Is it necessary to have a hysterectomy for uterine fibroids?

Having uterine fibroids is already very unfortunate for women. If the uterus needs to be removed because of uterine fibroids, it is even more unfortunate, especially for those women who are still in childbearing age and have not yet given birth to the fruit of love. This is undoubtedly a matter of adding insult to injury. So, is it necessary to remove the uterus for uterine fibroids? Are there other conservative treatment methods?

Patients have symptoms such as menstrual changes, anemia, compression, but have no fertility requirements. At this time, if the fibroids are larger than 250px cm, or the number is more than 4, or there is a suspicion of malignancy, a total hysterectomy should be performed. If such patients choose myomectomy or subtotal hysterectomy, they may be at risk of myoma recurrence and cervical stump cancer in the future. The advantage of total hysterectomy is that it eliminates the possibility of recurrence of fibroids and avoids the occurrence of cervical stump cancer, but the blood circulation of the ovaries may be affected, and when the supporting structure of the pelvic floor is damaged, vaginal or rectal prolapse may occur.

Subtotal hysterectomy is suitable for patients who have excluded cervical lesions, have complicated conditions (such as severe pelvic adhesions), and have difficulty in removing the cervix. Although subtotal hysterectomy preserves the integrity of the pelvic floor and can avoid or reduce the occurrence of postoperative prolapse, the preserved cervix is ​​still prone to lesions, such as cervical stump myoma, cervical stump cancer, etc.

Why can ovarian dysfunction occur even if only the uterus is removed?

Some patients with uterine fibroids retain both ovaries during hysterectomy. However, since nearly half of the blood supply to the ovaries comes from the uterine arteries, the uterine arteries are cut off during hysterectomy, and the blood supply and nutrition to the ovaries is affected, which can also cause ovarian dysfunction. There may be early onset of menopausal symptoms such as hot flashes, sweating, and irritability, and the age of onset of geriatric diseases such as osteoporosis, hypertension, and heart disease is also advanced accordingly. According to statistics, the age of ovarian failure after hysterectomy, that is, the age of aging, is an average of 4 years earlier than that of women who do not undergo hysterectomy.

Due to the decline in ovarian endocrine function, the decrease in estrogen secretion, and the decrease in vaginal secretions after cervical removal, vaginal dryness and discomfort during sexual intercourse may occur. At the same time, the vagina shortens after hysterectomy, which will also have a certain impact on sexual desire. Therefore, these patients also require estrogen replacement therapy.