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Uterine Removal: When appropriate, when not?

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Many women are unsure

Uterine Removal: When appropriate, when not? Expert Dr. Christiane Niehues explains the surgery and its alternatives.

We have with Dr. med. Christiane Niehues (50), chief physician of the gynecological department of the rehabilitation clinic in Bad Salzuflen, asked.

When does the uterus have to be removed?

There are two indications (medical jargon) where removal is essential. First, if the fallopian tubes are inflamed so badly that a perilous peritonitis threatens. And second, if the uterus or ovaries are affected by cancer. An exception here is the cervix cancer. Through regular check-ups at the gynecologist (Pap smear), he can be detected at a very early stage and treated uterus. Precursors often heal on their own, they should only be examined regularly by the doctor.

Are there any other reasons besides?

Yes. Much more common than tubal inflammation and cancer are indications where removal of the uterus may be appropriate, but not mandatory. These include z. Benign tumors or growths of the uterine musculature (fibroids) or mucosa (eg polyps, endometriosis). Bleeding Disorders (too frequent, too strong, and / or extremely painful). Lowering the uterus or bladder. In all these cases, the uterus should only be removed if the affected women are severely affected by the condition and can not help with alternative treatment options.

What alternatives are there to the distance?

It depends entirely on the cause, nature and severity of the symptoms. Fibroids do not need to be treated if they cause no discomfort. However, they are observed regularly.If they cause discomfort, there are several gentle surgical methods in which individual fibroids are excreted - either by abdominal section, abdominal or uterine mirroring. A newer method is embolization. Here mini-beads are injected into the vessels that supply the myoma with blood. This inhibits the blood supply, the myoma dies. In hormonal bleeding disorders, it often helps the affected women if they take a light birth control pills or other hormone preparations. These normalize the period again. Also herbal remedies such as chaste tree preparations or lady's mantle tea relieve the symptoms. To clarify the cause, it often makes sense to eradicate the mucosa and to examine the tissue. This method also removes polyps. The mucous membrane then forms again. In stubborn cases, the uterine lining becomes desolate.

In case of bladder or uterine subsidence, the most important remedy is pelvic floor training. Courses offer cash registers, VHS or physiotherapists. Operatively, the connective tissue can be tightened and lifted.

How is the uterus removed if necessary?

The uterus is removed either by abdominal (abdominal), laparoscopic (laparoscopic) or vaginal (vaginal). Depending on which organs are affected, only the uterus (sometimes without a cervix) or the ovaries are removed. The laparoscopy is more of a minor procedure, therefore more popular. In cancer, surgery is usually performed by abdominal section. Depending on the operation, you will stay in the hospital for about 5 to 10 days and then be on sick leave for about 4 to 6 weeks.

What consequences can the operation have?

That is very different. Severe complications are rare, which is why the surgery is often referred to as routine surgery. However, it is quite a big intervention. After all, an organ is peeled out of its environment and separated from other organs. In the first six to nine months after surgery, therefore, complaints such as pain, intestinal or bladder problems are quite normal. Often, women also feel limp during this time and suffer from mood swings. One must not forget: The uterine removal leads in many women to an early onset of menopause. An OP should therefore always be a deliberate decision!

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