When is it necessary to remove uterine fibroids? Is it necessary to operate on uterine fibroids Is it always necessary to remove uterine fibroids

Through organ-preserving surgery, since with conservative therapy there is a high probability of a recurrence of the myomatous process in the future.

Indications for surgical treatment of uterine fibroids

If the formation is small, does not grow and does not bother, then at first they try to cure it with medication, however, in the presence of specific fibroid factors, it is recommended to treat it surgically.

Unconditional indications for surgical intervention are:

1. Large size of myoma neoplasm, 12-week pregnancy or more;
2. In the presence of concomitant pathological processes such as ovarian oncology or endometriosis;
3. With necrosis of the myomatous formation caused by torsion of the leg or other disorders of tumor nutrition;
4. With functional disorders in the work of organs adjacent to the uterus (intestines or bladder tissues);
5. If a myoma tumor causes a pronounced and intractable pain syndrome;
6. The risk of malignancy of the myoma node;
7. If the pathology is accompanied by heavy bleeding that cannot be eliminated, or simply uterine bleeding began to disturb the patient too often, which provoked a severe form of anemia;
8. Intensive growth of myoma formation;
9. If the tumor prevents the conception or bearing of a child.

An indication for radical removal of the uterus may be the gigantic size of the tumor, especially its location or development.

Therapy Sizes

In accordance with the size of myoma formations are:

• small- similar to a 5-week pregnancy, the tumor is not more than 2 cm;
• Medium- 10-11-week-old uterus, tumor 2-6 cm;
• Big- the parameters of the uterus are equivalent to a 12-15-week pregnancy, and the size of the tumor exceeds 6 cm;
• Giant- when the uterus is enlarged, as in a 16-week or more pregnancy.

All formations of large and gigantic sizes are subjected to surgical treatment. In other words, if the size of the node exceeds the 12-week size, then it is indicated to delete it. Sometimes it becomes necessary to remove smaller fibroids, for example, in case of necrotic processes in the tumor, obstruction of conception or gestation, etc.

Types of help

In the choice of doctors, organ-preserving surgical measures usually prevail, especially in patients younger than 40 and women who have not given birth.

The choice of surgical tactics is also determined by the specific clinical situation, comorbidities, the location of the myoma formation, the patient's desire to have offspring in the future, the size of the nodes, the nature of the fibroids, and other individual factors.

There is also a non-surgical treatment of fibroids - arterial embolization, however, this technique belongs to the category of expensive and not always justified methods of treatment. The essence of the technique is the artificial blockage of the artery that feeds the myoma nodes, which leads to tissue death and shrinkage.

Surgical methods

Surgical intervention to remove myoma formation refers to full-fledged surgical operations, which are indicated only when conservative therapy is powerless and ineffective.

Any surgical intervention is accompanied by a certain risk for a woman, because postoperative complications, relapses or unforeseen surgical or postoperative reactions may occur.

Among the common surgical techniques for the removal of fibroids, abdominal, laparotomic, laparoscopic, hysterectomy or hysteroscopic operations are most often used. Let's get acquainted with them in more detail.

Abdominal surgery

Cavity surgery is usually performed if there are no other options for surgical treatment, as well as in case of necrotic processes in the myomatous nodes or torsion of the tumor stem.

In practice, such therapy is used very rarely, because experts prefer more gentle surgical methods of removal.

After the abdominal intervention, the patient has to stay in the hospital for some time. In fact, abdominal surgery is a laparotomy, because it is performed using incisions on the abdominal wall.

Laparoscopy

Compared with surgical removal of fibroids, in which the tumor recurs in 40% of cases, the effectiveness of arterial embolization is about 98%.

Under local anesthesia, a microcatheter is passed to the patient through the femoral artery, through which an occlusive solution of polyvinyl alcohol is injected.

As a result, there is a blockage of the vessels that supply food and blood to the nodes, which causes them to shrivel and die.

After embolization, patients note the occurrence of severe pain in the lower abdomen, which worries for several hours.

The procedure, with inept and unprofessional conduct, is dangerous with purulent processes and heart attacks in the uterine body, which is eliminated only by removing the uterus. The embolization procedure is not effective for nodes of a subserous nature.

The long-term consequences and results of such treatment have been little studied, and the effect of the procedure on the reproductive functions of the patient is unknown. Experts note that in 5% of patients against the background of UAE, amenorrhea (absence of menstruation) developed.

FUS ablation

This technique is more related to conservative methods of therapy and involves the conduct of focused ultrasonic evaporation of the myoma formation under the control of MRI. The method is based on the principle of ultrasonic waves passing through tissues without disturbing their structure.

Ultrasonic waves are focused on the node, heating its parts up to 90°C, although already at 60°C due to the evaporation of the liquid, active cellular destruction occurs, the collagen and protein structure is damaged, as well as the vascular network.

This method is highly effective, however, has not been fully studied, therefore it is rarely used and only in cases where myoma formations are localized on the anterior wall or on the uterine fundus. Such treatment is carried out only for patients with nodes of an average size of 2-9 cm.

Contraindicated in case of unrealized reproduction, infertility or subserous myoma nodes with a stalk.

Training

Surgical intervention, regardless of its complexity and invasiveness, requires specialized training.

Preoperative preparation includes:

• Studying the history of the disease and the clinical condition of the patient;
• Identification of indicators of age character;
• General condition of the body;
• Determination of the volume of surgical intervention in accordance with the age, condition of the patient and the degree of myomatous lesions.

Usually, in young patients, organ-preserving operations are a priority, while in women who are mature and not planning a pregnancy, a hysterectomy is performed. The final decision regarding the type of operation most often remains with the patient.

In the process of preoperative preparation, a thorough examination is carried out, including laboratory studies of biomaterials such as blood, urine, pieces of the node or the contents of the uterus.

In addition, ultrasound and colposcopic examination, hysteroscopic diagnostics, and a study to identify atypical cells that precede oncological processes are carried out.

Immediately before the operation, the patient takes a shower and shaves off her pubic hair, a light dinner is allowed the night before, after which the patient is given sleeping pills so that the woman has a good night's sleep and rest before the operation. Only after this, the patient undergoes the chosen surgical intervention.

Consequences

The operation itself to remove uterine fibroids is not dangerous, however, it can lead to a considerable number of unpleasant complications such as:

1. Infectious lesions of the wound surface during or after the intervention;
2. Risk of myomatous recurrence;
3. The likelihood of myocardial ischemia or breast cancer.

But it should be borne in mind that the risks of such consequences are much less than the likelihood of a hysterectomy when the pathological process is neglected.

After the removal of the uterus, the woman is waiting for the loss of reproductive function, and if the pathology is not treated for a long time, then the myoma node can become malignant. Therefore, you should not refuse the operation because of fear.

Rehabilitation

Rehabilitation recovery after removal of uterine fibroids usually takes about a month, with major abdominal operations - 2 months.

In order for the wound to heal faster, in the postoperative period it is recommended to exclude sexual relations for a couple of months, strict adherence to a dietary diet in order to prevent digestive upset or constipation. Pushing during bowel movements is also prohibited to exclude the possibility of a divergence of the surgical suture.

