home Audience 1 Prolapse and prolapse of the vagina and uterus during menopause. Primary failure and early loss of ovarian function

Prolapse and prolapse of the vagina and uterus during menopause. Primary failure and early loss of ovarian function

– displacement of the internal genital organs with their partial or complete exit outward from the genital opening. When the uterus prolapses, pressure is felt on the sacrum, a foreign body in the genital fissure, disturbances in urination and defecation, pain during sexual intercourse, and discomfort when walking. Vaginal and uterine prolapse is recognized during a gynecological examination. Treatment of uterine prolapse is surgical, taking into account the degree of prolapse and the age of the patient. If surgical treatment is not possible, women are advised to use a pessary (uterine ring).

General information

It is considered as a hernial protrusion, which is formed due to the failure of the functions of the closing apparatus - the pelvic floor. According to the results of various studies conducted by gynecology, genital prolapse accounts for about 30% of gynecological pathologies. Prolapse of the uterus and vagina rarely develops in isolation: the anatomical proximity and commonality of the supporting apparatus of the pelvic organs causes displacement following the genitalia of the bladder (cystocele) and rectum (rectocele).

A distinction is made between partial (incomplete) uterine prolapse, characterized by outward displacement of only the cervix, and complete prolapse, in which the entire uterus appears outside the genital slit. With uterine prolapse, cervical elongation (lengthening) develops. Typically, prolapse is preceded by a state of uterine prolapse - some displacement below the normal anatomical level within the pelvic cavity. Vaginal prolapse is understood as a displacement in which its anterior, posterior and upper walls appear from the genital slit.

Causes of uterine and vaginal prolapse

The leading role in the development of uterine and vaginal prolapse belongs to the weakening of the ligaments and muscles of the diaphragm, pelvic floor, and anterior abdominal wall, which become unable to hold the pelvic organs in their anatomical position. In situations of increased intra-abdominal pressure, the muscles cannot provide adequate resistance, which leads to a gradual displacement of the genital organs downward under the pressure of the acting forces.

Weakening of the ligamentous and muscular apparatus develops as a result of birth injuries, perineal ruptures, multiple pregnancies, multiple births, the birth of large children, radical interventions on the pelvic organs, leading to the loss of mutual support of the organs. Uterine prolapse is facilitated by an age-related decrease in estrogen levels after menopause, weakening of the uterine tone, and exhaustion.

Additional stress on the pelvic muscles develops with excess weight, conditions accompanied by increased intra-abdominal pressure (cough, chronic bronchitis, bronchial asthma, ascites, constipation, pelvic tumors, etc.). A risk factor for uterine prolapse is heavy physical work, especially during puberty, after childbirth, and during menopause. Most often, prolapse of the uterus and vagina occurs in old age, but sometimes it develops even in nulliparous young women with congenital disorders of the innervation of the pelvic floor or muscle hypoplasia.

The position of the uterus plays a role in the development of genital prolapse. In the normal position (anteversion-anteflexion), the uterus is supported by the pelvic floor muscles, pubic bones, and bladder walls. With retroversion and retroflexion of the uterus, the prerequisites are created for the appearance of a hernial orifice, prolapse of the vaginal walls, and then the uterus and appendages. Due to stretching of the ligamentous apparatus, vascularization, trophism and lymph outflow are disrupted. Representatives of the Caucasian race more often suffer from uterine and vaginal prolapse; In African-American and Asian women, the pathology is less common.

Classification of uterine and vaginal prolapse

Based on the degree of displacement of the uterus, there are 4 degrees of prolapse.

Diagnosis of uterine and vaginal prolapse requires the involvement of related specialists - a urologist and proctologist. Urological examination of patients with uterine prolapse may include a general urinalysis, bacteriological urine culture, excretory urography, kidney ultrasound, chromocystoscopy, and urodynamic studies. During the proctological examination, the presence and severity of rectocele, sphincter insufficiency, and hemorrhoids are clarified. Uterine prolapse is differentiated from vaginal cysts, uterine fibroids, and cervical changes from cervical cancer.

Treatment of uterine and vaginal prolapse

The only radical method of eliminating uterine and vaginal prolapse in gynecology is surgical intervention. In preparation for surgery, ulcerations of the mucous membrane are treated and the vagina is thoroughly sanitized. The surgical technique for uterine prolapse depends on the degree of prolapse, somatic status and age of the woman.

In the case of incomplete uterine prolapse in young women who have given birth, a “Manchester” operation can be performed, including anterior colporrhaphy with shortening of the cardinal ligaments and colpoperineolevatoroplasty, and in case of elongation and hypertrophy of the cervix, ruptures and erosions of the cervix - with its amputation. Another option for intervention in women of childbearing age with uterine prolapse can be an operation that includes anterior colporrhaphy, colpoperineoplasty, exercise therapy aimed at strengthening muscles, preventing constipation, and eliminating heavy physical labor and stress.

