Save the uterus seminar

Hysterectomy is the surgical removal of Uterus (the womb). In some women, the ovaries are also removed along with the uterus. Hysterectomy is usually done when there is excessive, painful and prolonged menstrual bleeding due to uterine tumours, for prolapse of pelvic organs and for cancers of uterus and ovaries. Gynaecologists resort to this surgery only after serious consideration and when all other available treatments fail. When a woman undergoes Hysterectomy it ends her menstrual cycle and her child bearing ability.

Sadly, more and more women in certain pockets of our country are going for Hysterectomy voluntarily to get rid of the pain and discomfort felt during the premenopausal period. It is reported that women in certain villages in North India resort to Hysterectomy as they consider uterus as an unnecessary organ in their body as they had finished giving birth. Little do those women know about the problems associated with unnecessary removal of Uterus? According to national health data findings, India leads the world in number of Hysterectomies done every year.

An alarming rise in the number of Hysterectomies in India

In India and across the world, removal of the uterus is the second most common surgery after caesarean delivery. Despite awareness, the rate with which hysterectomy is being conducted in India has been the same in the last two decades

The number of hysterectomies conducted in India continued to outnumber surgeries performed in other countries. For instance, number of hysterectomies conducted in 2013 in India stood at 23.2 lakh, while during the same period hysterectomies done in USA stood at 5.9 lakh while UK and Russia reported 1.3 lakh and 3.12 lakh respectively.

Worrying Trend in India

While the average age of women opting for hysterectomy in US is 46, in India it borders around 35 years. According to a survey done by an NGO, approximately, one-third of all hysterectomies carried out in rural India are for women younger than 35 years of age. It is reported that number of voluntary hysterectomies are high in the state of Andhra Pradesh and Gujarat where women prefer to undergo it as they feel uterus is unnecessary as they have finished giving birth. In many pockets of the country, woman goes for hysterectomy at as young as 24 years.

It follows that hysterectomy is increasingly being performed in younger women in India. It is associated with significant physical and emotional complications and increased costs.

Fact finding and media reports have found a widespread pattern in performance of inappropriate hysterectomies in various parts of rural india especially in Chatisgarh, Bihar and Rajasthan. Any hysterectomy is considered inappropriate when it is done without complete diagnostic evaluation and without trying effective alternative treatments

Nationwide ‘Save the Uterus’ campaign

The situation went so alarming that a nationwide ‘save the uterus’ campaign is initiated by health activists in India recently. The campaign sensitizes the need to preserve Uterus. The campaign educates women against voluntary removal of uterus to get rid of menstrual discomforts and a host of other easily treatable problems like vaginal discharge, backache etc. The campaign was effective in uniting gynaecologists across the country that are against voluntary removal of Uterus and are resorting to this surgery only in unavoidable conditions and extreme cases such as cancer in ovaries or uterus.

Satyamevajayate, a popular television program anchored by Aamir Khan a nationally renowned actor had discussed about unnecessary hysterectomies and the side effects associated with such surgeries.

Conditions where Hysterectomy is Necessary

There are several conditions for which hysterectomy is advisable or medically necessary. These include:

-          ovarian, uterine, or cervical cancer

-          large and multiple fibroids of uterus and

-          severe endometriosis or adenomyosis

-          heavy menstrual bleeding, not responding to medical treatment & LNG IUS

Heavy menstrual bleeding (HMB), or menorrhagia, are the most common type of abnormal bleeding from the uterus. Periods are considered heavy if there is enough blood to soak a pad or tampon every hour for several consecutive hours, need to change pads or tampons during the night, passing large blood clots during menstruation, a period that lasts longer than seven days.

In severe cases, heavy menstruation can interfere with sleep and daily activities. Blood loss from heavy periods can also lead to anemia, causing symptoms such as fatigue and shortness of breath. Heavy menstrual bleeding alone can be treated with medicines or the newer LNG IUS. Before thinking about Hysterectomy consult your doctor. Visit and which will be of help to you to preserve your uterus by providing safe and affordable alternatives.

Side effects of Hysterectomy

The most important complications of hysterectomy though not common include injury to adjacent organs in pelvis (such as the urinary bladder, the ureters and the bowel), excessive bleeding during or in the postoperative period, and infection in the postoperative period. Some women can develop clots in the leg veins which in turn can delay recovery and in some cases life threatening.

 Early menopause is the result of hormonal changes secondary to hysterectomy. Early onset of menopause can be associated with hysterectomy even when the ovaries are retained. One study found that menopause occurred an average four years earlier in premenopausal women who underwent hysterectomy (both ovaries retained) compared with similar women without hysterectomy.