It is necessary to consult a specialist about rehabilitation measures, then recovery will occur quickly and without complications. After organ-sparing myomectomy, pregnancy is quite possible, however, patients are not advised to give birth on their own, a caesarean section is usually performed to avoid rupture of the sutures during classical childbirth.

Treatment after removal

After surgery to remove fibroids, a relapse may occur, since the cause of this pathology is hormonal imbalance.

To avoid a recurrence of the problem, patients are advised to normalize their hormonal status. It is necessary to undergo an examination for deficiency and excess content of certain hormonal substances.

Only after that, the endocrinologist will be able to determine the deviations of the hormonal background and prescribe the appropriate therapy. In addition, it is necessary to avoid factors that provoke the occurrence of the myomatous process.

• All for and against
• Consequences of removal of the uterus
• Preservation of appendages
• Conclusion on the topic

Removal of fibroids without removal of the uterus is a rather rare occurrence in modern surgery. In 90% of cases of diagnosing this disease, patients are sent to the operating table. But almost all women from this number do not need surgical intervention.

All for and against

According to statistics, every year more than a million women in Russia undergo hysterectomy. Often, surgery is required for fibroids. But, given the average age of women diagnosed with this disease (41 years), it cannot be said that the removal of the uterus in this case is a rational solution.

Naturally, menopause during this period begins only in less than half of all women. At the same time, the most vivid sexual life falls precisely on 35-45 years. But many doctors neglect this and, contrary to all requests, completely remove the organ of the reproductive system.

The main reason for such a radical method of treatment is that, like any benign tumor, fibroids can turn into a serious oncological disease. Therefore, most specialists in such cases do not doubt for a minute the need to remove the uterus. But as a rule, the removal of the reproductive organ is fraught with its consequences.

Often, doctors are motivated to perform such an operation by the fact that if a woman already has children, then she no longer needs a uterus. But such an idea is refuted by a number of functions of this organ, which have not yet been well studied by medicine. It is believed that the uterus is needed not only for reproduction, but also to maintain physiological balance.

Each person is able to live with one kidney, lung, part of the intestine. However, this existence is not complete. In addition, the removal of a woman's reproductive organ, as a rule, causes a violation of her psychological state. Often these patients are diagnosed with a number of serious mental disorders. Such women are more likely to suffer from diseases of the endocrine, nervous, cardiovascular and other body systems. Medical research in recent years has confirmed the theory that the removal of the uterus leads to the development of cancer in neighboring organs, so such an operation is not always justified.

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Removal of the uterus can not only lead to many serious health problems, but also significantly increase the risk of diseases that are often fatal.

Nevertheless, some specialists and patients do not associate the appearance of these ailments with the amputation of the organ of the reproductive system. The reason for this behavior is considered to be the development of these complications at least a year after surgery.

The list of possible dangerous consequences of hysterectomy:

• cardiovascular diseases;
• oncological diseases;
• worsening mental state;
• ailments of the genitourinary system;
• diseases of the musculoskeletal system;
• problems in sexual life;
• a sharp increase or decrease in weight;
• deterioration of the central nervous system;
• premature aging.

There is a certain group of women who perfectly perceive the news of the removal of the uterus. Often these are those patients who previously suffered from heavy prolonged bleeding, pain, frequent urination. Naturally, the operation relieves them of these symptoms. However, they do not notice signs of developing diseases in the body.

In some women, all the symptoms of the above ailments may not be expressed clearly enough for the patient to pay attention to them. Often this phenomenon is due to the fact that the ovaries maintain a normal blood supply. Therefore, the necessary level of hormones in the body of a woman is maintained.

In addition to the long-term consequences of hysterectomy, you need to know about common problems after surgery:

• complications after anesthesia;
• mechanical damage to adjacent organs and main vessels during entry into the abdominal cavity (typical for laparoscopy);
• postoperative bleeding;
• inflammatory processes;
• intestinal obstruction;
• inflammation of the lining of the abdominal cavity;
• blockage of a pulmonary artery by a thrombus.

It is worth considering the fact that after such an operative intervention, a woman will definitely need a long rehabilitation period. On average, it lasts from a week to several months. This directly depends on the initial physical and mental state of the patient before such an operation.

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One more nuance should be pointed out, which some experts are silent about when they offer to get rid of the uterus. Often they focus the attention of patients on the fact that the appendages after surgery will remain and continue their full-fledged work. At the same time, they convince the patients that the removal of the “unnecessary” organ of the reproductive system will save them from various gynecological problems.

But doctors rarely mention that in the process of amputation of the uterus, it is impossible to avoid a violation of the blood supply to the ovaries. Since one of the main blood supply pathways of the appendage, a branch of the uterine artery, is crossed, the functioning of the ovaries will not be complete. Therefore, the claim that the quality of their work will continue is a myth.

It is worth considering the fact that after surgery, the appendages will begin to compensate for poor blood flow, but, as a rule, this leads to dystrophic processes. Thus, the process of hormone production will slow down significantly. Therefore, the statement that the body will function as before the operation is false.

Naturally, the doctor cannot make such a serious decision regarding the amputation of the uterus for the patient. If a woman is of childbearing age and the organ of the reproductive system can be left, then it is better to limit the removal of fibroids. So, the patient will be able to preserve the youth and health of her own body for a longer time.

If the disease was diagnosed in the early stages, then treatment may be limited to taking the necessary medications. But many doctors neglect this method of therapy, resorting to surgical intervention. In any case, the specialist must necessarily offer his patient alternative methods of treatment.

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Thanks to modern drugs, the treatment of fibroids can be done without surgery.

The decision on whether to remove the uterus in this case should be made by the woman. Amputation of an organ leads to irreversible changes in the body.

Is surgery always indicated for uterine fibroids?

According to statistics, uterine fibroids is one of the most frequently diagnosed gynecological diseases. The variety of its manifestations dictates the choice of treatment in each case, although the main method, of course, is surgical. What is the best surgery for uterine fibroids?

Should the uterus be removed?

The operations performed to get rid of fibroids are of several types. A radical method is the removal of an organ or a hysterectomy. There was a time when this was the only way surgery was performed even on young women who could still have children. Even now, having learned about the diagnosis, many people panic, thinking that they will have a hysterectomy.

Types of uterine fibroids

In fact, this method of treatment is not always used. There are more gentle methods that give excellent results. But the indication for choosing the type of intervention is, of course, not the desire of the patient, but clearer criteria:

Consequences of the operation

Fears in connection with the radical intervention are associated not only with the operation itself, which, of course, is more traumatic than the removal of only the tumor. And not with fear to stop feeling like a woman. After a hysterectomy, patients develop a whole range of symptoms, called post-castration syndrome:

• Cardiovascular pathologies. May occur, including with the preservation of the gonads. But removal along with the uterus and ovaries is more likely to lead to such consequences.
• Increased chance of developing kidney, thyroid, or breast cancer. This is a kind of "compensation" of the removed tumor.
• The appearance of symptoms of menopause, that is, hot flashes, depression, insomnia. Preservation of the ovaries does not save from this, since their blood supply, and hence their functions, are impaired.
• Increased fatigue. It leads to the presence of other signs of deterioration in well-being, as well as suppression of immunity.
• Problems in intimate life. Due to a decrease in the volume of hormones, libido disappears, but pain may occur during intercourse, orgasm becomes less intense.
• The prolapse of the walls of the vagina. Their weakening is due to a hormonal disorder.
• urological problems. This may be frequently occurring cystitis or simply increased bladder activity, urinary incontinence.
• Problems with bones and joints. Changes in the balance of hormones lead to osteoporosis. The joints begin to hurt, as they are destroyed faster.
• The emergence of endocrine diseases. Metabolism is disturbed, as a result of which weight may increase, the functions of the thyroid gland and pancreas may be impaired.
• Chronic pelvic pain. Adaptation to the absence of an organ is often accompanied by them.