Conservative therapy for uterine and vaginal prolapse is symptomatic and includes the use of a uterine ring (pessary), a hysterophore (a support bandage attached to a belt), and large vaginal tampons. Such methods entail additional overstretching of the reduced vaginal walls, which over time increases the risk of uterine prolapse. In addition, long-term use of a pessary can lead to the formation of bedsores. The use of various support devices for uterine prolapse requires daily vaginal douching and regular, twice a month, examination of the patient by a gynecologist.

Forecast and prevention of uterine and vaginal prolapse

Timely surgical intervention for uterine prolapse has a favorable prognosis. Most women regain social activity and sex life. After organ-preserving interventions, pregnancy is possible. Management of pregnancy in patients who have undergone surgery for uterine prolapse is associated with additional risks and requires increased precautions. Sometimes, even after elimination of uterine prolapse, repeated genital prolapse develops. During palliative treatment of uterine prolapse (using a pessary), irritation and swelling of the vaginal mucosa, ulcerations, bedsores, infections, pinching of the cervix in the lumen of the ring, and the formation of rectal and vesico-vaginal fistulas often develop.

Prevention of uterine and vaginal prolapse includes proper obstetric care during childbirth, careful suturing of perineal and birth canal ruptures, careful performance of vaginal operations, and timely surgical treatment of minor genital prolapse. In the postpartum period, to prevent uterine prolapse, it is necessary to fully restore the condition of the pelvic floor muscles - the appointment of special gymnastics, laser therapy, electrical stimulation of the pelvic floor muscles. Fitness classes, exercise therapy, balanced nutrition, maintaining optimal weight, eliminating constipation, and avoiding hard work are of preventive importance.

Ovarian prolapse manifests itself in the form of certain symptoms that women may complain about. The main complaints are discomfort in the lumbar region and lower abdomen.

The disease can be painless. But when an inflammatory process begins in the ovary, it increases in size, and patients experience severe pain during sexual intercourse or bowel movements.

Important! Often, with prolapses, urological complications appear - urinary and fecal incontinence, constipation, etc. Some women experience changes in menstrual function and also experience hormonal imbalances. Often such patients complain of the inability to get pregnant and difficult sex life.

Patients may develop varicose veins on the legs. This occurs due to venous outflow and insufficiency of connective tissue formations.

Causes

Ovarian prolapse occurs as a result of weakening of the musculofascial apparatus of the pelvic floor. That is, the muscles and ligaments that support the patient’s pelvic organs lose their elasticity. In addition, this disease is congenital. It occurs inside the mother's womb when the production or structure of elastin and collagen is disrupted.

Ovarian prolapse is typical for patients with impaired synthesis of sex hormones. These are postmenopausal women who have not had periods for more than a year due to ovarian depletion and decreased estrogen production.

Doctors identify several factors that predispose to the development of prolapse. These include:

Multiple births (more than two times), as well as carrying a large fetus (weighing more than 4 kilograms).
Rupture of the tissue located between the vagina and anus during childbirth.
Obesity.
Elderly and mature age of the patient.
Engaging in heavy physical labor.

Diagnostics

If ovarian prolapse is suspected, the patient is referred for a colposcopic examination. This diagnostic method allows you to examine the vaginal opening, walls and cervix of the vagina with a colcoscope (a device that consists of a binocular and a lighting element).

In order to determine the presence of the disease, the patient is determined to have a cystocele and a rectocele. In this case, a study of the functional state of the sphincter of the bladder and rectum is carried out. This is necessary to determine whether there is urinary or gas incontinence.

Note: The patient must submit urine for general analysis and bacteriological examination. In addition, she must undergo a rectal examination. If doctors decide to perform organ-preserving plastic surgery, the complex of mandatory studies includes hysteroscopy, ultrasound and hormonal examinations, as well as analysis of vaginal cultures.

Consequences

This disease in its advanced form can cause constipation in women. This occurs due to compression of the intestine by the posterior wall of the uterus. Sometimes the opposite reaction of the body is observed - fecal incontinence.

Ovarian prolapse is fraught with disruptions in the functioning of the urinary system. The patient's anatomical position of the bladder and ureter changes, resulting in incontinence and complications in the outflow of urine. In some cases, stagnation occurs, provoking the occurrence of infectious and inflammatory processes.

– incorrect position of the uterus, displacement of the fundus and cervix below the anatomical and physiological boundary due to weakening of the pelvic floor muscles and uterine ligaments. In most patients, uterine prolapse is usually accompanied by downward displacement of the vagina. Prolapse of the uterus is manifested by a feeling of pressure, discomfort, nagging pain in the lower abdomen and vagina, urination disorder (difficulty, increased frequency of urination, urinary incontinence), pathological discharge from the vagina. May be complicated by partial or complete prolapse of the uterus. Uterine prolapse is diagnosed during a gynecological examination. Depending on the degree of uterine prolapse, treatment tactics can be conservative or surgical.