Removal of ovaries at young age results in premature menopause and its symptoms like hot flashes, mood swings, vaginal dryness and could increase chances of bone pains, fractures and heart attacks.

Psychological effects that may manifest following hysterectomy vary from individual to individual. While some studies have found that women experience new feelings of depression, anxiety, decreased libido, or social disruption due to the lengthy postprocedural recovery, other studies have concluded that women undergoing hysterectomy have improved quality of life because their previous unpleasant symptoms have been relieved

Although multiple complications may result from this procedure, it is important to keep in mind that most women are quite satisfied with the results of surgery and with the significant symptom relief they experience


Alternative Therapies for hysterecomy

There are several hormonal, non-hormonal remedies, intrauterine devices like Emily, endometrial ablation (where the lining of the womb is destroyed), Uterine artery embolization ( where the blood supply to the womb is cut down) available to treat excessive uterine bleeding. These are also safe and affordable options compared to surgery.

LNG-IUS - Levonorgestrel Intra Uterine System ( example -Emily):

It is a plastic device placed inside the uterus by a minor procedure which steadily releases a small amount of hormonal drug levonorgestrel into the womb and reduces bleeding. This revolutionary device has drastically reduced the incidences of hysterectomy for heavy periods. It is Safe and effective for a period of 5 years.

Advantages of using LNG IUS

-          It has been conclusively proven that LNG IUS is much more cost effective than a hysterectomy.

-          LNG IUS provides most effective medical treatment with least side effects

-          It can replace in about 50% cases the need for endometrial ablation or hysterectomy

-          Especially useful when presently contraception is required but future fertility is desired

-          The New England Journal of Medicine recently published the results of a pragmatic, multicenter, randomized trial that compared the clinical effectiveness of Levonorgestrel Intrauterine Device (LNG-IUS) with that of medical treatment. The report conclusively stated that LNG-IUS should be considered as the first-line therapy for Heavy Menstrual Bleeding regardless of the need of contraception.

Problems reported

Women who have used LNG IUS were found to have the following problems during the first few months of insertion: irregular bleeding, breast tenderness, acne or headaches. But these are generally minor and short lived.

Endometrial ablation

In these techniques a device is inserted into the womb through the vagina and cervix. The device is heated using different methods (for example, using microwave or radio energy). This heat destroys the lining of the womb

Removing the womb lining should stop bleeding. This surgery is not suitable if the woman wants to become pregnant any time later.

Common problems after these procedures include vaginal discharge, increased period pain or cramping (even if no further bleeding), need for additional surgery and sometimes infection.

Uterine artery embolisation or UAE

This is a treatment done to block the blood supply to uterus, where small particles are injected into the blood vessels that take blood to the womb. The woman may be able to get pregnant after this procedure. Common problems include prolonged vaginal discharge, pain, nausea, vomiting and fever.

Doctor’s Participated in the event

  • · Dr.Rajsri Shankar. MBBS.,MRCOG. Consultant Obstetrician & Gynaecologist
  • · Dr.T.Kamala. MBBS., MRCOG, ABOG,MS. Consultant Obstetrician & Gynaecologist
  • · Dr.Padmapriya Vivek
  • · Dr.Wahitha Suresh

Inappropriate hysterectomies are happening in India and have been on the rise. It is good news that Govt of India is including Hysterectomy in National Family and Health Survey (NFHS). This means that every Hysterectomy conducted in registered hospitals will get reported and will be scrutinized if found to be inappropriate.

Hysterectomy offers a definite cure, but it is a major surgery for the treatment of Heavy Menstrual Bleeding (HMB) and it comes with significant anatomical, urological, sexual, psychological, and emotional problems attached to it. Hysterectomy should only be considered when: Heavy bleeding has a severe impact on a woman’s quality of life, other treatments haven't worked or are not suitable for her and when she fully understands the risks and benefits of having a hysterectomy done. Ovaries should not be removed if they are healthy. Hysterectomy as treatment should be the last resort when a woman suffers from HMB alone.

There are various alternative non-surgical procedures that are safe and effective. Endometrial ablation, uterine artery embolization are available in many hospitals in Tamilnadu. Among the alternatives, the usage of intrauterine device LNG IUS has been found to provide significant reduction of menstrual bleeding in patients with HMB problem. It can be considered as a top-of-the-line choice treatment in the management of HMB.

Sep 22, 2014
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