Given these difficulties, abdominal removal of uterine fibroids, as well as surgery through the vagina, are prescribed in extreme cases, when other methods are obviously useless, and the life and health of the patient due to the tumor are at risk.

Recovery after

Rehabilitation after hysterectomy is quite long, has its own nuances:

• The first 2 hours after waking up from anesthesia, nausea worries. But this is normal, even if the sensations last longer. After 3-4 hours, some can eat or at least drink water.
• Pain in the abdomen can also be noticeable, it is stopped with medicines (5-7 days). In the future, it weakens, but sipping in the stomach, tingling can disturb up to a month.
• The first days the temperature rises to 37.5 degrees. It also happens after discharge, but it is not dangerous if the value is not higher than the specified value. To prevent fever, that is, the development of infection, antibiotics are prescribed.
• You need to get up in bed a few hours after laparoscopy. If an abdominal operation was performed to remove fibroids, they get up after 2 days. This is important for preventing complications and faster recovery.
• At first, you will have to eat liquid food, gradually moving to a more varied diet. It is imperative to drink plenty of water so that there are no problems with stools and tension during bowel movements. Ration 2 - 4 months sparing, that is, with a minimum of salt, refractory fats, fractional nutrition. You can not eat something that contributes to flatulence. We need fiber, vitamins, lean meat, dried apricots, pomegranate juice.
• Lifting weights and straining in every possible way is prohibited for 4 to 6 weeks. And then physical activity should increase slowly and gradually.
• You can’t have sex for at least a month and a half. For some this can take up to six months.
• The seam is treated with alcohol-containing compounds. This is important to avoid infection. As the suture heals, it may itch, tingle even 2 months after the operation.
• There will be bloody discharge from the vagina, which should stop after 4 to 6 weeks. Tampons should never be used with them. If the volume of discharge increases, the smell becomes unpleasant, purulent, additional treatment will be necessary.

Is there a chance to save the organ?

Most patients are afraid of abdominal surgery, uterine fibroids seem to them no more terrible than the very fact of removing the organ through an incision in the abdominal wall. Panic before the intervention, as well as the reluctance to acquire problems associated with hysterectomy, cause the search for ways to save the organ.

This can be done with:

• Embolization of the uterine artery. The method is the introduction of a composition blocking the nutrition of fibroids into it. Deprived of the stimulus, the tumor shrinks.
• Operations to remove only fibroids. The intervention can be abdominal, laparoscopic (through small incisions in the abdominal wall) or hysteroscopic (access to the nodes is through the vagina).

But all methods make sense only with a small myoma. That is why it is important at any age to visit a gynecologist twice a year.

Early detection of the problem, control over it, makes the need for removal of the uterus minimal. If the doctor insists on a hysterectomy, it is worth getting the opinion of other specialists too. It is better to contact a modern clinic, where there are more opportunities for high-quality examination and experienced, knowledgeable gynecologists.

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When is it necessary to remove uterine fibroids before planning a pregnancy?

Many women who have been diagnosed with uterine fibroids ask questions about whether it is possible to plan a pregnancy without removing the neoplasm. Some are afraid that they will be prescribed an operation to remove the uterus along with the tumor. But do not forget that for any surgical intervention there are strict indications, in the absence of which the operation will not be performed. Since you did not indicate the size of the neoplasm and did not write your complaints, we will consider in which cases the fibroid itself is removed, and in which the removal of the uterus is indicated. As for pregnancy without its removal, it is possible if the tumor is small. When the formation is large, it is first removed, and only then conception is planned.

When is removal of the tumor without preservation of the uterus indicated?

Indications for surgery:

• Prolonged and heavy menstruation, the presence of bleeding, not associated with menstruation. All this is dangerous for the development of anemia in the patient.
• Volumetric education sizes corresponding to 12 weeks of pregnancy in women up to 45 and 15-16 weeks - in women over 45.
• The presence of symptoms of compression of surrounding organs.
• Rapid growth of neoplasm, especially during menopause or menopause.
• Subserous myoma on the leg. Such a formation is dangerous by twisting its legs, which can lead to symptoms of an "acute abdomen" and the need for emergency surgery.
• Submucosal benign nodes with a leg. They are also dangerous by twisting and bleeding, which is dangerous for the development of anemia.
• The birth of a node under the mucosa requires emergency surgery, there is a high risk of developing too much bleeding.
• The necrotic process in the tumor node occurs due to a violation of its blood supply and nutrition. There is also a risk of infection and the formation of cavities filled with fluid or pus. In some cases, due to fibroids, a uterine cyst forms. Necrosis of the neoplasm is especially dangerous in that a cavity with pus can break into the abdominal cavity, and peritonitis will develop.
• Myomatous nodes, which are located in the ligaments of the uterus. They can lead to compression of the nerve plexuses and dysfunction of the ureters and kidneys.
• Tumor nodes that are located in the vaginal part of the cervix.
• With a combination of fibroids with other pathologies of the reproductive system.
• Pathologies that negatively affect pregnancy, gestation and childbirth.
• Infertility due to fibroids. In some cases, fibroids close the lumen into the fallopian tubes, which prevents the fertilization of the egg.

Contraindications for surgery:

1. Severe pathologies of the heart and blood vessels
2. lung disease
3. Renal failure and diseases of the urinary system
4. Acute diseases of the pelvic organs
5. The presence of boils and abscesses (the operation is performed after a complete cure and the return of normal blood counts).

In all other cases, only the fibroids are removed, and the uterus is preserved.

About the surgical treatment of uterine fibroids is described in the video:

Pregnancy with myoma

The possibility of conception and bearing without surgery to remove fibroids is assessed taking into account many factors:

1. The location of the tumor node.
   • In the case when the node is located in the uterine cavity or in its wall and deforms it, pregnancy may not occur at all. Such nodes prevent the fertilization of the egg. When spermatozoa enter the uterus, they seem to settle on the surface of the node and cannot reach the fallopian tube. In order for a woman to become pregnant, fibroid removal is required.
   • Nodes that are small and immersed in the tissues of the uterine wall by about 3-4 cm, or located under its mucous membrane, do not cause deformation and do not prevent pregnancy. Before planning conception, they can not be removed. However, tumor nodes will cause some problems during gestation. There is a high risk of spontaneous abortion. If there is a pedunculated knot in the uterus, there is a danger of it twisting during pregnancy. This situation requires immediate surgical treatment and, in some cases, termination of pregnancy according to indications. Therefore, before planning the conception, doctors recommend removing such nodes.
2. Tumor growth rate. The growth rate is determined by ultrasound, its results are studied in dynamics. If the tumor has increased by 1.5-2 times in 6 months, it means that it tends to grow rapidly, and conception in this case cannot be planned. The fact is that during pregnancy, the tumor can grow even more actively, which will lead to malnutrition of the node and increase the risk of miscarriage. Before planning conception, experts recommend removing the myomatous node.
3. The size of the tumor nodes. If the size of the tumor exceeds 10-12 weeks of pregnancy, then conception is not recommended. Tumor size should not exceed 4 cm in diameter when in vitro fertilization is indicated. This is due to the high likelihood of spontaneous miscarriages. In addition, pregnancy itself is unlikely, because 70% of such fibroids are accompanied by endometrial pathologies, which makes implantation of the embryo impossible.