General information

– incorrect position of the uterus, displacement of the fundus and cervix below the anatomical and physiological boundary due to weakening of the pelvic floor muscles and uterine ligaments. It manifests itself as a feeling of pressure, discomfort, nagging pain in the lower abdomen and vagina, urination disorder (difficulty, increased frequency of urination, urinary incontinence), pathological discharge from the vagina. May be complicated by partial or complete prolapse of the uterus.

The most common variants of incorrect location of the internal genital organs of a woman are prolapse of the uterus and its prolapse (uterocele). When the uterus prolapses, its cervix and fundus shift below the anatomical border, but the cervix does not appear from the genital slit even with straining. Extension of the uterus beyond the genital slit is regarded as prolapse. Downward displacement of the uterus precedes its partial or complete prolapse. In most patients, uterine prolapse is usually accompanied by downward displacement of the vagina.

Uterine prolapse is a fairly common pathology that occurs in women of all ages: it is diagnosed in 10% of women under 30, at the age of 30-40 it is detected in 40% of women, and after the age of 50 it occurs in half. 15% of all genital surgeries are performed for prolapse or prolapse of the uterus.

Uterine prolapse is most often associated with weakening of the ligamentous apparatus of the uterus, as well as the muscles and fascia of the pelvic floor and often lead to displacement of the rectum (rectocele) and bladder (cystocele), accompanied by dysfunction of these organs. Often, uterine prolapse begins to develop during childbearing age and always has a progressive course. As the uterus prolapses, the accompanying functional disorders become more pronounced, which brings physical and mental suffering to the woman and often leads to partial or complete loss of ability to work.

The normal position of the uterus is considered to be its location in the pelvis, at an equal distance from its walls, between the rectum and the bladder. The uterus has an anterior tilt of the body, forming an obtuse angle between the cervix and the body. The cervix is deviated posteriorly, forms an angle of 70-100° relative to the vagina, its external os is adjacent to the posterior wall of the vagina. The uterus has sufficient physiological mobility and can change its position depending on the filling of the rectum and bladder.

The typical, normal location of the uterus in the pelvic cavity is facilitated by its own tone, relationship with adjacent organs, and the ligamentous and muscular apparatus of the uterus and pelvic floor. Any violation of the architectonics of the uterine apparatus contributes to prolapse of the uterus or its prolapse.

Classification of uterine prolapse and prolapse

There are the following stages of uterine prolapse and prolapse:

prolapse of the body and cervix - the cervix is determined above the level of the entrance to the vagina, but does not protrude beyond the genital slit;
partial uterine prolapse - the cervix appears from the genital slit during straining, physical exertion, sneezing, coughing, lifting heavy objects;
incomplete prolapse of the body and fundus of the uterus - the cervix and part of the body of the uterus protrude from the genital slit;
complete prolapse of the body and fundus of the uterus - exit of the uterus beyond the genital slit.

Causes of uterine prolapse and prolapse

Anatomical defects of the pelvic floor that develop as a result of:

damage to the pelvic floor muscles;
birth injuries - when applying obstetric forceps, vacuum extraction of the fetus or removing the fetus by the buttocks;
previous surgical operations on the genital organs (radical vulvectomy);
deep perineal lacerations;
disturbances of the innervation of the genitourinary diaphragm;
congenital malformations of the pelvic area;
estrogen deficiency developing during menopause;

Risk factors for the development of uterine prolapse and its subsequent prolapse include multiple births in history, heavy physical labor and heavy lifting, advanced and senile age, heredity, increased intra-abdominal pressure caused by obesity, abdominal tumors, chronic constipation, and cough.

Often, the interaction of a number of factors plays a role in the development of uterine prolapse, under the influence of which the ligamentous-muscular apparatus of the internal organs and the pelvic floor weakens. With an increase in intra-abdominal pressure, the uterus is forced out of the pelvic floor. Prolapse of the uterus entails displacement of anatomically closely related organs - the vagina, rectum (rectocele) and bladder (cystocele). Rectocele and cystocele enlarge due to internal pressure in the rectum and bladder, which causes further prolapse of the uterus.

Symptoms of prolapse and uterine prolapse

If left untreated, uterine prolapse is characterized by gradual progression of displacement of the pelvic organs. In the initial stages, uterine prolapse is manifested by nagging pain and pressure in the lower abdomen, sacrum, lower back, sensation of a foreign body in the vagina, dyspareunia (painful sexual intercourse), and the appearance of leucorrhoea or bloody discharge from the vagina. A characteristic manifestation of uterine prolapse is changes in menstrual function such as hyperpolymenorrhea and algomenorrhea. Often, when the uterus prolapses, infertility is noted, although pregnancy cannot be ruled out.

