Selected news stories from the international press relating to Asian (In)Fertilities:
Rising hysterectomies raise eyebrows - Times of India
(12 November 2009)
CHENNAI: The increasing number of young women undergoing surgeries to remove uterus and ovaries has raised eyebrows of several senior gynecologists and senior members of the Federation of Obstetric and Gynecology Society of India.
A recent audit by an insurance company showed that more than 500 women under the age group of 25-35, at least 100 of them in the 25-30 age group had undergone hysterectomies. In a majority of the casesheets, doctors have mentioned small fibroids, non-cancerous, causing excessive bleeding as the reason for removal of the uterus or overies. While the insurance company warned the hospital against such needless' surgeries, gynecologists are concerned about problems and medical risks these young women would face because of the surgical menopause . "Women are generally at risk of getting diseases such as heart attacks and osteoporosis after menopause. Removing their uteruses and overies at an early age lead to abrupt menopause, earlier than usual. This also makes them unable to give birth," says fertility expert Dr Priya Selvaraj. It is estimated that 40% of the women above the age of 35 or older can have uterine fibroids. Nevertheless, most fibroids do not show any symptoms. Less than 20% of them require treatment. While a majority of them can be medically managed, a few would require removal of the uterus. The usual symptoms of fibroid are prolonged menstrual periods and unusual bleeding, sometimes with clots leading to anaemia. There can also be severe pain of the pelvis, back and legs, pain during sexual intercourse and unusual bladder pressure leading to frequent urge to urinate. "We were taught in medical schools that no reproductive organ can be removed unless it's life threatening. A small fiberoid needs to managed medically. Fibroids do not always cause symptoms, even if they are more than one in number. But their size and location can cause problems. If the fibroid is big, it can be removed safely. Only in cases where the fibroid is as big as 8 cm or when the woman is profusely bleeding, making her anaemic or when it harms other organs, hysterectomy is suggested," said senior obstetrician-gynecologist Dr Jayashree Gajaraj, former president of FOGSI. Several other gynecologists argue that with the advancement in diagnostic facilities, doctors get to pick fibroid cases early. "Earlier we were seeing fibroids that were huge. Now, the ones as small as 1 cm is picked up by the scans. Some doctors tend to overtreat this," she said. A study done by Dr Amarjeet Singh, Professor, Department of Community Medicine in PGI, Chandigarh in 2005 showed that seven per cent of married women aged above 15 years had undergone hysterectomy in northern rural India by. The incidence was significantly more common in women above 35 years. The study also showed that in a majority, the lag between advice and operation was more than a month. A majority reported relief after operation. Some women reported a sense of void' and loss of womanhood' after the operation. "It can be very traumatizing for a woman to loose her uterus. And when the ovaries are also removed, she goes though a lot of hormonal problems that need to be addressed. It's sad to see many young women being subjected to hysterectomy needlessly. In fact, we are now planning to start a foundation to save the uterus," said Dr Jayashree.