In any case, with myoma, the risk of miscarriage increases dramatically, regardless of the size and location of the tumor. After the operation, this probability becomes much lower. In addition, it is almost impossible to predict how the tumor will change during pregnancy. According to statistics, about 70% of nodes become smaller during pregnancy, while 30% begin to grow actively. For the entire period of pregnancy, they increase by 2 times.

In your case, you should not refuse surgery to remove the myomatous node with preservation of the uterus, if there are serious indications for that. And only then to plan conception. If the tumor is small and does not cause you discomfort, and the risk of complications is low, you can do without surgery. In the case when the tumor is large, and it is recommended to remove it along with the uterus, and pregnancy is contraindicated, it is worth comparing all the risks to health and life.

netmiome.ru

Removal of large fibroids with preservation of the uterus

Uterine fibroids - sizes for surgery

Preparing for surgery to remove uterine fibroids

Removal of uterine fibroids - consequences

Recovery after removal of uterine fibroids

Is it possible to get pregnant after the removal of uterine fibroids

At the Center for Endovascular Surgery Prof. Kapranova is the removal of large fibroids with the preservation of the uterus. For the operation, specialists use the possibilities of embolization. You can choose the clinic for treatment yourself.

Features of fibroids

Uterine fibroids is a benign tumor that develops from muscle tissue and consists mainly of connective tissue elements. The disease develops in approximately 35-45% of women over the age of 35-40 years. The peak incidence is in age group 35-50 years old. Recently, there has been a "rejuvenation" of uterine fibroids. Even women of reproductive age are affected.

Tumor types

subserous myoma. Such a formation develops on the outside of the uterus. The tumor then grows down into the pelvic cavity. It does not interfere with the flow of menstruation, but can cause discomfort, as it reaches a large size. Education presses on the surrounding tissue.

Intramural myoma. This disease is more common than others. The growth of fibroids begins in the middle muscular layer of the uterus. This leads to a strong increase in the body. As a result, menstrual irregularities occur. Often, patients suffer from pain, feel pressure in the pelvic area.

Submucosal (submucosal) fibroids. This form is less common than the others. Education appears inside the uterus, in a thin layer of the mucous membrane. Often there are submucosal nodes, nodes on the leg in the form of cysts. This form of uterine fibroids is clearly expressed, it has obvious symptoms.

Why does the disease occur?

The following factors can lead to the development of fibroids:

Hormonal disorders. Clinically, they manifest themselves in failures of the menstrual cycle. Usually there is an abundance of discharge, a late onset of menstruation. Patients with fibroids suffer from mood swings. They occur due to a decrease and increase in the level of estrogen and progesterone.

Irregular sex life. Disharmony often leads to general disruptions in the body. One of them can be called myoma.

mechanical factors. Women with fibroids in the past had abortions, underwent a curettage procedure. Also, a number of patients suffered traumatic childbirth.

genetic predisposition. Daughters of women with fibroids often face the same disease as their mothers.

Presence of comorbidities. Often, uterine pathology is provoked by obesity, high blood pressure, thyroid pathology, diabetes mellitus, etc.

Sedentary lifestyle.

What entities are considered large?

Regardless of the type of education, it is customary to classify by weeks of pregnancy. The affected uterus is equal in size to a healthy one at a certain period of fetal development.

The following parameters of education are distinguished:

Small uterine fibroids. They equate to 5-12 weeks of pregnancy.

Large uterine fibroids. They are similar to 12-16 weeks of pregnancy.

Giant fibroids. Such formations are equated to 16 or more weeks of pregnancy.

In some cases, myoma nodes reach such a size (20 weeks) that a woman begins to show all the signs of future motherhood.

Among them:

belly enlargement,

lack of menstruation

fetal heartbeat.

The last symptom occurs due to the pulsation of the aorta in the peritoneal space.

What signs of the disease to look out for?

Often women live with uterine fibroids without even knowing that they are suffering from the disease. His discovery often becomes a godsend for the gynecologist, which he does during a standard preventive examination.

Often there are situations when the symptoms are smoothed out. They can be perceived as a variant of the norm.

Most clearly, the signs of uterine fibroids are manifested in the submucosal location of the formation. Also, the symptoms are pronounced when the tumor is large.

What signs should alert the patient?

Prolonged and profuse menses. They are called menorrhagia. Such bleeding can be so profuse that a woman simply cannot leave the house. Often there is spotting, which is not associated with menstruation at all. They are called "metrorrhagia". All secretions are dangerous! They can lead to a decrease in hemoglobin levels and iron deficiency anemia. The disease is expressed in pallor of the skin, weakness, drowsiness.

Pain in the lower abdomen and lower back. They take on an acute character when blood circulation is disturbed in the myomatous node. But usually the tumor grows gradually. In this case, with myoma, the pain is aching in nature. At the same time, education is growing and becoming larger and larger.

Violation of the function of neighboring organs. Women suffering from fibroids often have difficulty urinating, emptying the rectum. This is due to the fact that the fibroid grows and compresses neighboring organs.

Steal Syndrome: What is it?

If the fibroid has reached a large size, it negative impact intensifies on the body. The result is the steal syndrome. What it is?

The tumor is benign. However, she constantly needs oxygen and nutrition. The fibroid node can receive the elements necessary for life only from other organs and systems.

As a result, the liver, kidneys, pancreas suffer. Violations in these organs affect metabolic processes. Therefore, a woman with fibroids is often exposed to many dangers. She can gain weight rapidly. Often, patients are diagnosed with diabetes mellitus and other diseases. If oxygen is supplied to the heart muscle in insufficient quantities, then the formation can even provoke coronary disease, myocardial infarction.

Pathology also affects the functioning of the respiratory system. As a result, a woman suffers from laryngitis, bronchitis, rhinitis.

When does steal syndrome occur?

Usually, the onset of the development of the syndrome coincides with the achievement of the size of 12-14 weeks of pregnancy. The syndrome reaches its peak at formation parameters equivalent to the 16th week.

Can you live with uterine fibroids?

Yes! But only on condition that the growth of fibroids is not intense. It is very important to consult a doctor in a timely manner. Only he is able to constantly monitor education, assess the condition of the uterus and other organs.

You should not refuse treatment, even if it seems to you too long, difficult, unpleasant. Remember that the doctor is ready to do everything to ensure the safety of your health!

What to do?

First of all, get tested.

Diagnosis of fibroids is a multi-stage. However, it presents no particular difficulty. Usually education is found on the first examination. However, doctors usually prescribe a series of studies. Diagnosis allows you to confirm the diagnosis.

What examinations need to be done?

Ultrasound of the pelvic organs. The study is carried out using a vaginal probe. For better visualization, fill the bladder. The method used is highly informative. It allows you to determine the size of education, its shape.