Subsequently, the symptoms of uterine prolapse are joined by urological disorders, which are observed in 50% of patients: difficulty or frequent urination, development of the symptom of residual urine, congestion in the urinary organs and subsequently infection of the lower and then upper parts of the urinary tract - cystitis, pyelonephritis develop , urolithiasis disease . Long-term progression of uterine prolapse leads to overstretching of the ureters and kidneys (hydronephrosis). Often, downward displacement of the uterus is accompanied by urinary incontinence.

Proctological complications with prolapse and uterine prolapse occur in every third case. These include constipation, colitis, fecal and gas incontinence. Often it is the painful urological and proctological manifestations of uterine prolapse that force patients to turn to related specialists - a urologist and proctologist. With the progression of uterine prolapse, the leading symptom becomes a formation independently detected by the woman, protruding from the genital slit.

The protruding part of the uterus has the appearance of a shiny, matte, cracked, raw surface. Subsequently, as a result of constant trauma when walking, the protruding surface often ulcerates with the formation of deep bedsores, which can bleed and become infected. When the uterus prolapses, circulatory disturbances in the pelvis develop, the occurrence of congestion, cyanosis of the uterine mucosa and swelling of adjacent tissues.

Often, when the uterus is displaced below physiological boundaries, sexual activity becomes impossible. Patients with uterine prolapse often develop varicose veins, mainly of the lower extremities, due to impaired venous outflow. Complications of uterine prolapse and prolapse can also include strangulation of the prolapsed uterus, bedsores of the vaginal walls, and strangulation of intestinal loops.

Diagnosis of uterine prolapse and prolapse

Uterine prolapse and prolapse can be diagnosed by consulting a gynecologist during a gynecological examination. To determine the degree of uterine prolapse, the doctor asks the patient to push, after which, during vaginal and rectal examination, he determines the displacement of the walls of the vagina, bladder and rectum. Women with displacement of the genital organs are registered at the dispensary. It is mandatory for patients with such uterine pathology to undergo colposcopy.

In cases of prolapse and prolapse of the uterus, requiring organ-preserving plastic surgery, and with concomitant diseases of the uterus, additional examination methods are included in the diagnostic complex:

hysterosalpingoscopy and diagnostic curettage of the uterine cavity;
ultrasound diagnostics of the pelvic organs;
taking smears for flora, degree of vaginal cleanliness, bacterial culture, and also to determine atypical cells;
urine culture to exclude urinary tract infections;
excretory urography to exclude urinary tract obstruction;
computed tomography to clarify the condition of the pelvic organs.

Patients with uterine prolapse are examined by a proctologist and urologist to determine the presence of rectocele and cystocele. They assess the condition of the sphincters of the rectum and bladder to identify gas and urinary incontinence under stress. Prolapse and prolapse of the uterus should be distinguished from uterine inversion, vaginal cyst, newborn myomatous node and differential diagnosis should be carried out.

Treatment of uterine prolapse and prolapse

When choosing treatment tactics, the following factors are taken into account:

The degree of prolapse or prolapse of the uterus.
The presence and nature of gynecological diseases accompanying uterine prolapse.
The need and possibility of restoring or maintaining menstrual and reproductive functions.
Patient's age.
The nature of dysfunction of the sphincters of the bladder, rectum, and colon.
The degree of anesthetic and surgical risk in the presence of concomitant diseases.

Taking into account the combination of these factors, treatment tactics are determined, which can be either conservative or surgical.

Conservative treatment of uterine prolapse and prolapse

When the uterus prolapses, when it does not reach the genital slit and the functions of adjacent organs are not impaired, conservative treatment is used, which may include:

physical therapy aimed at strengthening the muscles of the pelvic floor and abdominal muscles (Kegel exercises, according to Yunusov);
estrogen replacement therapy, which strengthens the ligamentous apparatus;
local introduction into the vagina of ointments containing metabolites and estrogens;
transferring a woman to lighter physical work.

If it is impossible to carry out surgical treatment for prolapse or prolapse of the uterus in elderly patients, the use of vaginal tampons and pessaries, which are thick rubber rings of various diameters, is indicated. The pessary contains air inside, which gives it elasticity and firmness. Once inserted into the vagina, the ring creates support for the displaced uterus. When inserted into the vagina, the ring rests against the vaginal vault and fixes the cervix in a special hole. The pessary should not be left in the vagina for a long time due to the risk of developing bedsores. When using pessaries to treat uterine prolapse, it is necessary to perform daily vaginal douching with chamomile decoction, solutions of furatsilin or potassium permanganate, and see a gynecologist twice a month. Pessaries can be left in the vagina for 3-4 weeks, followed by a break for 2 weeks.

