Hysterectomy— a surgery to remove the uterus— is one of the most frequently conducted major surgeries among women worldwide, especially in developed countries. It is a common treatment for a variety of conditions that affect a woman’s reproductive organs; while there is limited data available to compare from earlier, it’s widely believed that the number of hysterectomies is also increasing in developing countries. India is no exception.
A new study from India puts the country-wise prevalence at 11.5% in women aged 45 years and above. The article uses the Indian government’s LASI (Longitudinal Aging Study in India) Wave-1 dataset, 2017-18, to investigate the prevalence and underlying reasons for hysterectomy among women aged 45 years and above in the country.
“Country-wise about 11.5 per cent women aged 45 years and above in India have undergone hysterectomy, which amounts to more than one in ten women above age 45. The southern (18.2%), western (12.7%) and northern (10.3 per cent) parts of India have the higher prevalence rate, while north-eastern (3.8 per cent) region reported the lowest prevalence rate…,” the research paper said.
According to the paper, the most common causes for performing hysterectomy include fibroids (47.6%), uterovaginal prolapse (13.4%), benign ovarian cysts (12%), malignancy (9%), and adenomyosis, which leads to endometrial tissue growing into the uterus wall (6%) globally.
In India, out of all the reported hysterectomies nationally, more than one-fifth were performed only for the reason of excessive menstrual bleeding. Fibroid or cyst (17.4%) and uterine prolapse (12.2%) were also reported to be the sole reason for undergoing the surgery. Uterine disorder (5.2%) and severe post-partum haemorrhage (2.5%) also accounted for a significantly large number of hysterectomies getting performed.
“Though the hysterectomy incidence rate is very high in the United States (510 per 100,000 in 2004) and several European countries in recent times more hysterectomies are being conducted in developing countries compared to developed countries,” said the paper’s researchers.
The percentage of hysterectomies performed for reasons such as cancer and severe post-partum haemorrhage is the least reported. Nationally, the analysis found that women in the age group of 45-55 years were more likely to have undergone hysterectomy.
Women belonging to the other backward castes category, women belonging to the richest wealth quintile, and those with a lower age of marriage were at a higher risk of undergoing hysterectomy. Women belonging to the richest wealth quintile (17.3%) had more than two times higher prevalence than the poorer women (7.7%). Moreover, women living in urban areas were more likely to report having had a hysterectomy as compared to women from rural areas.
“Another interesting finding was that financially better-off women underwent hysterectomy as a preventive medical procedure for menstrual pain relief, whereas the poor women undertook the surgery for uterine prolapse and other reasons,” said the researchers.
And therein lies the need for better regulation of this surgical procedure to ensure doctors and hospitals do not perform this surgery unnecessarily for financial benefits. The researchers also aptly highlight this point in the paper.
“The high number of unnecessary surgeries is a topic of concern. Despite the health benefits, hysterectomy also has several long-term ramifications on women’s health… The findings of this research emphasize the potential impact of hysterectomy on the health burden of women, and underline the need for a careful evaluation of its use, applicability, and suitability for each individual. The study throws light on investing further research and effort in exploring viable alternative medical treatments, especially the non-invasive ones that prioritize women’s health and overall wellbeing,” argued the researchers.
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Rohit Malhotra is a medical expert and health journalist who offers evidence-based advice on fitness, nutrition, and mental well-being. His articles aim to help readers lead healthier lives.
