problems are solved, in the family such a woman should be surrounded with love and care, and if necessary, insist on a visit to a psychologist.
- Reduced sexual desire. Such an unpleasant effect is associated with a violation of hormonal background, which has arisen due to the removal of reproductive organs. However, contrary to public opinion, a decrease in libido is not observed in all patients of the surgeon. Even despite the complete removal of the entire childbearing complex, in the vagina of a woman, there are still receptors responsible for getting pleasure from intimate life.
- Climax. Due to the loss of reproductive organs, the production of the female sex hormone, estrogen, is also stopped. As a result, a grand hormonal failure occurs in the body. With the breakdown of the hormonal chain, all the systems and functions of the patient’s body begin to change quickly. The result is hot flashes, decreased libido, and partial loss of female sensitivity. Unpleasant symptoms may begin to manifest just a couple of days after surgery. Moreover, the younger the woman, the stronger the symptoms. In the normal state, the woman enters into menopause gradually, she enters into menopause, and after the operation these changes are so sharp that they are transferred, as a rule, quite hard. To alleviate the manifestations of artificial menopause, doctors prescribe hormone replacement therapy to patients.
Good day. I had a huge cyst on my right ovary (10 cm), it was removed together with the ovary, the second one was saved. What could be the consequences? (Sonya, 39 years old)
Good afternoon, Sonya. There will be no consequences if the doctor did everything right, and you follow his recommendations. Your body will function in the same way as before surgery, because the second ovary continues to synthesize hormones and eggs. Visit the doctor for examination every six months.
In addition to the above consequences, in patients after hysterectomy of the uterus and ovaries, the possible complications are:
- Dryness in the vagina. When such a problem is manifest, doctors prescribe special ointment-lubricants or phytopreparations to the woman.
- Violation of the gastrointestinal tract. This problem is most often manifested by constipation, and occurs in the first month after surgery. To prevent the seams from diverging, a woman should eat right and not strain herself. From food should be at the time to exclude fatty foods, rice, flour, sugar, white bread. In case of severe constipation, you should contact your doctor.
- Problems with teeth and gums. In about 10% of cases after hysterectomy in women, periodontitis occurs due to a failure in the hormonal background. To prevent this complication, doctors recommend the use of medicinal toothpastes.
- Impaired urination After surgery, the bladder has to work without the support of the previously located uterus. In case of violation of the emptying of this body, doctors may prescribe medications, subcutaneous or intravenous injections, and in the most severe cases, recommend surgical intervention.
- Omission of the vagina. Often this complication occurs when straining, so patients do not need to endure constipation. Also, for the prevention of omission, women are recommended to perform Kegel exercises aimed at strengthening the muscles of the pelvic floor. Exercises are prescribed by the attending physician, it is not recommended to do them at will. Gymnastics consists of alternating contractions of the muscles of the perineum with their smooth relaxation, and then rhythmic contractions. To begin to perform them, it must take at least 2 months after the extirpation. With significant omission, doctors recommend contacting a surgeon.
- Excess weight. After a radical surgery in the body a lot changes. Some women begin to recover quickly. To lose weight, you must adhere to a strict diet, use a lot of fluids, eat metered, take vitamins and do gymnastics.
- Osteoporosis. For the prevention of osteoporosis, doctors prescribe a diet that includes more fermented milk products, greens and beans, small sports loads, taking vitamin complexes.
Hello, Doctor. I was removed 2 months ago, the uterus, but left the ovaries. Tell me what I need to do, and whether there will be monthly? (Elizabeth, 40 years old)
Hello, Elizabeth. The arrival of monthly possible, if the cervix was not removed. Otherwise, do not wait for menstruation. You do not need to do anything if your ovaries work and synthesize hormones. Doctors should only give you a general strengthening therapy. If the ovaries are not removed, and bleeding will appear when the cervix is removed, immediately contact your doctor.
Replacement hormone therapy (HRT) and maintaining the patient’s general condition after the uterus and ovaries have been removed
The hormone estrogen is hard to overestimate, in the female body it is almost indispensable. It is responsible for the youth of the skin, the normal functioning of the cardiovascular and bone systems and
The hormone is mainly produced by the ovaries. Therefore, after their removal, its entry into the body stops abruptly. The only effective method of solving this problem today is HRT.
Good day. Six months ago, the uterus was removed, along with the tubes, but the ovaries were left. I feel good, everything is as usual. But I still worry, do I need to drink hormones and what could be if nothing is done? (Svetlana, 42 years old)
Good afternoon, Svetlana. When the ovaries are stored, it is not necessary to take hormones if these organs themselves produce the necessary hormones. Show yourself every six months to your doctor for examinations, and the rest – live life to the fullest and do not worry.
And yet, in some cases, patients are strictly forbidden to take hormones. These situations include:
- removal of the uterus and appendages, produced due to the detection of a malignant process;
- the presence of serious diseases of the veins of the lower extremities;
- any oncological processes in the body;
- acute pathologies of blood-forming organs.
Even if there are direct contraindications to HRT, doctors will always find an alternative treatment option (homeopathy is often used) and will not leave their ward in trouble.
In all other cases, hormonal preparations are prescribed to patients. Start taking the medication should be within 1-2 months after surgery. In each situation, doctors prescribe individual medications, depending on the patient’s age, her weight, health condition, and
After the uterus and ovaries are removed, it is not only hormones that change, because the functional features of the organs removed also affect other processes in the body. Therefore, doctors prescribe minerals and vitamins to their wards, which allow a depleted female body to recover faster: vitamins B9, D, C, and E, folic acid.
Hello, Doctor. 3 months ago I had my uterus removed along with my ovaries and tubes. I am already 48, but the climax came only after the operation. Do I need to take hormones, or is it useless at my age? (Yana, 48 years old)
Hello, Yana. To take drugs or not is your choice. But I would recommend, nevertheless, not to sweep aside hormonal preparations, and even, as you say, at 48 years old, because this is still quite a young age! Without the right amount of estrogen, changes in your appearance and even well-being can occur. Consult your doctor, describe your concerns to him and together, I am sure, you will find an option that is acceptable to you.