Surgical treatment of uterine prolapse and prolapse

A more effective radical method of treating uterine prolapse or prolapse is surgery, the indications for which are the ineffectiveness of conservative therapy and a significant degree of organ displacement. Modern surgical gynecology for uterine prolapse offers many types of surgical operations that can be structured according to the leading feature - anatomical formation, which is used to correct and strengthen the position of organs.

The first group of surgical interventions includes vaginoplasty - plastic surgery aimed at strengthening the muscles and fascia of the vagina, bladder and pelvic floor (for example, colpoperineolevatoroplasty, anterior colporrhaphy). Since the muscles and fascia of the pelvic floor are always involved in the prolapse of the uterus, colpoperineolevatoroplasty is performed in all types of operations as a main or additional stage.

The second large group of operations involves shortening and strengthening the round ligaments supporting the uterus and fixing them to the anterior or posterior wall of the uterus. This group of operations is not as effective and produces the greatest number of relapses. This is explained by the use of the round ligaments of the uterus, which have the ability to stretch, for fixation.

The third group of operations for uterine prolapse is used to strengthen the fixation of the uterus by suturing the ligaments together. Some operations in this group deprive patients of their ability to bear children in the future. The fourth group of surgical interventions consists of operations with fixation of displaced organs to the walls of the pelvic floor (sacral, pubic bone, pelvic ligaments, etc.).

The fifth group of operations includes interventions using alloplastic materials used to strengthen ligaments and fix the uterus. The disadvantages of this type of operation include a significant number of relapses of uterine prolapse, alloplast rejection, and the development of fistulas. The sixth group of operations for this pathology includes surgical interventions leading to partial narrowing of the vaginal lumen. The last group of operations includes radical removal of the uterus - hysterectomy, in cases where there is no need to preserve reproductive function.

Preference at the present stage is given to combined surgical treatment, which simultaneously includes fixation of the uterus, vaginal plastic surgery, and strengthening of the ligamentous-muscular apparatus of the pelvic floor using one of the methods. All types of operations used in the treatment of uterine prolapse or prolapse are performed through vaginal access or through the anterior abdominal wall (abdominal or laparoscopic access). After the operation, a course of conservative measures is required: physical therapy, diet therapy to eliminate constipation, and avoidance of physical activity.

Prevention of uterine prolapse and prolapse

The most important preventive measures for uterine prolapse and uterine prolapse is adherence to a rational regimen, starting from the girl’s childhood. In the future, it is necessary to strictly adhere to legislation in the field of women's labor protection, to prevent heavy physical work, lifting and carrying weights over 10 kg.

During pregnancy and childbirth, the risk of genital displacement increases. In the development of uterine prolapse, not only the number of births plays an important role, but also the correct management of pregnancy, childbirth and the postpartum period. Properly provided obstetric care, protection of the perineum, avoidance of protracted labor, and selection of the correct delivery method will help to avoid future troubles associated with uterine prolapse.

Important preventive measures in the postpartum period are careful comparison and restoration of perineal tissue, prevention of septic complications. After childbirth, in order to prevent uterine prolapse, it is necessary to perform gymnastics that strengthens the muscles of the pelvic floor, abdominal muscles, and ligaments; in cases of traumatic labor, prescribe laser therapy and electrical stimulation of the pelvic floor muscles. In the early postpartum period, heavy physical activity is contraindicated. If women are prone to constipation, a diet aimed at preventing constipation is recommended, as well as special therapeutic exercises.

Particular attention should be paid to the prevention of uterine prolapse and prolapse during the premenopausal period: limit excessive physical activity, engage in therapeutic and preventive exercises and sports. An effective way to prevent uterine prolapse during menopause is to prescribe hormone replacement therapy, which improves blood supply and strengthens the ligaments of the pelvic organs.

When the vagina prolapses, one of its walls hangs into the vaginal lumen. Due to the fact that the bladder is located in front of the vagina, when its front wall hangs down, the bladder also begins to descend. This condition is called cystocele. The rectum is located behind the vagina, so when the posterior wall of the vagina prolapses, prolapse of the rectal wall, or rectocele, is also observed.

When the uterus prolapses, it moves downwards, and with severe prolapse, the uterus may even “fall out” of the vagina. Of course, when we talk about “prolapse,” we do not mean that the uterus will suddenly tear away from the body and fall to the floor. Despite everything, the uterus remains securely attached to the body, but when the uterus prolapses, it begins to “peek out” from the vagina.

Why does prolapse of the vagina and uterus occur?

