BENGALURU: Uterus (womb) as an organ is pivotal not only to giving birth, but also to the overall well-being of women and their physical, emotional, and sexual health. Yet, an alarming number of women today, especially in rural communities, are undergoing hysterectomy (surgical removal of uterus). Women are getting their uterus removed even in cases where the organ can be saved by other surgical or medical options.
Today. the removal of uterus is the most common surgery in women after caesarean delivery. A significant number of hysterectomies done in India are unnecessary and may even be unethical.The purpose of hysterectomy is to save women from uterus-related, life-threatening conditions. The procedure should be done above 45 years to decrease its side effects. Yet, in India, 6 per cent of women in the age group of 30-49 years have undergone hysterectomy.
Causes
The most common causes of hysterectomy in India include benign tumours called fibroids (45%), heavy menstrual bleeding (31%), a precancerous condition known as cervical dysplasia (3%), Pelvic inflammatory Disease, and endometrial hyperplasia (the lining of the uterus becoming abnormally thick). Prolapsed uterus and cervical cancer are other conditions that may necessitate hysterectomy.
Women, mostly from poor socio-economic backgrounds, are often coaxed into hysterectomy with the fear of cancer. In many instances, it is inappropriately recommended as the first line of treatment for minor gynaecological issues that may not directly be related to the uterus, such as lower abdominal pain, back ache or white discharge. Early marriage, closely spaced childbearing and early hysterectomy is a road map followed by many Indian women during their reproductive years.
Rural women lack access to proper medical advice around menstruation and are often restricted to manual labour on farms. These are often controlled by unscrupulous contractors who place a huge strain on these women’s bodies through hard labour, leading to health problems. Local doctors recommend hysterectomy to alleviate many of these conditions even in young women, when alternative therapies could have saved the uterus.
Hysterectomy is not without its side effects, with younger patients bearing their brunt. Hysterectomised women see their ovarian reserve go down, which in turn causes skin dryness and decreased sexual desire. The surgery is often accompanied by removal of ovaries to reduce the risk of ovarian cancer. There may be vaginal burning, increased urinary frequency and early onset of menopause. Women who have undergone hysterectomy tend to have increased incidence of heart disease and may also show symptoms of osteoporosis at an early age.
Treatment
In recent years, the Western world has seen a reduction in the number of hysterectomies, with healthcare practitioners actively favouring more conservative approaches. Many alternative methods of treatment to hysterectomy today exist, including oral remedies, hormonal injections for excessive menstrual bleeding, and removal of just the fibroid and not the entire uterus. Indian women, especially those living in small towns and villages, have poor knowledge of their reproductive health.
Public health initiatives should create this awareness through people-to-people contact and mass media. Regular cervical cancer screening will also help reduce the incidence of hysterectomy. There is a dire need of counselling services for women regarding their reproductive health, the importance of uterus and the medical conditions that necessitate hysterectomy. With the advances in medical science, hysterectomy should be the last resort for a woman, not the first.
The author is laparoscopic surgeon and fertility specialist, medical director, Radhakrishna Multispeciality Hospital and IVF Center, Bengaluru