Hysteroscopy. This technique is also informative. It is usually used to recognize submucosal and interstitial formations in the uterus. During the examination, the gynecologist may take a piece of tissue for a biopsy.

Laparoscopy. This study is performed when fibroids cannot be distinguished from an ovarian tumor.

MRI and CT. These techniques are informative, but, unfortunately, expensive. Therefore, they are rarely used.

Important! The gynecologist determines the volume of research individually. Usually, only an examination and ultrasound is enough to make a diagnosis.

How to be treated?

As a rule, large fibroids are removed.

If the formation is larger than 10-15 weeks, the nodes exceed 6 cm in diameter, myomectomy can be performed. With this operation, the uterus can be saved. The surgeon only removes the tumor. This method treatment is demanded by women who plan to have children. Unfortunately, after the operation, the formation may reappear, continuing its growth.

Consider the types of myomectomy:

Abdominal. This intervention is traditional. An incision is made in the lower abdomen. The operation is performed with multiple formations. It is also relevant in the presence of nodes that are located deep in the tissues of the uterus.

Laparoscopic. Removal of the formation is carried out through small incisions using special equipment. This technique is less traumatic. Nevertheless, modern installations make it possible to eliminate even multiple tumors or large-sized formations.

Hysteroscopic. Such an operation is performed with submucosal formations. A hysteroscope is inserted into the uterus. Through it, the surgeon inserts instruments.

A more radical method of removing the formation is a hysterectomy. It does not imply the preservation of the organ. After the intervention, the woman needs a long recovery. The patient will never be able to have children again.

Is it possible to preserve the uterus with formations of large and very large sizes?

It is only important to correctly choose a technique that will allow you to perform the removal of education.

One of the newest methods is embolization.

This procedure consists in clogging the blood vessels. As a result, the flow of blood to the myomatous nodes stops. This leads to the cessation of their growth and gradual death.

An operation aimed at removing nodes is performed under local anesthesia by inserting a catheter with a special solution into the femoral artery. The special particles contained in the solution do not adversely affect the healthy tissue of the uterus and mucous membranes.

The intervention is painless. It allows you to save the uterus, a woman gets a chance to become a mother. In addition, the operation does not lead to serious complications. The patient is discharged from the clinic in as soon as possible.

History of the method

As early as the 70s of the last century, practical surgeons used the technology, which in the future became the basis for the method of uterine artery embolization. For various pathologies, injuries that were accompanied by bleeding, they injected particles that prevented blood flow.

Subsequently, the technique was used as a prophylactic. It avoided the risk of bleeding during surgery on organs with abundant blood supply. Special particles were introduced even before the start of the operation.

In gynecology, the technique was first used by Jacques Henri Ravin. It was he who, in order to avoid blood loss, clogged the nodes of the uterus during the operation. All of his patients wanted to become pregnant and bear a child in the future.

Not all women after embolization were operated on. Major surgery was delayed. During the examination before the operation, the doctors stated:

reducing the size of nodes,

reduction in bleeding

improving the well-being of patients.

This allowed us to conclude that it is possible to treat nodular formations without major, serious interventions.

How is the intervention carried out today?

Embolization of the uterine arteries is carried out in a specially equipped operating room. It must be equipped with angiographic equipment. This is what allows you to control the progress of the intervention.

The operation can be performed on any day (except menstruation). The procedure is carried out only on an empty stomach. The patient is warned about this in advance.

UAE (uterine artery embolization) is performed in several stages.

1. Puncture of blood vessels. The doctor pierces the femoral artery. Previously, the puncture site is treated with an antiseptic. Then an introducer (an elastic sleeve made of polymeric materials) is placed in the vessel. It allows you to reliably protect the walls of blood vessels from damage.

2. Angiogram. A catheter is inserted into the protective sleeve. It is used to transport the contrast medium. This stage is required so that the surgeon can see the place where the pathological growth of the vascular network is noted.

3. Conducting emboli into the vessels. The catheter is advanced until it reaches the uterine artery. After that, emboli are delivered. They are compounds that block the flow of blood. As soon as the reverse flow of substances begins, the supply stops. The procedure is performed on both sides.

4. End of the procedure. The catheter is removed from the vessel. The puncture site is tightly bandaged. This allows you to reliably stop the bleeding.

As a rule, the operation, which ensures the safety of the uterus, takes 40-60 minutes. In some cases, more time is required. The duration of the procedure depends not only on the classification of the doctor, but also on the size of the formation, the characteristics of the patient's body.

Does the method have disadvantages?

Critics of embolization to its shortcomings include:

the likelihood of infection.

Important! Immediately after the manipulation, the woman undergoes anti-inflammatory prophylaxis. In addition, she receives pain medication. Moreover, the patient needs a bandage only on the first day. If there is no bleeding from the puncture site, the bandage is removed. The patient can go home.

Full recovery occurs within 15-20 days. The rehabilitation period depends on the size of the nodes and their number.

What are emboli and how do they work?

When conducting UAE, 2 types of substances are fed into the artery:

Contrasting compounds. They allow you to see the vessels on the screen of a special X-ray machine.

Emboli (also called blockers).

Consider the features of the latter.

Emboli are tiny (diameter - 300-700 microns) polymeric balls. They are made of a special polymer, able to move freely through large arteries, but get stuck in small ones. Thus, emboli allow artificial thrombosis of the vessel.

Can the procedure be carried out if a woman is planning a pregnancy?

Actually, the technique was introduced for this purpose. Owners of healthy uterus can successfully become pregnant and give birth to children.

Embolization does not affect a woman's reproductive function.

Have you heard that after UAE, the patients could not get pregnant?

Most likely, this is due to the fact that there were other factors leading to infertility (hormonal disorders, impaired patency of the fallopian tubes, inflammatory processes, etc.).

Who is shown UMA?

Patients diagnosed with large lesions.

Women with multiple nodes that have arisen in the organ after the removal of the formation (relapse).

Patients with severe symptoms (bleeding, pain, dysfunction of neighboring organs, etc.).

Women whose hormonal therapy did not bring the desired result or caused complications.

Patients suffering from diseases that do not allow general anesthesia.

Attention! In some cases, removal of the mass by embolization is not possible.

Contraindications for surgery are:

pregnancy,

malignant tumors,

postmenopause,

endometrial hyperplasia,

leg knots,

allergy to the contrast agent.

Also, UAE is not prescribed for infectious diseases, their history (in the last 3 months), in violation of the function of the kidneys and liver.

Embolization eliminates the need for major surgery. Removal of education is carried out in the mode of a simple procedure.

The patient's condition after embolization

The procedure is safe and painless. But a few hours after the intervention, severe pain may occur. Discomfort is effectively relieved.

In addition, after the operation associated with the removal of nodes, patients may experience weakness. Often their body temperature rises. These symptoms pass quickly, they do not pose a threat to life and health.

After the embolization procedure, menstrual bleeding returns to normal. In addition, the patient does not suffer from a sensation of squeezing the internal organs. Recovery takes about six months. In this case, the risk of recurrence is almost completely eliminated.

EMA in Russia

Have you prepared for the removal of the mass during embolization, but were refused? Such situations are possible. This is due to the fact that relatively few operations are carried out in our country.

Everything is simple!