Normally, the pelvic organs (ovaries, fallopian tubes, uterus, vagina, bladder and rectum) are supported in a suspended state by the muscles and ligaments of the pelvis, which in turn are attached to the skeleton. The design is quite complex, and a separate lecture on anatomy can be devoted to the structure of the pelvic floor (the structure that holds all the listed organs in their proper place). But we will not go into details, it is enough just to understand that the vagina and uterus occupy the place that is allocated to them by nature for a reason, but thanks to the muscles and ligaments of the pelvis.

With age, the tone of the pelvic floor muscles decreases significantly, and the ligaments can stretch, so during menopause prolapse of the vagina or uterus is often observed. Among other things, the decrease in estrogen levels in the blood, observed with, also promotes relaxation and stretching of ligaments.

Who can develop vaginal and uterine prolapse?

An increased risk of genital prolapse during menopause is observed if:

The woman has given birth many times or had multiple pregnancies (twins, triplets, etc.)
Are overweight or obese.
Frequent constipation is observed.
There is a chronic cough (chronic bronchitis, bronchial asthma).
The woman smokes.
There is a dysfunction of the liver with accumulation of fluid in the abdominal cavity (ascites).
There is a pronounced enlargement of the spleen.
A woman lifts weights.

Does prolapse occur without symptoms?

It happens, and even more than that: in most cases, in the early stages of vaginal and uterine prolapse there are no symptoms. There is no need to doubt the correctness of the diagnosis if the gynecologist has discovered prolapse and you have no signs of this disease.

How does prolapse of the vagina and uterus manifest?

Sensation of a foreign body in the vagina, as if there is a small ball deep in the vagina.
Dull pain in the lower abdomen.
Feeling as if something is falling out of the vagina.
Difficulty walking.
Difficulty urinating and defecating.

With a cystocele (prolapse of the bladder wall), symptoms such as frequent urination, urinary incontinence, involuntary urination, and urinary retention may appear. .

With a rectocele (prolapse of the rectal wall), difficulties arise during bowel movements, when it is necessary to exert more effort than before to empty the intestines.

What are the degrees of uterine prolapse?

1st degree of uterine prolapse: the cervix is not above the vagina, as it should be normally, but descends into the vagina.

2nd degree of uterine prolapse: the cervix descends towards the entrance to the vagina.

Stage 3 uterine prolapse: the cervix “peeks out” from the vagina.

4th degree of uterine prolapse: the entire uterus “peeks out” from the vagina. This condition is also called uterine prolapse.

What tests are needed?

The diagnosis of genital prolapse can be made during an examination by a gynecologist. The doctor will examine you in a lying and standing position. Because vaginal or uterine prolapse becomes more noticeable as intra-abdominal pressure increases, your doctor will ask you to cough or strain.

The gynecologist may also order the following tests:

Ultrasound of the uterus
If there is a problem with the functioning of the bladder, the doctor will prescribe an ultrasound or x-ray of the kidneys
General urine analysis

What to do if the vagina or uterus prolapses?

Vaginal or uterine prolapse does not always need to be treated. If you do not feel any symptoms, nothing bothers you, and the gynecologist finds slight or moderate prolapse, then no treatment is prescribed. The gynecologist will recommend several exercises that strengthen the muscles and ligaments of the pelvis, and recommend that you return for a re-examination in 6-12 months.

If you have symptoms of prolapse, you will need treatment: some you can do at home, and some your doctor can do.

What can you do at home?

If you have detected prolapse of the walls of the vagina or uterus, listen to the following advice from gynecologists:

Avoid standing for long periods of time. If this is unavoidable (for example, you need to stand in line), it is better to take a leisurely walk or sit down.
Before getting up from a chair or lifting anything, take a breath, tense your pelvic muscles (as if trying to hold in gases), pull in your stomach a little and slowly exhale to perform the desired action.
Avoid constipation. If you have frequent constipation, consult a gastroenterologist: until you get rid of constipation, prolapse of the vagina or uterus cannot be cured.
During bowel movements, you should not strain or push too hard. If you have difficulty defecating, as you exhale, “inflate” your stomach so that it becomes round and say “shhh”, but do not hold your breath. Allow enough time to go to the toilet so that you are not in a rush, but you should not spend more than 15 minutes on the toilet. If you are unable to have a bowel movement within 15 minutes, try again later.
If you are overweight, you need to get rid of it.
Do Kegel exercises. .

What can a doctor do?

If the vagina or uterus prolapses, conservative treatment (pessaries and hormone replacement therapy) or surgery may be prescribed.

Pessary

Your gynecologist may recommend wearing a special device that supports your uterus and prevents it from falling below a certain level. Such devices are called "pessaries", or simply uterine rings (although there are other forms of pessaries, not just in the form of rings).

