Dr. Valdés: Today we are here at Creafam to introduce you to our doctor, the Psychologist Adriana González Piña, she is a clinical sexologist and in sexual health, she studied at the University of Barcelona and today she is with us, so that Please know that we are here with the support of our patients, which can be in person or via video call. We are very happy to have or count on the doctor who is now going to be part of the Creafam Puebla group.

Psych. González: Well, I am happy to be here, in addition to being here with all of you and also in the Creafam family, to be able to give both psychological and sexological support to all the procedures, which are wonderful, that are done here.

Dr. Valdés: Today, in addition to introducing the doctor, we are here because this week we had a surgery that was aimed at a myomectomy, but the patient ended up with a hysterectomy, that is, we had to remove her uterus for some time. medical issues and indications. But in addition to talking a little about the importance of the hysterectomy, we also wanted to see the behind the surgical aspect, that is, the emotional aspect, the physical and mental aspect of the patient post surgery and also talk a little about some myths, some fears that exist in the information or misinformation about hysterectomies. Remember that at Creafam #KnowledgeIsSuccess

Psych. González: On the one hand, world institutions propose that 1% of women will undergo this type of surgery, but then we look in other types of places and it seems that approximately one in every 5 women will be having a hysterectomy throughout their life, then this type of data is quite strong also because this psycho-emotional part has not been considered in the face of this type of treatments, which seem to be not so relevant, but in reality they are occurring continuously . All of the above serves to tell you, woman who has been going through what you are possibly going to go through in a type of surgery of this type, that you are not alone, there are many women who are also experiencing the same thing as you. I would like to ask you in which cases a hysterectomy is inevitable or in which cases it is also preferable to perform this type of surgical practice.

Dr. Valdés: Be careful! Removing a uterus is not such a simple decision for the doctor either and generally has a medical indication and especially health and prognosis for the woman, so rather talk to your doctor before surgery and make the decision to have a hysterectomy. because yes, what are my contraindications, what are my risks and what will happen after they remove my uterus. An example, the hysterectomy that we just performed was on a young woman, relatively 45 years old, I think, fortunately already with children, but she had been told that she had a fibroid, she was very afraid and stopped going to the doctors until she was completely diagnosed. tumor reached above the umbilical scar. She could already cause problems even for her routine life, that is; She jumped, moved, walked and felt the ball as she moved from one side to the other, so we had to remove this patient’s uterus. The uterus weighed 4 kilos 200g. That is to say, it was a tumor that was too large, with significant blood sequestration and, yes, it was a complicated surgery, fortunately everything went well, but these types of surgeries are the ones that have risk both for future life and for recovery. It cannot be immediate, much less as easy as a woman who has a 12cm uterus removed from whom you have a 35cm uterus removed.

It is very important to know that there are several types of hysterectomy, that is, the abdominal hysterectomy, which can be open or laparoscopic, there is the vaginal hysterectomy, there is the partial hysterectomy and there is the obstetric hysterectomy. Each one has very important connotations. The least common is obstetric hysterectomy. What does it mean? During a birth process or cesarean section, the uterus does not contract well due to some history, perhaps the patient already had surgery for fibroids, or perhaps she already had four babies or three surgeries and then, the uterus begins to bleed and when this stops Yes, we cannot recover that contractility of the uterus, since we need to remove the womb or uterus in the event of a cesarean section or postpartum. This type of surgery is one of those with the highest risk of mortality and obviously morbidity in the patient, because the bleeding is very profuse, very abundant and we have to react very quickly, let’s say that the indication or the decision has to be made in minutes or seconds, to such a degree that they are fortunately the least frequent, but this can occur in more or less one of every two hundred cesarean section or childbirth surgeries and you must always be present and aware that it can be an inherent complication of a labor. childbirth or cesarean section.

Then come the hysterectomies that the vast majority of patients have, these are patients who are already in the final phase of their reproductive life, called perimenopausal or already climacteric and who perhaps begin to have hemorrhages or frequent bleeding and they are treated, They give medications and there is no real or satisfactory improvement for the patient and then they opt for the easiest thing, which is “Well, remove my uterus. And with that, my bleeding problems are over?” Yes, the truth is that it is one of the hysterectomies that are most frequently performed and there is a third group that is no less negligible, which is the one that is indicated by some cancer process, called ovarian cancer, called cervical cancer and/or less cases, endometrial cancer, those are the least frequent, but they are also… Let’s say the easiest to do, that is, if I have a patient who has already had a reproductive life, already has satisfaction, already has children and then They detect cancer in situ or initial cancer, many times they say “Well, let’s remove the uterus and with that we will solve the problem.” I believe that they are the one that would be the most precise or easiest indication to make from the obstetric or gynecological point of view and that of the woman, however, as I tell patients, other aspects must be evaluated.