In Russia, there are very few endovascular surgeons who are able to perform operations related to the removal of formations by blocking the arteries.

It is also important that not all clinics have expensive equipment that allows monitoring the uterus and blood vessels during the intervention.

What to do?

Contact the center of endovascular surgery of Professor Kapranov!

In December 2001, the first EMA in Russia was successfully performed in the surgical hospital of the City Clinical Hospital No. 1 in Moscow by Professor S.A. Kapranov.

At the moment, the specialists of the Center for Endovascular Surgery - Professor S. A. Kapranov and his colleagues - have a unique experience in the field of minimally invasive operations for embolization of the uterine arteries. Highly qualified doctors have successfully performed over 5,000 such operations, which is many times greater than any individual experience of world-renowned specialists in the field of intravascular surgery.

Of course, such a colossal scientific and practical work of Russian doctors could not go unnoticed. Evidence of the international recognition of this invaluable experience was the fact that Professor S. A. Kapranov received an invitation to participate in the international congress of the European Society of Radiologists ECR, which took place in Vienna, Austria in 2009. There Sergey Anatolyevich delivered a report on this topic to leading European experts. It is noteworthy that the co-chairman of this congress is Jean-Pierre Pelage (France), who rightfully has the status of an international authority in the field of intravascular treatment of the disease.

At this stage, Professor S. A. Kapranov has written and published 2 scientific monographs, more than 100 articles, which describe in detail all the subtleties of the use of EMA. In 2010, Sergey Anatolyevich was awarded the Prize of the Government of the Russian Federation in the field of medicine for achievements in restoring women's reproductive health. So highly at the state level was the work of the professor on the restoration of reproductive health in several hundred women who were successfully cured of formations of various sizes. Many of them were able to produce not only one healthy baby, but also twins!

The main advantages of the operation in the center of endovascular surgery prof. Kapranova

High professionalism of doctors. Specialists take into account the general state of health of a woman, strive to eliminate all risks for the existence of the most important organ of patients. In addition, doctors have many years of experience in performing surgeries. They know exactly how to perform all actions as quickly as possible and with minimal risks.

Choice of clinic. Turning to Professor Kapranov, you can independently choose a medical center where the operation will be performed.

Optimal cost of all services.

Opportunity to discuss all the conditions and features of the intervention. As a rule, EMA is a planned operation. This allows you to slowly consult a doctor, go through all the necessary studies. You do not have to make a decision on hospitalization in a few hours. You will have time to evaluate all the risks, weigh the pros and cons.

What determines the cost of treatment?

Experts told about the curse of courtesans

“One thirty-year-old patient, having learned about uterine fibroids, wailed: someone must have cursed me! My career is going uphill, I make good money - there are a lot of envious people, - says the professor of the department of obstetrics and gynecology of the medical faculty of the Moscow State Medical University. A.I. Evdokimova Alexander Tikhomirov. - No one cursed her! It's just that the uterus should be used for its intended purpose.

The entire female world today is practically on the verge of a non-infectious epidemic of fibroids. The representatives of the fair half pay for the fact that they postpone the birth of children almost to old age. And although today there is a bloodless treatment of fibroids, in Russia, the removal of the uterus remains the most popular abdominal operation.

At the beginning of the last century, fibroids were considered a disease of nuns, or, in extreme cases, courtesans. It was these categories of the female population that were at risk of encountering the named disease. The rest actually lived from birth to birth, letting the uterus work as intended by nature.

Now, as Professor Tikhomirov says, modern young ladies have dissertations, careers, and so on in their heads. The birth of a dozen kids is almost not included in anyone's plans. As a result, with each new period, the risk of fibroids increases - after all, nature has provided for this organ to rest during pregnancy and lactation.

Myoma has become one of the most common female diseases - it occurs in at least a third of women aged 35+. According to some estimates, to one degree or another, it can be found in as many as 72% of women over 40 (the peak incidence occurs at the age of 35-50).

“When women are diagnosed with fibroids for the first time, they have a lot of questions,” says Alexander Leonidovich. - For example, is it cancer? No, not cancer, and will never grow into cancer. Will the uterus need to be removed? In the vast majority of women with timely diagnosis, there is no need for such an operation. Although there are situations when it is better to live without a uterus than to die with a uterus.”

Unfortunately, myomatous nodes tend to grow. Is always. It does not happen that the fibroids freeze in one size. But many doctors, having discovered a nodule, tell their patients: nothing needs to be done, come in half a year. Despite advances in modern medicine, there are gynecologists who prefer to passively observe this tumor until radical surgery is required. “What is there to see? How will the node grow? So that he grows up to 12 weeks, when will you have to tell the patient: is it time to remove the uterus? Professor Tikhomirov is indignant.

He is sure that treatment for uterine fibroids should be started immediately. There are two groups of drugs for this - selective progesterone receptor modulators and gonadotropin-releasing hormone antagonists. If the nodes are very small, they may disappear against the background of such treatment. If medium or large - will gradually decrease. “However, when the symptoms - bleeding, pain, heaviness in the abdomen, difficulty urinating - disappear, no one will care whether there is a fibroid or not. The main thing is that it does not interfere with life,” says the professor.

In some cases, a conservative plastic method is required - the removal of nodes. Today it is performed by anemic methods - laparoscopy, endoscopic instruments. There are other minimally invasive hardware methods for getting rid of fibroids. For example, by exposure to X-ray the best. Or embolization of the uterine arteries (in the process of introducing special drugs through the femoral artery into the uterus, the tumor is deprived of blood supply nodes). Another technique from this series - high-speed ultrasound - unfortunately, has many contraindications.

Meanwhile, hysterectomy - an operation to remove the uterus - is the most common abdominal operation in our country. Average age carrying out such an operation in Russia - 40.5 years plus 3.5 years. Of course, such a procedure ends in infertility. But in fact, there are very few indications for it - either if the fibroid is in a very advanced stage, or if it is combined with other tissue pathologies. “It is important to follow the principle of four “not”: do not allow, do not miss, do not start the disease, do not allow a larger volume of myomatous tissue to form. Passive surveillance is not allowed!” - Professor Tikhomirov repeats.

Many women are worried - is it possible to give birth with fibroids? “Yes to health! Get timely treatment and give birth, ”says our expert. As for prevention, apart from childbirth and lactation, there is only one scientifically proven method of preventing this disease - taking complex oral contraceptives. Everything else from the point of view of preventing this disease does not play any role.

Less than a third of Russian women of reproductive age (29%) undergo a preventive examination by a gynecologist, as recommended by experts. This was shown by the "Women's Health Index" survey conducted by VCIOM.

Although the majority of women (86%) aged 18 to 44 agree that it is necessary to visit a doctor for preventive purposes regularly, only one in three do this, as expected, once every six months. In addition, only every seventh woman of reproductive age (14%) goes to a gynecologist exclusively in case of health problems. 40% wait a few days to see if the alarming symptoms go away on their own, and 26% are willing to endure long enough until the situation seriously worsens. 49% of Russian women consider themselves healthy; 39% say that since they already have a permanent sexual partner, they have nothing to worry about; 38% don't have time, and 21% don't have a good doctor. 4% of women are embarrassed or afraid that, God forbid, they will find something.

