Uterine bleeding

General

Each year some 160,000 women in Germany have a have their wombs removed (hysterectomy). In more than 80 % of cases, hysterectomy is performed because of bleeding disorders, myomas or even just because of an enlarged womb. A less invasive form of treatment would have been possible for between one third and one half of these patients. In most cases, there is no need to hurry and agree to a hysterectomy immediately. It is a good idea to first of all obtain information and carefully weigh up the pros and cons of a hysterectomy much more so than has been the case up till now. 

Bleeding disorders

The womb is a pear shaped, muscular and hollow organ measuring between seven and nine centimeters in length. It is lined on the inside by a layer of mucosa (endometrium) into which the fertilized egg implants itself in the event of pregnancy. In the absence of pregnancy, the mucosa is shed around every 28 days (menstruation), and then begins to be formed again. At least one out of every five women between the age of 35 and 50 years suffers from severe and prolonged menstruation, often with intense premenstrual complaints. These may be caused by hormonal changes prior to or during the menopause, by benign growths in the womb such as polyps or myomas, certain infections but also by chronic diseases. Those women affected have symptoms such as strong, uncontrollable bleeding, intense cramps in the lower abdomen, anemia, vomiting and fatigue or reduced stamina. Their quality of life is impaired on the whole. In such cases, many women view themselves as "not being presentable" and withdraw into themselves. They restrict their activities, thus adversely affecting their professional and family life. 

When must the womb be removed?

In women above the age of 40 years, removal of the womb (hysterectomy) continues to be the most common form of treatment for complaints where this organ is concerned. Total hysterectomy is a decision that has profound implications for many women, and is associated with physical and psychological problems. Therefore this decision should be carefully pondered and weighed up. However, an operation is inevitable if premalignant changes or cancer is diagnosed. But this compelling indication applies only in around 20% of treated cases. 

Treatment of bleeding disorders (see Special treatment > Endometrial coagulation)

If there is heavy bleeding which does not respond to hormonal treatment or to curettage, womb removal is often recommended as the only effective treatment. But in most cases the organ can be preserved, because today there are by all means less invasive treatment modalities available. For example, in the case of a procedure known as "endometrial ablation or coagulation", only the mucosa and a thin layer of muscle are removed, or subjected to coagulation, from inside the womb. There are different methods of doing this: electrosururgical instruments, thermal balloons or microwaves and radio-frequency operated electrodes are used to perform the procedure. The mucosa is expelled from the body after treatment. Afterwards, no – or only slight, menstruation occurs. This procedure can be carried in an outpatient center using a short-acting general anesthetic. Before this procedure is carried out, it must be ensured that no malignant changes are manifest by the mucosa and the patient concerned should not have any plans for a future pregnancy. 

Source: A program broadcast on the Second German Television ( ZDF) with Dr. Kruschinski in "Ratgeber Gesundheit"