It is not the same to remove a uterus from a woman who has already had satisfied parity, who is 42 years old.

And they were diagnosed with cancer in situ or cancer 1a, 1b or 2 and then there are no cases of preserving the uterus, however, there are also those who detect cervical cancer and they are young women of 32, 34 years old and nothing more They have a baby. So, I believe that, as we have always said, in a multidisciplinary manner, the gynecologist, the oncologist and even the gynecologist-oncologist will decide if that patient has the advantages of preserving the uterus or not, however, abdominal hysterectomy, at least in some Reports from 2006 at the National Institute of Perinatology speak of up to 17% of hysterectomies. We who call ourselves reproduction, as I always tell the patient, are more reluctant to remove the uterus, for one simple reason: Because it is the only way to have a pregnancy, even if they do not have ovaries or if they do have ovaries. .

Now, vaginal hysterectomy, which is one of the least frequent or is becoming less and less, is for patients who were multi-parity, that is, they had many babies per birth, which is one of the main consequences or sequelae of multiple births, that sometimes the wall of the vagina tends to fall and fall and then the uterus at ages 60 to 65 due to the same laxity of the tissues because that uterus comes out through the vagina which is a protrusion, so these types of hysterectomies are also frequent, but they are simpler because it is not an abdominal approach but through the vagina itself you remove the uterus, they are smaller uteruses, which is not an indication of bleeding or tumors or cancer, so what is the advantage or importance of knowledge? Well, first you have to see what approach the hysterectomy is. Why do you have to do a hysterectomy? and third, always, that sometimes doctors do not take this into consideration… We should always be accompanied by psychological support because what is true, it has been shown that more or less 5% or up to 20% of Patients who have received a hysterectomy, whether they are young or late patients, always have psychological repercussions.

The patient feels like a kind of amputation and we have to see what repercussion it has psychologically, emotionally and most importantly also sexually, you who are an expert in this, because it is true that when we do a hysterectomy, whether it is called vaginal or abdominal, the recovery can be more torpid or faster but you also have to look at the healing, on many occasions patients have pain in relationships called “dyspareunia” and that sometimes affects a relationship that apparently was normal before.

Psych. González: I find all these differences incredible because notice that the approach or the sexual psycho-emotional impact that it can have will depend a lot on the type of procedure that is being done and why it is being done, it is not the same double news, right? ? “You have cancer and in addition to the cancer we have to remove your uterus” then, also in the fact that I am giving birth and at that moment well out of nowhere it turns out that I already came out without a womb, right? So, I think that each of these processes requires a theme of grief, which I think is something very important on a psycho-emotional level, being able to go through grief, the loss of a part of your own body, but also sexual functionality. , even gender. Because many times they have been educating many of us women and I already talk about this from the sexual side, that your sexuality is linked to reproduction and then the moment you take away my uterus and as you said a moment ago No? Well, it seems that my reproductive possibility is lost and many times women fall into a very strong depression. Here I am also talking about psychiatric disorders, which are not just sadness and mourning. When grief is not resolved, it can bring about possible depression, whether mild, moderate, or in many cases it can also go deep and very serious. This type of depression also has to be treated and worked on, because if this stage of grief is not accompanied, then those are the possibilities that are going to bring greater complications, not only on an individual level, here I already see it on a relational level. . On the one hand, depression when you are in a relationship with someone as a couple will also begin to bring many complications and depression in itself will also bring complications in the sphere of sexuality, that is, in enjoyment, in enjoyment, something that greatly characterizes depression is this as a loss of desire for pleasure, of activities that we like, low energy. This whole part also begins to limit our psycho-emotional, relational and sexual life, so these types of procedures, in addition to being shocking due to the simple physical fact and its recovery itself, will also bring up issues on a psycho-emotional level.

