Uterine Surgeries
Gynaecological surgeries can be carried out in various surgical ways depending on the type of problem. Hence, we can talk about laparoscopic surgeries, where therapeutic interventions occur within the abdominal cavity, hysteroscopic interventions, or uterine mirrorings, where we reach the uterine cavity through the vagina, and there may also be situations that require open abdominal surgeries. You can read in detail about these surgical methods by clicking here.
Below, we provide information about the most common surgeries performed on the uterus.
Abrasion, or curettage in healthcare
Abrasion, also known as curettage, is the most frequently performed gynecological intervention. During the operation, the endometrium is removed and then histologically examined, so that both benign and malignant diseases can be diagnosed. In the case of certain lesions, the curettage is also a curative intervention.
Correctage may be justified in case of abnormal uterine bleeding, it can identify the lesion behind the bleeding disorder. Bleeding disorder can be caused by:
- hormonal abnormalities
- inflammatory diseases
- benign and malignant tumors
The most important things to know about curettage
Diagnostic Hysteroscopy
During hysteroscopy, the inner cavity of the uterus is examined with a special endoscope, the hysteroscope. The device is passed through the vagina, cervix and cervix into the uterine cavity.
During the intervention, the tissues of the endometrium and uterus can be thoroughly examined, thereby excluding or confirming benign and malignant lesions.
What complaints may require diagnostic hysteroscopy?
If any intrauterine lesion is suspected during other imaging diagnostic tests, such as ultrasound, X-ray, CT, MR. These can be e.g. the fibroid, polyp or tumor. If repeated miscarriages occur, or in case of infertility, it may be necessary to perform a diagnostic hysteroscopy in order to find out the causes. In case of bleeding disorders, especially after menopause, the use of this diagnostic procedure may also be justified.
During the examination, it is also possible to treat and surgically resolve certain detected lesions. In this case, the intervention is called operative hysteroscopy.
How is diagnostic hysteroscopy performed?
Termination of pregnancy (abortion) before the 12th week
Termination of pregnancy, i.e. interruption or artificial abortion, is a medical intervention during which an unwanted pregnancy is terminated by a small operation. One in three women will have an abortion once in her lifetime.
In Hungary, the conditions for termination of pregnancy are defined in the LXXIX of 1992. Defined by law.
The age of the pregnancy is calculated from the first day of the last menstrual period, if you are not sure about this date, we can get an approximate picture of the age of the fetus by ultrasound examination. Nowadays, the interruption procedure is much safer than it used to be.
The most important things to know about abortion
Surgical Completion of Spontaneous Miscarriage (Curettage in Cases of Incomplete Abortion or Missed Abortion)
Spontaneous miscarriage is the termination of pregnancy before the 24th week of pregnancy, if the fetus does not show any vital signs at birth and weighs less than 500 grams, and the miscarriage occurred without any detectable external influence. During the operation, the pregnancy tissue remaining after the spontaneous abortion and the dead pregnancy are emptied from the uterus.
Key Things to Know About Surgery Following Spontaneous Miscarriage
Conization (conisatio), also known as cone biopsy of the cervix
Cone excision or conization may be performed due to abnormally transformed cells detected during cervical cancer screening (colposcopy and Pap smear) due to HPV virus infection (CIN = cervical intraepithelial neoplasia, change in the epithelial layer of the cervix, pathologically degenerated epithelium). Pathologically degenerated (dysplastic) epithelial cells rarely transform into malignant cervical cancer, however, without treatment, any patient has the chance of the cells transforming into a malignant tumor over time. During cone excision, these abnormal, dysplastic cervical cells are removed.
The most important information about conization
Hysterectomy
Hysterectomy, i.e. hysterectomy (pronounced: hysterectomy) is a gynecological surgical procedure in which the uterus is removed. Consequently, after the intervention, monthly bleeding does not occur and pregnancy is no longer possible. The surgery is most common among women aged 40-50.
A hysterectomy is a large-volume operation with a long recovery time, so it is only justified if other, less invasive (penetrating into the body cavity) treatments have already been tried, but still did not prove to be sufficient to cure the given disease. An exception to this may be malignant tumors, the only possible treatment of which - in an advanced stage - is hysterectomy.
Depending on the condition that necessitates hysterectomy, three types of hysterectomy may be considered.
Types of hysterectomy:
- partial
- total
- radical
The most important things to know about hysterectomy
Uterine Polyp (Endometrial Polyp, Polypus Endometrii, Endometrium Polyp)
Uterine polyps are growths of the lining of the uterus (endometrium), which grow towards the uterine cavity. The vast majority are benign lesions, but in some cases they can be malignant or become cancerous over time.
