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What to expect after an endometrial ablation
The destruction or removal of the lining of the womb is an effective alternative to hysterectomy for the treatment of heavy menstrual bleeding Interestingly there was an article in the daily mail a few years ago calling these sort of procedures the “three minute hysterectomy”. The “3 minute hysterectomy” it is NOT. Though it is a quick operation and some women will not have periods afterwards, the womb is still retained so without EFFECTIVE CONTRACEPTION, women can still become PREGNANT. For some women the Mirena intrauterine contraceptive device may be a suitable option. If it is it can be inserted at the same time as the procedure. There are various methods of destroying the lining of the womb. Some of these like the NOVASURE technique can be done in some centers under local anaesthetic. All however are done as “day cases” where you go into hospital. Have the procedure and are discharged the same day. For some women who have continuous bleeding your doctor may give you some medication to ensure that you are not bleeding on the day of the operation, this may be in tablet form for example PROVERA or injectable ZOLADEX. This is known as pre-treatment. How long does it take? For those procedures that are performed under general anaesthetic, they averagely take about 15-20minutes however “turn-around” time (meaning the time it takes to get into theatre, and be sent back to the ward from recovery) can take up to an hour. Out of the recovery area Once you come round from the anaesthetic, you would be offered something to eat and drink, and once your observations are satisfactory and you have emptied your bladder, and you are not bleeding heavily, your nurses will start preparing you for home. Going home You will not be able to drive home your self and you will need to be accompanied home by a friend or relative. After an anaesthetic you should not operate heavy machinery for a day or two Women are usually discharged with some painkillers as most describe a crampy abdominal pain similar to a bad period. This usually disappears within a day or so There is usually some bleeding vaginally, which is no worse than a heavy period; sometimes this changes into a watery discharge for up to 10 days. Sex It is best to wait till the bleeding and discharge stop before resuming sexual intercourse Women are advised to use Sanitary Towels rather than Tampons till the bleeding and discharge stops. Back to work You should be able to go back to work within a few days of the procedure. Complications of the procedure include Perforation of the womb, which can result in Bowel or bladder injury If these injuries occur it may be necessary for your doctor to perform a laparoscopy or laparotomy (open surgery) to inspect and repair the damaged organs Bleeding Which can result in needing a hysterectomy as a life saving measure in about 1:500 women Infection The effects of this type of treatment are not immediate it can take up to 3 months if not longer to see whether the treatment has had the desired effect. Follow up visit You are advised to keep a record of your periods for both bleeding and pain symptoms (Menstrual Calendar- with modern technology there are a number of good “aps” you can use) so you can discuss them with your doctor at your follow up visit How you recover after a laparoscopy will depend on how fit you are, what the laparoscopy was for and how long the operation takes. women tend to recover quicker after a diagnostic procedure than after an operative laparoscopy
After Surgery You will be monitored closely for a few hours until after the anaesthetic wears off. Once you are able to walk and get out of bed without help and have emptied your bladder you will be allowed to go home. If you are unable to empty the bladder of have lot of pain or sickness be prepared to stay. What to Expect? Going Home Even though you may feel awake the effects of anaesthetic may take some time to wear
Pain You may have a period like crampy pain for a day or two. The amount you have depends on how much surgery you have had. Sneezing, laughing, crying and coughing may be uncomfortable. The pain should improve by the next day and can be eased by taking the usual painkillers and wearing loose fitting clothes to prevent any pressure on your tummy especially the belly button. Lie in whichever position is most comfortable. If it helps, keep your legs bent upwards, propping your legs up with pillows. Hugging a pillow can also help protect your cuts especially if you are lying on your side or with your partner. The gas used to swell up your tummy can cause rib, neck or shoulder pain and tummy bloating. It may also make you burp or break wind a lot. It will take a few days for the symptoms to ease. Try moving around and lying flat to help the gas disappear. Heat (e.g. hot water bottle, warm shower) massage and drinking water either hot or cold /tea with fresh lemon can also help as can peppermints. your partner. The gas used to swell up your tummy can cause rib, next or shoulder pain and tummy bloating. It may also make you burp or fart a lot. It will take a few days for the symptoms to ease. Try moving around and lying flat to help the gas disappear. Heat (e.g. hot water bottle, warm shower) massage and drinking water either hot or cold /tea with fresh lemon can also help as can peppermints. Activity Expect to feel sore and “washed out for