A little while ago you were saying about the dyspareunia part, which I think is a very important point in many of the times when this type of interventions are done. Practically 80% of women feel pain after childbirth when having intercourse, something that is often not reported in gynecology. They tell them “quarantine and you can start again” but of course, there is prolactin that is lowering desire, the ability to arouse us begins to be much more diminished and that lack of lubrication, plus physical recovery brings us a lot of problems and what? is what is going to end up happening? That I am going to flee from the pain! Because this is also our mental structure: “If something hurts me, I’m going to run away” and what I’m going to start doing is avoiding and what starts to happen? That the couple begins to separate and this type of relationship that could be through sexuality a part of bonding, of joy, of enjoyment ends up being like two strangers and then I no longer even know how to approach you. I talk about this in pregnancy and post-pregnancy, but in the hysterectomy something very similar is going to happen because on the one hand I have the grief I carry, plus the pain in the recovery and this part of the dyspareunia is going to bring complications on a sexual level especially. everything in the desire, in the excitement and until this issue of pain is recovered, because sexual relations are the worst thing that can happen to you. How does this begin to affect the couple? Look! The woman’s self-esteem begins to be greatly affected, one, the body image begins to be this part of the “amputated limb” that you said, it begins to be like a mourning, I don’t feel myself, I don’t feel in my own body and This part of body image also begins to generate shame when showing oneself sexually with partners, it begins to be a shame of showing my body and also of being a woman, right? Because they are taking away a part of you that has taught you throughout history that this is your function, that your womb and that reproductive performance is the function of a woman. Yes, it is one of the functions, but it is not the whole and then, when we are too focused on this, a hysterectomy becomes an issue of gender identity, it becomes an issue of eroticism in terms of the couple and also a issue of possible reproductive duel depending on each of the stages.

In terms of the hysterectomies that you mentioned that already have more to do with the climacteric, there are also many modifications that are made here, on the one hand there is the loss of this identity as a woman but there is also another loss that is at the h level. hormonal, because that also generates difficulties at a physiological level and starting to incorporate these two sometimes becomes too difficult for women to manage, many times and I always use my grandmother as an example saying “There is a little girl, and to me age, why am I going to have this type of sexual relations or this type of encounter? And I don’t just hear these types of comments in the climacteric part or in people who are entering menopause, but I have also reached it to hear in people who have lost or had part of their uterus removed… “Since my reproductive life is no longer there, well I need to stay, I have already lost meaning” and what I have encountered a lot is a loss of meaning, an existential crisis even due to confronting one’s own identity in order to resolve it. So, I believe that all these aspects that I am mentioning both at a sexual level and at a psychological level make it extremely important to be able to provide psychological, psychotherapeutic and sexological support to through this type of procedures, not only to prepare for surgery, but also to accompany the post-surgery process that has to do with all these twenties that are falling on us and that we are trying to digest little by little, because we are already in that situation.

Dr. Arturo Valdés: What function or what role would be that of the couple, that of the husband? because sometimes, as you say, there is that little rejection, that sexual dysfunction between the couple. From the man, what would be indicated or how could he participate or help?

Psych. González: Any medical or psychotherapeutic treatment, when the partner is there and supportive, the results are abysmal between going alone and being accompanied. So, I think what attitude can the couple take? You can take an attitude: 1 understanding. I think that one of the main points that we need is to inform ourselves, many times that lack of information that we have about how you are going to react, that it is normal that you are grieving, what emotions are normal that you are having through grieving? Which can be sadness, anger, anguish, fear, right? If I put them there, being able to validate these emotions in the grieving process I think is a fundamental part that as couples we need: Accompanying, understanding and validating, on the other hand, the information about how the woman’s body is going to react and Above all, what type of situations is needed, here I believe that the communication between the couple about the needs, about certain requests for support and at this moment above all also this part of containment, of affection that there may be and that they can bring that closer. Support can help a lot, especially in these types of procedures.

I also think that something very important is to be with a “Floating Attention” that’s what I call it, that is: I understand that you are in your grief, I am validating it but I am also going to be attentive to see if at some point I start to I see that this grieving thing is starting to last too long and I’m starting to see that your symptoms are no longer just grieving… There’s a lot of irritability, you’re starting to see everything in a super negative way, I’m already feeling a sense of hopelessness both in the couple and in yourself, because then I feel that it is like a bit of alarm and being able to see that they may already be falling into another type of situation, already of a psychiatric type that we could accompany or realize and be able to address . So, if I summarize it: Information, understanding, validation, support and being able to be attentive to resolving certain types of conflicts through communication, those would be the points that I would leave for couples.

