Specific Aspects of Life Quality Estimation and Ways of Rehabilitation in Women Who Underwent Uterine Surgery

Abstract

Recently, it has been noticed a great number of uterine fibroids in women with unrealized reproductive function; moreover, the number of combined forms of hyperplastic processes of the reproductive system in 20-25% of women under 30 years of age and 60% of women over 40 years of age is constantly growing creating a favourable background for cancer. It is also known that women with hyperplastic processes suffer from psycho-emotional disorders both before surgeries and after surgical recovery; many of them are diagnosed with adjustment disorder. As many researches note, the main psychotherapeutic aspects include passive view of life, increased anxiety, tendency to dependent behaviour, rejection of own body, protective behaviour and problems with self-assessment. It should also be noted that a comprehensive study of clinical and laboratory data and subjective criteria of life quality is essential in assessment of the feasibility of hysterectomy in women of reproductive age, even if they do not plan to bear children in the future. The objective of the research was to estimate life quality as well as to improve the system of dispensary observation and rehabilitation of women who underwent uterine surgery.Materials and methods. There was performed a comprehensive examination and surgical treatment of 60 women of reproductive age with uterine fibroid who underwent hysterectomy with preservation of appendages. We used modern high quality endocrinological and instrumental techniques. The assessment of the received data was made immediately after surgery, 6 and 2 months, 3 and 5 years after surgery. Quality of life was studied on the basis of a comprehensive assessment using the modified scale of the Nottingham Health Profile and the study of such important indicators as energy, sleep, emotional reactions, social isolation, physical activity, pain. All statistical analysis was performed using a standard package “Statistica for Windows – 6.0”.Results and discussion. On the basis of anamnestic data of patients we revealed health deterioration with high rates of liver and gastrointestinal tract disorders, metabolic disturbances (obesity, hypertensive disorders, fibrocystic breast disease), metabolic-endocrine changes and surgery. Reproductive health in women with uterine fibroid was characterized by long establishment of regular menstrual cycle, its breach in the period of puberty, inflammatory diseases of the genital organs, benign ovarian tumours and their surgical removal, inadequate reproductive behaviour with absent or delayed implementation of reproductive function and induced abortion. 12 months and especially 5 years after surgery there was noticed a progressive deterioration of the ovarian function, which was reflected as the reduction in their volume due to the reduction in the number and size of follicles, deterioration of blood supply to the ovaries, decreased blood flow in the internal iliac artery basin. It should also be noted the progressive hypestrogenism; in addition, there was a clear correlation with the age of the woman, who underwent surgical operation. Changes in life quality of patients with hyperplastic processes of the uterus were manifested in the postoperative period as follows: a decrease in physical activity (43.33% of cases), increased sexual dysfunction (36.66%), inhibition of mental state, conflict-orientated social behaviour, weakening of role functions and subjective deterioration of health and life quality (51.66% of cases).Conclusions. Thus, surgery on uterine fibroids with total or subtotal hysterectomy contributes to interference in a complex neuroendocrine interaction between hypothalamus, pituitary, ovaries, adrenal cortex, thyroid gland and affects the blood supply, innervation, and lymph efflux in the pelvic floor; therefore, postoperative syndromes are polyglandular and polysystemic. Long-term effects after surgery are accompanied by progressive hypestrogenism, decrease in the ovarian function (the reduction in their volume observed during ultrasound examination), reduction in the number and size of follicles, deterioration of blood supply to the ovaries, low blood supply to the internal iliac artery basin.