As he says Chief Researcher, Research Institute of Women's Health, First Moscow State Medical University. THEM. Sechenova Irina Kuznetsova:“The culture of caring for women's reproductive health began to take shape not so long ago. Today, this topic is considered a bit shameful. Even at an appointment with a specialist, they are embarrassed to talk about their problems using euphemisms. Yes, and doctors began to speak openly on these topics not so long ago. For example, interest in PMS arose in the 70s of the last century, when lawyers tried to justify their clients that they were not in the best shape. It must be remembered that a preventive examination is not just an ordinary event. At a doctor’s appointment, women can receive recommendations on preparing for pregnancy, adjusting diet and lifestyle, as well as on preventing diseases of the reproductive system.”

Content

Myoma is a benign neoplasm of a hormone-dependent nature, localized in the muscular layer of the uterus. Pathology is typical for women from 30 to 45 years old, but can also develop at a younger age. If you start when the formation is small, you can avoid surgery, as well as more serious indications in the form of removal of the organ.

The feasibility of surgical treatment

Uterine fibroids form and develop in a muscular layer called the myometrium. Upon reaching a significant size, the formation can migrate and be diagnosed:

• in the body of a muscular organ;
• in the neck part.

Specialists distinguish the following options for fibroids regarding its localization in the uterus:

• subserous, located under the serous membrane;
• submucosal or submucosal, is located under the mucous membrane;
• intramural or interstitial, grows in the thickness of the myometrium;
• intraligamentary, progresses between the leaves of the broad ligament;
• retroperitoneal, grows from the cervical part.

Uterine fibroids usually have the form of nodes, which are characterized by a different number and size:

• multiple and single tumor;
• neoplasm of small, medium or large sizes.

Large nodules are often an indication for surgery or removal of the uterus. Myomatous nodes are attached to the tissue of the uterine wall through a wide base or thin stem. The growth rate of neoplasms depends on the structure.

1. Simple fibroids grow slowly and reach significant volumes within five years.
2. Proliferating tumor characterized by rapid progression.
3. Presarcoma contains altered cells, characterized by the presence of several large nuclei.

Histological composition may differ. If the formation contains predominantly smooth muscle cells in the structure, leiomyoma is diagnosed. Fibrous tissue in the composition of the tumor characterizes fibromyoma.

Myoma has a hormone-dependent etiology and pathogenesis. Congenital disorders occurring in the muscular tissue of the uterus under the influence of internal and external adverse factors are also considered as the cause of the formation of a neoplasm.

Before treating the disease, it is necessary, if possible, to eliminate the factors that provoke the progression of the nodes. Otherwise, the treatment may be useless, which will lead to tumor growth and an indication for its surgical removal.

The severity of the clinical picture is essential when choosing treatment tactics. Often, the disease proceeds latently, which contributes to its rapid progression and detection at an advanced stage. This explains why doctors often have to remove nodes surgically.

Features of the clinical picture are often an indication for surgery.

There are certain indications for both the removal of fibroids and the body of the uterus.

Doctors distinguish the following indications for the removal of fibroids:

• leiomyoma size at least 12 weeks;
• combination of fibroids with endometriosis or cancer;
• torsion of the legs of fibromyoma, its necrosis;
• violations of the functioning of internal organs;
• severe pain;
• oncological alertness;
• reproductive disorders;
• lack of effect from the use of drugs that stop acyclic.

The following sizes of nodes are called, which correspond to the weeks of pregnancy:

• a small fibroid corresponds to five weeks of pregnancy and two centimeters;
• secondary education, equivalent to a pregnancy for a period of eleven weeks and having a size of up to six centimeters;
• a large tumor looks like a 15-week pregnancy with nodes that have a volume of more than six centimeters;
• with a giant neoplasm an increase in the uterine cavity reaches 16 weeks or more.

A large or giant fibroid is an indication for removal. Sometimes doctors have to remove small fibromyomas, in particular, with torsion of the leg, necrosis of the formation, infertility. A few decades ago, gynecologists believed that with fibroids, the uterus should be removed.

In recent years, indications for hysterectomy have been reduced to a minimum. In modern gynecology, large fibroids and the onset of menopause are no longer indications for removal of fibroids.

It is necessary to remove the uterus with myoma in the following cases:

• suspicion of oncology;
• concomitant prolapse of the uterine body and cervix;
• active progression of endometriosis.

When a woman's uterus is removed, she not only loses her reproductive function. Removal of the uterus will necessarily entail serious consequences for health. In this connection, organ-preserving operations are carried out in modern gynecology. Removal of the uterus is necessary only for certain indications.

Operation methods

If indicated, uterine fibroids should be removed. Before removing the neoplasm, the doctor must conduct an examination to determine the exact location and type of leiomyoma.

When indications for surgical treatment of fibromyomas are carried out using:

• organ-preserving treatment;
• radical operations.

For small fibroids, the indication is treatment with sparing tactics, for example, uterine artery embolization, myomectomy, FUS ablation. During such operations, the myomatous node is removed, and the reproductive function is preserved.

Embolization of the uterine arteries consists in removing the node by blocking the vessels that feed it. Such removal of fibroids refers to an effective technique with a relatively low percentage of relapses.

Organ-preserving removal is carried out by several techniques.

1. Laparoscopic and laparotomic myomectomy. Indications for removal are single and multiple tumors of the interstitial or subserous variety. Laparotomy removal is used quite rarely due to trauma and the risk of surgical complications. Among the indications for the isolation of large leiomyomas, uterine deformities.
2. . Removal must be carried out using a hysteroscope with a submucosal location of the tumor. During this manipulation, gynecologists have to both diagnose and remove leiomyomas. The operation is also performed at the birth of the submucosal node. Removal must be performed in the first days of the cycle during a planned operation. You can remove fibroids in a hospital and outpatient setting.

When using surgical methods of treatment, it is necessary to take into account that the removal of uterine fibroids is often accompanied by a risk of complications and relapses.

In gynecological practice, sometimes doctors have to remove uterine fibroids using a radical method. Radical surgery requires removal of the uterus. Radical surgeries include:

• hysterectomy;
• extirpation.

After the surgical treatment The patient is undergoing medical examination. As a rule, a woman also has to take hormonal drugs to prevent relapse.

Hysterectomy

A uterus with fibroids can be removed with an operation called a hysterectomy. This intervention ranks second in frequency in women. Experts note that this is one of the most common ways to remove fibroids.

Absolute indications, in which it is necessary to remove the uterus in case of myoma, are the processes of its prolapse or prolapse, as well as the suspicion of cancer. Hysterectomy is often necessary for women to remove a uterus with advanced tumor after menopause.

With fibroids, the removal of the uterus can be carried out in different ways. There are several types of hysterectomy, with which you can remove the body:

• subtotal, consisting in the removal of the uterus while preserving its cervical part;
• total, meaning the removal of both the uterus and its cervix;
• hysterosalpingo-oophorectomy, implying the removal of the uterine body, ovaries, and tubes.

Before removing the affected organ, the doctor must warn about the complications that may arise during and after the hysterectomy. Complications after a hysterectomy include:

• allergic reactions to anesthesia, leading to death;
• damage to organs located in the pelvis, as well as nerve bundles;
• postoperative bleeding;
• intestinal obstruction;
• development of the adhesive process;
• peritonitis.