Dr. Arturo Valdés: Patients then tell me: How long will it take me to recover? When can I return to my normal physical activity? So, I always say, let’s see, the recovery in one week the patient already has complete healing, at least if it is abdominal of the abdominal wall and the scar, if it is vaginal it is much faster because it is mucosa and obviously we have a month where the patient should not or could not do important physical activities such as running, jumping, jumping and even sexual life depends a little on this physical recovery, but also the emotional part that you mentioned, that is, in my experience what note is: With information the patient knows that in a week he will be at his best in a common routine physical activity and a month to start doing his physical activities if he exercised or ran, jumped, etc.

But the emotional issue, I do believe that it depends a lot, as you say, on the patient’s prior information on how the hysterectomy was approached, that is, if it was something sudden as in an obstetric hysterectomy, obviously the recovery is going to be later and emotionally Much more so if you have to handle it in a psychological way, but when a patient already knows that her uterus is going to be removed, or due to hemorrhages, they often feel relief, like “Well, they already removed it, yes.” Maybe I feel strange, what’s going to happen to my body? But I think the patient is grateful that she no longer has that initial problem for which she went to the doctor and the emotional recovery that you mentioned, yes, sometimes we gynecologists forget, That is to say, I see the patient after a month, I tell her everything very well and I see you in six months, but maybe the patient leaves with that little one of What’s going to happen to me? Am I going to continue being a woman? Will I be able to continue having a sexual life in an adequate way? I think that, as you mentioned, it is a multidisciplinary way of saying, ah well, I noticed that this patient is not 100% convinced of the hysterectomy, maybe send her or refer her to the psychologist and let the psychologist take care of it. of the whole emotional issue, but that they rejoin not only their physical or emotional life, but also sometimes work because they are patients who sometimes stop going to work because they feel like they are singled out, as a matter of fact I am a weirdo … From now on, what is going to happen to my body, what is going to happen to me. There are patients who have told me: “But if I no longer menstruate I will no longer become a woman.”

And that is very important, as much as you say, I mean, they have taught us that equal to woman, equal to menstrual cycles and you have to get ready and you have to get pregnant. I can no longer get pregnant, I no longer have periods, so I am no longer going to become a woman, I can no longer exercise my role in society and that is very important that sometimes we do not see it as gynecologists. So, my question is aimed at: How much time does grieving last or how long is it normal or how long do I have to say, do I have to go to someone because it is already causing me a conflict?

Psych. González: I love that you said that! This differentiation of how the procedure was is brutal and is essential to also be able to determine the time because the type of trauma it can generate, and I speak of trauma because, if in the end it is a trauma because they are taking something away from you and the duels that is Part of what it implies, depending on how it was, is part of what will also begin to be managed in a matter of time. So, the emotional impact that it can have on me, that’s what we’re going to take to be able to determine part of the time.

More than a prolonged period of time that I can say, I would say that whether you are going through the stages of grief or there is a stagnation in some stage of grief, because if there is a stagnation then that is going to be prolonged, it is a prolonged grief because These stages are not being managed, part of the stages is going into shock after denial, hence it is a struggle between sadness and anger. Why did it have to touch me? Why did I have to go through this? Sadness of now what is going to happen. These comments that you were mentioning just now are that I am no longer a woman, now how are they going to see me? This part of the loss is sadness and anger because it’s my turn and then we begin a type of negotiation stage, that is, between this loss plus the anger part we begin to negotiate these two emotions that are taking us to an acceptance of my new role, of my new identity and it begins to help me go through this trauma through an integration of my new self, that is, the new person that I am, with the one I was with the uterus and the one I am today without the uterus as such, so for a while it is very difficult for me to be able to say “No, well after three months that’s it” Right? But I would talk about these stages of grief, knowing that they are dynamic, but knowing that they are moving.

When someone gets stuck in one and the waters are not moving there, that would be a sign that it is happening. Approximately according to statistics in thanatology studies on grief, we say that the approximate time will depend on the type of loss and we are talking about approximately six months. If it is a duel that has to do with a situation where I was not expecting this and you are holding me in a curve, then perhaps it will last a little longer and if it is something that I was already going to opt for surgery because I had already decided and so on, well this can last for about three months while the physical part is recovering as the accompaniment of assuming this new role is being done, even if it brings benefits, well better, right? because then I see the part that benefits me from having had the hysterectomy. So, I would talk about stages of grief or stagnation and not so much a prolonged time.