If the gynecologist believes that you can remove and install the pessary yourself, he will teach you how to do it correctly. In some cases, the pessary must be worn constantly, in other cases it will need to be removed before going to bed. If there is slight prolapse of the vagina or uterus, the pessary will need to be installed only before long walks, physical activity, etc.

A pessary does not cure uterine prolapse, but it can help relieve the symptoms of the condition and make your life much easier.

Hormone replacement therapy with estrogen

Surgery for prolapse of the vagina and uterus

If conservative treatment does not help, or there is grade 3-4 uterine prolapse, then surgery is prescribed. The operation can be performed through an incision in the abdomen or through the vagina.

During the operation, the doctor can install a special implant - a structure that will hold the pelvic organs where they should be normally. In some cases, the gynecologist may recommend removing the uterus. It is available on our website.

After surgery, you will not be able to lift anything heavy for at least 6 weeks, and for another 3 months you should avoid any situations that increase genital prolapse: constipation, coughing, smoking, weight gain.

How to prevent prolapse of the vagina and uterus during menopause?

Maintain a normal weight for your height.
Eat right to avoid constipation.
Do Kegel exercises.
Do not lift heavy objects (more than 5 kg).

The ovaries are a paired organ of the female reproductive system in which the maturation of eggs and the synthesis of sex hormones occur. A woman’s well-being, appearance and health largely depend on their work. The production of small amounts of hormones occurs in the ovaries throughout life, and their peak activity occurs during childbearing age, which lasts on average 35-37 years.

Afterwards comes menopause - the natural decline of female reproductive function. Such changes do not happen to a woman by chance. With age, not only the body ages, but also the genetic material transmitted with the egg to the offspring. Age-related changes in germ cells lead to numerous errors in DNA, which often results in serious illnesses for the child. Thus, the frequency of birth of a baby with Down syndrome increases exponentially after 40 years.

Ovarian wasting syndrome is a pathological condition in which a woman’s menopause occurs much earlier than the aging process. It usually occurs before the age of 40 against the background of normal reproductive function. The syndrome is rare - according to statistics, its prevalence in the population does not exceed 3%. Hereditary transmission of ovarian wasting syndrome is observed: in most cases, there are indications of similar problems in the mother or immediate blood relatives.

Causes of pathology

To date, there is no consensus on the cause of premature ovarian failure syndrome. The only known consequence is a sharp cessation of follicle maturation and, accordingly, the synthesis of sex hormones. During the prenatal development of a girl, a strictly defined number of primordial follicles are formed in her gonads and on average it is 400 thousand. After birth and until puberty, they are in an inactive state, since their maturation requires a signal from the outside - hormones of the hypothalamus and pituitary gland.

The listed structures are located in the brain and are responsible for the functioning of the endocrine glands of the body like a conductor. At the time of puberty, the amount of GnRH increases, which, in turn, stimulates the synthesis and release into the blood of follicle-stimulating (FSH) and luteinizing hormones (LH). Under their influence, the growth of primordial follicles begins inside one of the ovaries. From 5 to 15 vesicles develop at the same time, but only one of them will reach final maturity and release an egg during ovulation. As it develops, structures are formed that synthesize female sex hormones - estrogens.

During ovulation, the follicle bursts, the egg is released into the fallopian tube, and the membrane remaining from the vesicle is transformed into the corpus luteum. The latter synthesizes progesterone, the pregnancy hormone. Under its influence, the female body prepares to conceive and bear a child. The described processes are also controlled by hormones of the pituitary gland and hypothalamus according to the type of negative feedback. This means that with a high level of estrogen or progesterone in the blood, the production of FSL and LH is suppressed, the ovaries reduce the activity of the synthesis of their own hormones and the endocrine balance in the body is restored.

As already mentioned, the supply of primordial follicles is established during intrauterine development and is not replenished throughout life. Therefore, after each menstrual cycle it decreases and as soon as it reaches a certain minimum, the woman experiences menopause. On average, the ovarian reserve lasts up to 45-55 years of life. Early ovarian failure syndrome has the same morphological basis - the number of follicles is insufficient to further maintain reproductive function, however, it occurs much earlier than the specified age.

Among the provoking factors of the syndrome are:

genetic defects - in women whose mothers suffer from this pathology, it develops much more often than average;
negative factors affecting the prenatal development of a girl - maternal illness, severe psycho-emotional stress during pregnancy, poisoning, trauma disrupt the process of formation of primordial follicles in a female fetus, and therefore their number can be sharply reduced compared to the norm;
resection of the ovary during surgery to remove a tumor or gonadal cyst - a sharp decrease in the amount of ovarian tissue sometimes leads to premature depletion of the ovaries and menopause;
the influence of unfavorable environmental factors (poisons, toxins, viral infections, medications) - affecting ovarian tissue, they lead to an inflammatory process, as a result of which functional cells are replaced by connective tissue.