After removal, the patient needs to carefully monitor her well-being. In the absence of complications, recovery after a hysterectomy will take about two months.

Hysterectomy has a number of distant ones that adversely affect a woman's life. The long-term consequences after removal by the hysterectomy method include:

• posthysterectomy syndrome;
• exacerbation of diseases of the cardiovascular system;
• the risk of developing a tumor in the mammary glands;
• the development of manifestations of menopause, for example, depression and sweating, hot flashes, osteoporosis;
• problems in intimate life due to the occurrence of vaginal dryness, decreased libido;
• prolapse of the vaginal walls;
• urinary incontinence;
• bacterial vaginosis;
• hypertension;
• obesity.

The patient after the removal of the uterus, which implies a hysterectomy, must take hormonal drugs. After a hysterectomy, a woman loses her reproductive function, which is especially important for women of childbearing age.

Many modern gynecologists say that it is not always worth removing an organ through a hysterectomy. In some cases, an organ-preserving intervention is required. Before deciding on a hysterectomy and removing an organ, one must think about the consequences that may appear in the long term.

29.04.2017

Uterine fibroids is a pathology that consists of blood vessels and connective tissue. It grows from the muscular layer of the organ, and may look like a single or multiple node.

When diagnosing a tumor, the first thing the patient asks the doctor is whether it is necessary to remove the fibroids.

Causes of the appearance of pathology

Doctors identify several main causes of the appearance of such a tumor, these are:

1. Hormonal disbalance.
2. Low immunity.
3. genetic predisposition.

Tumor types

There are three types of fibroids:

• Submucosal - means that the pathology grows inside the uterus.
• Subserous - try to get out of the organ.
• Interconnective.

On average, pathologies are diagnosed with a size of about fifty millimeters, although it can grow up to one hundred millimeters. But large tumors are a rarity.

Symptoms of the disease

It should be noted that in the early stages, the disease does not show any symptoms, so it is very difficult to diagnose it. Although this can happen if a woman undergoes a preventive examination by a gynecologist.

But if the disease is running, the tumor has already reached a sufficiently large size, then certain symptoms appear, namely:

• Profuse and prolonged menstruation.
• Pain in the lower abdomen.
• Infertility (spontaneous miscarriage or premature birth in which the child does not survive).

If fibroids do not pose any danger to a woman's health, doctors recommend treatment with medications. However, it rarely gives a positive result and ultimately, the tumor has to be removed surgically.

Is it possible to cancel the operation

Speaking specifically about the removal of the uterus, then such an operation is recommended to be carried out when a woman has crossed the line of forty years. At this age, women already have children, they no longer plan to give birth, so they no longer “need” the uterus.

If a woman agreed to such an operation, then before performing it, the doctor should observe the development of the pathology for some time. Find out how fast it grows and only after that make a decision about removal.

For the operation to take place, certain indications are necessary:

1. The patient is over forty years old.
2. The size of the pathology is more than twelve weeks of pregnancy.
3. The development of fibroids for more than four weeks a year.
4. The degeneration of a neoplasm into a cancerous tumor. The age of the patient will not be taken into account, as well as the presence of children. Because the focus will be on her life.

In medicine, there are cases when fibroids resolve themselves, during the period when a woman reaches menopause. At this time, the body stops producing estrogen, which feeds the pathology, and over time, the tumor disappears. It doesn't happen in one month, it can take years. If everything goes well, then the operation can not be carried out.

If the patient is diagnosed with many fibroids, then she is sent for examination. Having studied its results, the doctor will be able to clearly understand the whole picture of the pathology, and only after that will make a decision about the removal.

If the disease is found in a woman who is under forty years of age, then the decision to remove will be made in order to save the organ and remove only the tumor.

The question of whether it is necessary to remove uterine fibroids can be answered as follows: if the woman's age has crossed the forty-year limit, then the entire organ must be removed. Thus, doctors will save a woman from possible relapses and cancerous pathologies.

The main indications for surgery

So, there are certain indications that indicate the need to remove the pathology, regardless of the age of the woman:

• The size of the neoplasm is more than twelve weeks.
• The rapid growth of pathology.
• With the appearance of heavy bleeding, not only during menstruation, but also between it.
• development of anemia.
• The appearance of fainting.
• With pain that occurs due to the fact that the neoplasm begins to compress neighboring organs or nerve endings.
• Negative changes in the structure of pathology.
• With a formation growing on a thin, long base, by which it is connected to the uterus. In this case, the leg may twist and bleeding will occur.
• The location of the tumor in the cervix.
• Infertility due to this pathology.

Any disturbances in the functioning of the organs located near the neoplasm can affect the removal:

1. Violation of the emptying of the bladder. Because of this, urine can accumulate in it, and this leads to inflammatory processes, sand and stones.
2. The ingress of urine into the ureter, which causes inflammation and pyelonephritis.
3. Due to the clamping of the rectum, defecation is not going well. The consequence of this is constant constipation, and then poisoning of the body.
4. Squeezing of the nerve endings near the rectum, because of this there is pain in the heart, lower back and legs.

Surgical removal of fibroids

Before determining which method will be used to remove the pathology, it is necessary to consider the following factors:

• The age of the woman.

If the patient is not yet forty years old, then only the neoplasm is removed, without touching the uterus. After forty, the removal of an organ is possible because it has already completed its leading role in a woman's life.

• Tumor size twelve weeks.
• The location of the neoplasm, if it is found on the back wall of the uterus.

If the removal is directed only at the tumor itself, then the pathology may occur again, after some time.

With a small tumor, it is necessary to monitor its further development. If it does not increase and does not cause discomfort to the patient, then surgery is not required. A woman needs to regularly undergo preventive examinations in order to see the changes in time and make the right decision.

Varieties of operations

There are several types of surgical treatment:

• Laparotomy. To excise the tumor in this way, you will have to make an incision in the patient's abdomen. The main indications of this method are a large or multiple neoplasm that deforms the organ itself. A good prevention would be a woman's pregnancy two years after the operation.
• Laparoscopy. To do this, you do not need to cut the stomach, only its piercing is required, which subsequently does not leave scars. The most appropriate indication would be a small tumor size, about nine weeks. If this method is applied to a large pathology, then bleeding from the uterus may occur.
• Hysteroscopy. No incisions or punctures are required during this process. The operation is performed through the vagina. Indications are small neoplasms, a pathology on the basis, a pathology that degenerates into a cancerous tumor.
• Hysterectomy. Excision of not only neoplasms, but also of the uterus, which can be carried out through an incision in the abdomen or vagina. This method is used if the tumor is critical and can threaten the woman's life. Such removal is carried out mainly by women after forty years of age, but if the situation is critical, then it can be prescribed to patients who have not reached this age.
• Embolization. In this case, the blood vessels are clogged and the neoplasm, due to lack of nutrition, slowly dies off.

Condition of a woman after removal of the uterus

After the removal of the organ, the following consequences may occur:

1. Depressive states of a woman.
2. Mental disorders.
3. Pain syndrome in the pelvis.
4. Violations in the work of the genitourinary system.
5. Lack of orgasm.
6. Loss of interest in sexual activity.
7. Early menopause (if ovaries remain).

The main thing is that doctors remember that there are no “extra” organs in the body, so you should think about it before completely removing the uterus.