Posthysterectomy syndrome is a combination of such neuropsychiatric and metabolic disorders that occur after removal of the uterus from a woman’s body. At the same time, one or two ovaries may be preserved. Clinical indications of posthysterectomy syndrome can manifest numerous psychoemotional and neurovegetative disorders, including tachycardia and hot flashes, excessive sweating and hypertension, lability and weakness in the body, unjustified anxiety and other indicators. When diagnosing post-hysterectomy syndrome, it is necessary to rely on ultrasound and gynecological examination data, a detailed study and study of hormones. In therapy, HRT and sedatives, physiotherapy and antidepressants are actively used. Due to the active and widespread use of subtotal and total hysterectomy in gynecology, the problem of post-hysterectomy syndrome is extremely relevant today. This applies to absolutely all diseases of the uterus. In the absence of optimal and adequate treatment, after total extipation or amputation of the uterus, a stable form of post-hysterectomy syndrome may develop rapidly, which may be accompanied by an early onset of physiological menopause: approximately 3-5 years earlier than could have been expected.
The content of the article:
Classification of post-hysterectomy syndrome
Causes of post-hysterectomy syndrome
Symptoms of post-hysterectomy syndrome
Diagnosis of post-hysterectomy syndrome
Treatment of post-hysterectomy syndrome
Prevention of post-hysterectomy syndrome
Post-hysterectomy syndrome
Posthysterectomy syndrome may develop due to a sharp decrease in the cyclic function of the ovaries preserved during surgery, the appearance of hypoestrogenism, as well as its negative effect on the central nervous system.
How often post-hysterectomy syndrome can occur in operated patients depends only on their age and the nature of blood supply, the volume of hysterectomy and related pathologies. Posthysterectomy syndrome can develop in women of relatively active social age.
Classification of post-hysterectomy syndrome
The timing of the development of posthysterectomy syndrome may be different, they are completely individual. The syndrome may develop in the first days of the postoperative period, be early; the syndrome may appear within a year and be late. The duration of posthysterectomy syndrome can also vary from persistent to transient. With the latter form, which can be found in women of reproductive age, ovarian function can recover in the period from 4 weeks to 1 year after hysterectomy. With a persistent form of post-hysterectomy syndrome, symptoms may appear even after a year from the date of surgery, which will indicate the extinction of ovarian function and indicate the risk of early menopause. The complexity of posthysterectomy syndrome can be different: mild, moderate and severe clinical manifestations.
Causes of post-hysterectomy syndrome
The factor that leads to the formation of posthysterectomy syndrome may be hypoestrogenism. Such a violation of ovarian innervation, as well as the withdrawal of blood flow from them as uterine arteries after surgery leads to weakening of the uterine appendages due to a decrease in their blood supply. Acute ischemia, structural changes, venous as well as lymphatic stagnation, functional and other changes may develop in the appendages of the uterus. Uterine appendages lose ovulatory and hormone-producing function, in which ovulatory cycles with high estradiol levels were predominant. After the myometrium and endometrium are removed, the process of disruption of reverse receptor connections will begin.
Cases of post-hysterectomy syndrome are much more common after extirpation. If compared with the procedure of supravaginal amputation of the uterus or removal of the ovaries, cases of the genesis of posthysterectomy syndrome are much more common. A severe form of post-hysterectomy syndrome is most likely when the operation is in the luteal phase of the cycle, as well as in those patients who suffer from diabetes mellitus or thyrotoxicosis.
Symptoms of post-hysterectomy syndrome
The main clinical indicators of posthysterectomy syndrome may be neurovegetative and psychoemotional changes. Disorders of this kind can occur under the guise of asthenic syndrome or depression, during which patients are able to experience weakness and fatigue, lethargy and deterioration of attention, memory lapses and tearfulness, anxiety and fear of loneliness, a sense of inferiority.
With posthysterectomy syndrome, changes affect the neurovegetative system of a woman, and therefore tachycardia may appear, which manifests itself in a rapid heartbeat even at rest, sensitivity to temperature changes, numbness of the skin and vestibulopathy, the appearance of goosebumps on the skin, increased sweating, insomnia and swelling. At the same time, the incidence of cardiovascular pathology increases significantly, affecting the genesis of obesity and osteoporosis.
Persistent post-hysterectomy syndrome can manifest as urogenital disorders, colpitis, stress urinary incontinence, pain during sexual intercourse, vaginal dryness, and so on may occur.
Diagnosis of post-hysterectomy syndrome
To diagnose posthysterectomy syndrome, it is necessary to conduct a detailed assessment of neurovegetative and psychoemotional disorders, to examine the probable structural and functional changes of the ovaries, as well as their blood flow, the presence of disorders in the hypothalamic-pituitary system during rehabilitation after hysterectomy. To determine the severity of clinical manifestations of posthysterectomy syndrome, you can use the Kupperman index.
In order to determine how functionally active the ovaries, hypothalamic-pituitary regulation are, as well as to give an approximate prognosis of posthysterectomy syndrome in a woman, a number of detailed studies are conducted that are aimed at determining the amount of estradiol in the body, FSH and LH in dynamics.
With the help of ultrasound, it is possible to identify those structural changes that occurred after hysterectomy. This may be a cystic transformation of the ovaries that have been preserved, and in the intraovarial blood flow — a decrease in the speed of blood flow and activation of the process of venous stagnation. At the same time, posthysterectomy syndrome may be accompanied by a decrease in the size of the ovaries, the poverty of their follicular apparatus, a decrease in perfusion and an increase in the echogenicity of the stroma, a restructuring of the vessels of intraovarial blood flow, which is similar in structure to postmenopausal indicators. If the post-hysterectomy syndrome has a transient character, then over time it will be possible to observe the regeneration of the volume and structure of the ovaries.
Treatment of post-hysterectomy syndrome
Depending on the severity and duration of the disease, the nature of therapy for post-hysterectomy syndrome is determined. During the rehabilitation period, sedatives are prescribed, provided that the syndrome is mild or moderate and has a bright psycho-emotional coloring. In addition to sedatives, tranquilizers and antidepressants, reflexology and homeopathic remedies can be prescribed.
To normalize microcirculation in the organs of the collar zone and pelvis, physiotherapy is often used: galvanization of the cervical-facial part, electrophoresis, transcranial electrical stimulation.
If the post—hysterectomy syndrome has a severe or persistent form, then HRT – hormone replacement therapy can be added to the treatment. It will quickly help to get rid of psychoemotional problems and vegetative-vascular disorders, neutralize and normalize the work of the hypothalamic-pituitary regulation of the ovaries, prevent the development of metabolic disorders.
If the stage of development of posthysterectomy syndrome is early, then parenteral administration of combined estrogen-androgenic drugs can be added to the main course of treatment. It is also possible to use estrogen-containing patches. If the period is late surgical, then various combined drugs will be introduced into the course of treatment at the discretion of the doctor.
Long-term HRT involves the control of blood clotting by means of coagulogram studies with subsequent preventive measures to prevent thrombosis with the use of dasagregants and venoprotectors.
Prevention of post-hysterectomy syndrome
In order to prevent the genesis and further development of post-hysterectomy syndrome, it is necessary to rationally distribute indications for performing total extirpation of a woman’s uterus. Therefore, if possible, surgical intervention should be as limited as possible to supravaginal amputation of the uterus. This kind of intervention should be performed only during the follicular phase of the cycle.