Dr. Arturo Valdés: Ok, for those who are going to watch this talk and this video, finally Adriana, is there a red light? Because perhaps, as we always say, the patient is not informed, many times we doctors do not have that culture or education of saying “ah well, you go ahead, even if it is just a talk.” What are the red flags that you recommend for patients who already Did you have a hysterectomy? For whatever reason, where we have to say “hey, I need to go to psychological support because this is already happening to me or I’m feeling this.”

Psych. González: Ok, these red flags are going to be linked to grief but also to the part of depression and anxiety, so, if I could put a little red I would put the anxious-depressive symptomatology, which means:

Constant worries that are not in the present, that I can no longer do anything, that is, if I start to catch my partner or I start to catch myself: “So why should I take it away? I shouldn’t have having done this.” Like trying to go back to the past and solve and create alternative stories, these are concerns that are not productive because they do not help us move forward and overcome this part of the situation, but rather they keep us in a type of worry that is causing us discomfort. psycho-emotional and therefore it is also interfering with our well-being and quality of life.

Another type of symptom can be a complete reluctance to do things, in which I lose the desire to do things that I liked or my day-to-day routine is making it very difficult for me to incorporate into everyday life, that can also be another of the symptoms that are there of alarm to say well I need to do something.

Starting to have continuous conflicts with our support networks, both family; sons, daughters in terms of friendships, with the partner, the fact that there is a lot of irritability that is also a red flag that something is happening on a psycho-emotional level. So I could put these three as the most present and also the future ones…
What will happen now that I’m like this? How will people see me? Being too focused on evaluation of other people more than incorporating this new stage of our life can also be another red light that we need to start detecting.

Continuous negative thoughts, which it seems, let’s not evaluate… Of everything I’m thinking during the day, how many of these thoughts lead me to rather negative thoughts? And that they have to do with this situation in a more negative way, then it could also be a good time to decide that I need to go to a psychotherapy process so that it is not biased by the emotional part or the emotional difficulty that I am going through. .

Well, we already talked a lot about the psycho-emotional part. I would also like to know why, how does information save us many times, right? I would like to know how I can prevent a hysterectomy? What do I have to be aware of to be able to detect, well maybe I can do something before reaching that final point, right? That on the one hand and on the other, what symptoms can I begin to detect in myself that possibly they are already telling me that you are probably going to need a hysterectomy?

Dr. Arturo Valdés: Well, this is very interesting to see, it is very similar to what we were talking about before, that is, for me to be able to prevent a hysterectomy it is very difficult to know, but obviously what we have always said in our talks, in our myomectomies mainly is: One knowledge and two education. What does this mean? Well, I have to know if I am well and the only way to have knowledge is not to “suspect” if I am good or bad or if I feel good or bad, because that is really very subjective. I always tell them to look at the annual pap smear, that’s not that it can’t fail, it’s just like breast cancer. How can I prevent breast cancer? Doing scans and the other depending on the age, doing a mammogram with breast ultrasound.

Here it is very easy, I have to go to my gynecologist every year, year after year, whether I am a young woman of 25 years old or an adult woman of 48 or 50 years old. Why? Because since I begin reproductive life I have the possibility of having infections or contracting papilloma viruses or having some alteration, whether called gynecological or called endocrine, then annual check-ups, pap smears without a doubt, colposcopy would be ideal and if not, then accompany a colposcopy depending on one pathology or not cervical and the other is obviously an ultrasound, why? Because hysterectomy, as I mentioned, can also be endometrial cancer, it can also be ovarian cancer, which is fortunately less common. Weight, weight also means that if I have a high weight I have a greater risk of bleeding.

You tell me signs or symptoms, they also go hand in hand, that is, if I am having bleeding that is not regular or that is not normal or that is abundant, then I have to go to the doctor. Why? Well, because one way to prevent a hysterectomy is to have good gynecological health control and the only way you are going to have good gynecological control is by attending your routine periodic consultations year after year with a doctor, because it can be an example: Hey, well yes I’m going to realize when I already have a protrusion, I feel a lump in my vagina, I cough or sneeze and I pee a little bit, I’m already 60 years old and suddenly I noticed… And that’s very common, it’s good that you asked. , because then sometimes the mothers don’t tell their daughters or the grandmothers don’t tell the daughter, or the mother is afraid of “They’re going to take me to the doctor and I don’t want them to do anything to me, it’s more I’m sorry to tell people.” Communicate because it is already something uncomfortable, I am at a party and suddenly there is something there that is in the way, that is very important, you have to do your check-up, if you already felt that you have something that you are not liking, then go to the doctor because if If you let more time pass, it will be even worse and your complications will also be more important. That’s why I tell fibroid patients, hey, I’m bleeding, I go to the doctor and he said I had a 5 or 6 centimeter tumor, I’m afraid to have surgery or attend and then I stopped going for 4 or 5 years and when they come, they There are the videos, they arrive with tumors of 15, 16 centimeters and obviously the surgery is going to be more difficult, more complicated and with many more risks for the patient.