Polyps can vary in size from a few millimeters in diameter to the size of a golf ball. Polyps attach to the wall of the uterus with a wide base or a narrow stalk. They can occur alone, but in many cases there are several growths in the uterus at the same time. They are usually located inside the uterine cavity, but they rarely protrude through the cervix into the vagina.
Hormonal factors play a role in the growth of polyps, the hormone estrogen circulating in the blood promotes their formation. Uterine polyps are most common in women who have gone through menopause, but they can occur at any age.
Key Information about Uterine Polyp Surgery
Uterine fibroid (leiomyoma/myoma of the uterus)
Fibroids are the result of benign overgrowth of the muscle layer of the uterus. Lumps are made up of smooth muscle and connective tissue and can vary greatly in size.
The exact cause of the development of the disease is still unknown, but what was known was that their growth is related to the female hormones called estrogen. They usually grow during the fertile age, when the level of estrogen is high, and after menopause in many cases they regress on their own and no longer cause complaints.
The most important things to know about fibroid surgeries
Who is often affected by the disease?
Fibroids are a common disease, affecting every 3rd woman in her lifetime. It mostly occurs between the ages of 30 and 50. It occurs more frequently in the case of overweight and obesity, as the level of estrogen has increased in this case. Its probability decreases in women who have given birth before, and the more pregnancies there have been in the past, the lower the chance of future fibroids.
What are the types of fibroids?
Based on the location of the nodules, we distinguish 3 types:
- growing from inside the wall of the uterus (intramural): the most common type
- growing under the uterine mucosa (submucosus): nodules growing towards the uterine cavity
- subserosal nodules: tumors growing on the outer, connective tissue surface of the uterus or towards the pelvis, which can even grow huge
The nodules are attached to the wall of the uterus with a wide base or attached to it on a thin stalk.
What are the symptoms of fibroids?
In many cases, fibroids do not cause symptoms, but in a third of cases, the following complaints may draw our attention to the patient:
- very heavy, possibly spasmodic-painful periods
- lower abdominal pain
- lumbar pain
- frequent urge to urinate
- constipation
- discomfort and pain during sexual intercourse
In rare cases, fibroids can prevent the development of pregnancy (causing infertility) or its maintenance.
As it does not cause complaints in many cases, it is often discovered during a routine gynecological ultrasound examination.
Treatment of fibroids
There is no need for treatment if the fibroid does not cause complaints or if they do not have a great impact on the quality of life. After menopause, the tumors usually shrink and no longer cause complaints.
In case of a lesion causing symptoms, if it has a disturbing effect on the quality of life, the following treatments are available.
Symptomatic treatment: aims to relieve menstrual pain and cramps.
- Hormone-releasing spirals (IUS-intrauterine system): they inhibit the thickening of the endometrium during the monthly cycle, which means that the mucous layer that comes off during menstruation becomes thinner, and thus the amount of bleeding and the associated pain and cramps also decrease.
- Preparations containing tranexamic acid: medicines used in case of heavy, heavy menstrual bleeding, which promote blood clotting. If the blood coagulates, less will be released to the outside world in the form of menstrual bleeding.
- Non-steroidal anti-inflammatory drugs (e.g. preparations containing ibuprofen): administration on painful days (maximum 3 times a day) reduces the pain associated with menstruation.
- Contraceptives: there are many forms: oral tablets, vaginal rings, injections. Their common effect is to reduce the amount of bleeding and menstrual pain. Your doctor will help you choose the most suitable active ingredient and form on an individual basis.
Medicines are available to shrink fibroids, such as GnRH analogues and ulipristal acetate, which reduce the size of the tumors, thereby reducing the symptoms they cause, but their use is only possible for a limited time due to the side effects they cause.
Surgical treatment methods
In case of severe complaints, the following surgical interventions should be considered, since in many cases they can provide a permanent solution to the symptoms caused by fibroids.
- Hysterochromia: Removal of the uterus is a permanent solution to fibroid complaints for those who no longer wish to have more children. You can read more about uterus removal here
- Myomectomy (myomectomy): the surgical removal of the lump from the uterine wall can provide an alternative to hysterectomy for those whose family planning intentions have not yet been finalized. Although this procedure is not suitable in all cases, its applicability depends on the size and location of the nodule. The operation can be performed by laparoscopy and laparotomy, depending on the case. This procedure is a very effective treatment for fibroids, but rarely the nodules can grow back later on.
- Hysteroscopic removal: A modern, incision-free procedure that also allows you to have children later on.
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