the first few days .Most women need at least 2 days to recover from the anaesthetic alone. In this time spend as much time as possible lying down or sleeping. After this if you feel up to it, walk around the house a little bit but don’t overdo it or you may end up feeling light headed and exhausted. It is usually safe to resume your normal activities but avoid strenuous exercises /activity until you are feeling fit, usually after your first post operative visit. Arrange to take a week off work but ask your doctor as it largely depends on your condition and the type of surgery performed. Sore Throat You may experience sore throat caused by the irritation of the tube passed down your throat during anaesthesia. Throat lozenges may help. Eating Nausea as a result of anaesthetic may be made worse by greasy or oily food. Try eating light easily digestible food for a few days such as a cup of tea, soup, dry toast, jelly or crackers. Start with liquids and slowly work up to a normal diet as your stomach will accept it. Room temperature foods are better than hot or cold foods at first. Chewing gums or sucking on hard sweets can help control nausea as can waving an alcohol wipe under your nose (ask nurses for a few).To prevent dehydration and constipation (side effects of both general anaesthesia and pain killers )be sure to drink lots of fluids and include high fibre fruits and vegetables like prunes and spinach. Cuts Keep your cuts clean by bathing and showering as normal and dry your skin thoroughly. Avoid possible irritants like talc or bubble bath. If you have stitches they usually dissolve over a few weeks or can be removed by your GP, You may also have a watery pink tinged discharge from your cuts for a day or two. Steri strips which look like tape may be used to cover your cuts and prevent your clothing from rubbing on them. They can be removed 2 to 3 days following surgery or if they become too wet. The cuts tend to heal quickly and tech to itch more than they hurt. The area around your belly button will be tender and swollen for a week so avoid clothing that may rub. Bleeding You may have light vaginal discharge or bleeding like at the end of the period. It will last for up to 2 weeks. If your laparoscopy was to investigate infertility, there may also be some bluish discharge (from a blue dye used during surgery). To reduce the risk of infection whilst bleeding:
Chronicles of a UK gynaecologist: Myomectomy or hysterectomy for treatment of symptomatic fibroids4/8/2012 What is the ideal pathway for women with symptomatic fibroids?
Comparing Myomectomy with hysterectomy for the management of fibroids Management of symptomatic fibroids will always depend on the number, size and location of the fibroids. Importantly however is the woman’s age and need for present or future reproductive capacity. In the ideal world once a woman’s family is complete and she remains symptomatic of her fibroids she should have definitive treatment, which would either be Uterine artery embolization or surgery When surgery is considered comparing myomectomy and hysterectomy there are trade-offs in terms of benefits and drawbacks. When a myomectomy is performed; Benefits: retaining the womb and potential reproductive capacity Drawbacks: The complications of a myomectomy include; Adhesions, which can give, rise to Pain and Bowel obstruction, Delayed recovery being a potentially bloody operation recovery can sometimes be delayed. There is also the risk of New growth of fibroids. If there is a reason to retain the womb for fertility purposes then these risks may be worth taking otherwise when family is complete and fertility no longer desired a hysterectomy might be a superior operation to myomectomy. For women who do not want a hysterectomy Understandably for a number of reasons women may not want to have their wombs removed. For this group of women the choices would either be a uterine artery embolization or a formal myomectomy either open myomectomy or laparoscopic, having weighed up the risks and benefits. Young women who have not completed their family and fertility desire is not immediate The hardest group of women to advise are those who have relatively asymptomatic fibroids are young and have no children because of the inherent risk of hysterectomy with whatever modality they choose to treat the symptoms of their fibroids. Though the risk is low (about 1:100-250) it is a real risk. Traditionally the advice was to keep the fibroids try for pregnancy and if pregnancy does not happen then come and have the fibroids removed. However no one knows what the natural progression of growth of fibroids are. There are studies that have looked at growth difference between women over time and growth of different fibroids in the same woman and the conclusion is that no two fibroids grow at the same rate either in different women or in the same individual. With increasing advancements in laparoscopic surgery for the management of fibroids and because it is not as traumatic as open surgery, with less risk of adhesion formation, it may be appropriate to advise these women to have a laparoscopic myomectomy while the fibroids are still of a manageable size. The cut off point would be 5cm or more. |
Jimi's blogConsultant Gynaecologist and Obstetrician with a wide experience in Minimal access surgery. Enjoys teaching and training, photography and Travel Membership:Archives
May 2014
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