Do patients with uterine fibroids need to have their uterus removed? How should patients with uterine fibroids be treated?

After a clear diagnosis of uterine fibroids, which patients are suitable for myomectomy and which patients are suitable for hysterectomy? In the medical community, the relevant standards have been changing. The uterus is very important for maintaining the physical and mental integrity of women. Even after the mission of childbirth is completed or even after menopause, the uterus is still valuable to women. So, is it really good to insist on not removing the uterus?

A woman with uterine fibroids refused to have 55 tumors removed from her uterus four years later

Four years ago, a 36-year-old female patient underwent surgery for uterine fibroids in the hospital. The first time, 27 tumors were removed. Because she had a tumor constitution, the doctor recommended that she remove her uterus, but she insisted on leaving the uterus. The reason was that her child was only 3 years old at the time, and she was worried that if the child had an accident, she would not be able to have another child. A year later, she went to the hospital again and found that she had a small amount of uterine fibroids in her uterus. Three years later, 55 tumors grew in her uterus again. However, the patient finally insisted on not having a hysterectomy.

Which patients need a hysterectomy?

If the fibroids are larger than 250cm, the patient has symptoms such as menstrual changes, anemia, compression, but has no fertility requirements, or more than 4, or the possibility of malignant changes is suspected, a total hysterectomy should be performed. If such patients choose myomectomy or subtotal hysterectomy, there may be risks of fibroid recurrence and residual cervical cancer in the future. The advantage of total hysterectomy is that it eliminates the possibility of fibroid recurrence and avoids the occurrence of residual cervical cancer, but it may affect the blood circulation of the ovaries, damage the supporting structure of the pelvic floor, and cause vaginal or rectal prolapse.

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

Why only remove the uterus and not the ovaries?

Some patients with uterine fibroids retain both ovaries during hysterectomy, but since nearly half of the blood supply to the ovaries comes from the uterine artery, hysterectomy cuts off the uterine artery, affecting the blood supply and nutrition of the ovaries, which can also lead to ovarian dysfunction, early hot flashes, sweating, irritability and other menopausal symptoms, and the onset age of osteoporosis, hypertension, heart disease and other elderly diseases is also correspondingly advanced. According to statistics, the age of ovarian failure after hysterectomy, that is, the aging age, is 4 years earlier than that of women who do not have their uterus removed.

Due to the decline in ovarian endocrine function, estrogen secretion decreases, vaginal discharge decreases after cervical resection, vaginal dryness and discomfort during intercourse may occur, and vaginal shortening after hysterectomy will also have a certain impact on sexual desire. Therefore, these patients also need estrogen replacement therapy.