So, the only way to prevent or avoid a hysterectomy is to have routine consultations with your gynecologist and obviously the knowledge of hey this is not normal, the bleeding is not normal, hey I’m already feeling or I’m peeing with very little effort, well from ago to a check-up, then the only way to do that is your gynecological consultation. They tell us like “If you have bleeding that is not regular”, but I am very sure that there are thousands of women out there wondering: And how do I know? How do I know when bleeding is not normal? So, as a matter of practice, how could a woman detect that bleeding is not normal? I say in a menstrual issue, because I understand that if you are not menstruating and you have bleeding, then from there we are seeing that either there is an infection or something is happening. But within menstruation, how do I know if my bleeding is normal, it is not normal. How do I count it? How can I realize it? That is a very good question, look, normally on average a woman should last her menstrual cycles between 3 to 6 or 7 days, but that is not the same as the one that lasts seven days and uses only one or two towels.

Regular during the day, to a woman who says I last seven days, but I use three or four of the towels that are the nighttime ones, which are the ones that in theory absorb a little more…

To give you an idea, between 100ml to 120ml of bleeding during menstruation is considered normal, above that it is no longer normal. An average towel can absorb between 30 to 50 or 30 to 40 milliliters at night. The normal ones are 10 or 15 milliliters of blood. What does that mean? It is also important how many towels you are using, so when would I tell them to “be careful” or pay attention? When my bleeding is very abundant, that is, it is very abundant, I am using more than two nighttime sizes or three a day and I soak them, but they also last seven days, because if it lasts two or three days, there are patients who sometimes have bleeding very profuse but they are short. The other patient “hey, I have spots and it can last ten days” that is not normal, even if they are spots and spots, spots on many occasions are one of the main signs of myomatosis, for example, I mean I am having spots, spots and then it comes my rule is two or three days and that’s it, then they get used to it. They think it’s normal because it’s just a stain. No! If I am having spots, spots and spots and then the bleeding comes, those spots are called metrorrhagia and they also have pathologies. So, the most important thing to your question is 3 to 5 days, 7 at most but the one that lasts seven days you have to see how many towels. If they are regular or the nighttime ones that we are staining and then if that is why I told you, I go to the doctor and he asked doctor is that I use three pads a day at night and for seven days I bleed and bleed and also sometimes when I have bleeding well if I I feel a little tired, I feel fatigued, I can’t do this or anything, she is having a hemorrhage that is causing a temporary anemia and is affecting her daily life. So, if it is important to go to the doctor and consult because you cannot say, ah, if it is five days and they are normal, no, five days is the best, they can be very abundant and cause anemia, then we already have a problem of hemorrhage.

Psych. González: Ok, so in summary I think this is important for all women, sometimes we change them for hygiene because we need to take them out, but when the towel is full that’s when then yes, there are more than three full towels that’s when we have to take action. Especially depending on the towel, I don’t know much about the performance but the night one is very big and if that one soaked it and I’m soaking them for two or three days, then go do a check as well, because maybe it’s normal for those two or You have that bleeding for three days and it’s over, but normally what you mention, if I’m soaking them, they are patients who either have spotting before their period, or they end those three days and the spotting lasts for another three or four days, so you have to do a good gynecological examination an ultrasound, to see if I don’t have polyps, to see if I don’t have submucous fibroids, or another type of fibroid or even to see if it is not a hormonal imbalance because many of the hemorrhages or bleeding are not all fibroids and polyps , the vast majority of them are endocrine alterations, so it is very important to do a gynecological evaluation.

Well, with this we finish and I want to tell you that knowledge is power and that is why we are very interested in listening to each of you. How has your experience been? What elements can you add that have benefited you? How have you also been improving your daily life? And what has this process of going through a hysterectomy also been like?

Dr. Valdés: Tell us on our blog. How did they do it? What was your experience? What did you implement or how did you help each other to move forward? And not just focus on what affected me or how I feel bad, but rather tell us about their experience, what they did to be well and feel better.