Manifestations

The symptoms of ovarian wasting syndrome are identical to those of menopause. First of all, a woman pays attention to the irregularity of the menstrual cycle. Menstruation does not occur every month, becomes scanty and gradually disappears altogether. Against this background appear:

Hot flashes and sweating - they occur suddenly, usually at night, after stress, heavy food, or a change in ambient temperature. The woman suddenly gets hot, she sweats profusely, the skin of her face and upper chest turns red. There may be a feeling of palpitations, pain in the chest, darkening of the eyes and a short-term loss of consciousness.
Changes in psycho-emotional status - a woman becomes irritable, tearful, and prone to depressive thoughts. Any existing mental abnormalities are aggravated, be it manic-depressive psychosis, psychopathy, or depression. Night sleep is disturbed, anxiety appears, and libido decreases.
Disorders in the urogenital tract - a lack of estrogen with depleted ovaries leads to atrophy of the mucous membrane of the vagina and vulva, a feeling of dryness, itching in the genitals and urethra, chronic inflammatory processes (colpitis, vulvitis, urethritis). Sex life becomes unpleasant due to dryness and burning during intercourse.
Skin aging - in the presence of ovarian depletion syndrome, it loses its elasticity, becomes thinner, and numerous wrinkles appear on the face and hands. Hair becomes dull, brittle, dry, and its density decreases due to excessive hair loss. Nails change: the nail plate peels off, grooves, irregularities, and white spots appear on it.
Metabolic disorders - the concentration of other hormones in the blood changes. There may be insufficiency of the thyroid gland or its excessive activity, leading to thyrotoxicosis. The latter is manifested by hand tremors, anxiety, outbursts of anger, palpitations, increased blood pressure and body temperature. In some cases, type 2 diabetes mellitus, metabolic syndrome, and hyperadrogenism develop—a partial change in a woman’s body into a male pattern due to the predominance of testosterone.

Without appropriate treatment, the symptoms of ovarian wasting syndrome progress, complicating a woman’s life and disrupting her activity.

Necessary research

Diagnosis of the syndrome is within the competence of a gynecologist, gynecologist-endocrinologist. The doctor collects anamnesis, paying special attention to heredity and harmful factors. He studies the complaints, the time of their appearance and examines the patient. Externally, the woman looks older than her age; age-related changes in her skin and hair are visible. When examined in a chair, the doctor reveals a decrease in the size of the uterus and its appendages, and dryness of the vaginal mucosa.

To clarify the diagnosis, hormonal blood tests are performed, which reveal:

increased levels of FSH and LH;
insufficient concentration of estrogen and progesterone;
low levels of prostaglandin E2.

Since only ovarian function suffers, the hypothalamic-pituitary system adequately responds to a decrease in sex hormones by increasing its activity. A trial administration of estrogen-gestagen drugs reduces the level of FSH and LH down to normal, causing the appearance of a menstrual-like reaction.

Among the imaging methods, ultrasound of the uterus and its appendages is used, during which the following is revealed:

reduction in the size of the uterus;
thinning of the endometrium to 0.5 cm or less;
a decrease in the size of the ovaries, the absence of large maturing follicles in them.

One of the reliable ways to diagnose early ovarian failure syndrome is. The surgeon observes small, wrinkled ovaries in the pelvic cavity, without signs of ovulation. During the examination, the doctor takes a small piece of gonadal tissue for cytological examination - biopsy. The resulting material is studied in the laboratory, the replacement of ovarian connective tissue and the absence of maturing follicles are revealed.

Therapy

The only possible treatment for ovarian wasting syndrome today is hormone replacement therapy. Its essence is to maintain normal hormonal levels by introducing female sex steroids from the outside. In rare cases, such measures lead to spontaneous restoration of reproductive function.

The gynecologist’s task is to select the optimal drug that will reliably reproduce the cyclical fluctuations in hormone concentrations in a woman’s body. For this purpose, oral contraceptives containing estrogen and progesterone are used, for example Femoden, Marvelon, Regulon, Novinet. They should be taken under the supervision of a gynecologist with laboratory monitoring of a biochemical blood test. They are prescribed for the period until the onset of physiological menopause, that is, up to 45-50 years.

Possibility of pregnancy

The main question that worries childless women: is pregnancy possible with ovarian wasting syndrome? It is impossible to get pregnant naturally, since there are no mature eggs necessary for conception and the corpus luteum does not form in the ovary. The only way to become a mother with ovarian wasting syndrome is. The procedure uses a donor egg and sperm from a partner. A woman is prepared for pregnancy with increased doses of progesterone: under its influence, the endometrium reaches sufficient thickness for implantation of the embryo.

Throughout pregnancy, the patient takes hormonal medications that simulate normal ovarian function. If it is impossible to prepare her body for pregnancy, they resort to surrogacy.