Medical

Hysterectomy Is Common In India, But So Are The Side Effects—What's Going Wrong?

When necessary, a hysterectomy can be a life-saver. But, an ill-advised or uninformed one can lead to multiple complications. Here's what to keep in mind.

By Debashruti Banerjee

24 Mar 2022

When American celebrity chef Sandra Lee decided to share the honest picture of hysterectomy recovery in the beginning of March this year, support and well wishes poured out from all over the world. What was surprising was the number of hate comments on some of the media outlets that shared her story, belittling her post-op symptoms and overlooking the fact that Lee does not regret her decision to undergo the major surgery one bit.

What is a hysterectomy? It is the surgical removal of the uterus, and in some cases surrounding structures like ovaries, fallopian tubes and cervix. A permanent procedure that eliminates the occurrences of periods and pregnancy, hysterectomy is available to be performed for low costs or even free in several Indian government hospitals. This is probably the reason why it is very common in India—1 in 10 people in their 40s or above underwent the operation according to The National Family Health Survey of 2015-2016 (NFHS-4). The numbers could very well be higher as this was the first national-level survey to record the prevalence of hysterectomies in India and owing to the methods of data collection, we must hold some space for error.

Lee's rough recovery is not a standalone case, as Artika Singh, Menstrual and Sexual health educator and the founder of the Taarini Foundation, sheds light on why hysterectomy is one of the highest used methods of contraception in India despite the fact that it is a non-reversible method, requiring medical intervention and can sometimes pose risks to the patient's health.

What are the potential side effects of a hysterectomy?

"During my work in rural areas in and around Delhi NCR from 2015 to 2018," Singh recounts, "we would come across complaints about body aches, back pains, legs aching from many people across ages, even as young as 18 years. Upon further investigation we recorded that many of them had opted for a hysterectomy solely as a method of contraception as their families did not want them to produce any more children. We noted that many of them had been married at ages as early as 14-15 years and had finished bearing all the children their family approved of while still in their late teens or early twenties and thereafter underwent hysterectomies at the same age.”

“Based on recorded surveys it was concluded that hysterectomy was preferred as a method by the families as it was a quick, free of cost method, permanent, fail-proof method and didn’t involve the recurring hassle of using a condom. In most cases the decision was not entirely discussed with the person undergoing the surgery and neither were they counseled about the procedure and/or side effects by the doctors.”

Several studies have now reported a link between hysterectomies, oophorectomy (ovary removal) and lower bone density, risk of arthritis and osteoporosis—all of which can show up as body aches.

While the people from Singh's acquaintance would complain of a variety of body aches, hysterectomies can also be accompanied by other symptoms such as:

Pain, swelling or numbness
Menopausal symptoms like vaginal dryness, night sweats and hot flashes
Decreased sex drive
In some cases, organ prolapse or infections
Bone weakness and higher risk of osteoporosis

Research suggests that hysterectomies in premenopausal people pose a higher risk of lower bone density. According to a 2011 study by Johns Hopkins Medicine, USA, people who had both their ovaries removed before the age of 45 had an average of three per cent lower bone mineral density than those who had not. Moreover, another 2020 study published in PLoS One concluded that hysterectomised people had a higher tendency of osteoporosis and bone fracture than others.

What kinds of ailments necessitate a hysterectomy?

Extremely heavy periods
Presence of fibroids and tumours
Cancer in the ovaries, cervix and/or uterus
Uterine prolapse
Endocrine diseases like endometriosis, adenomyosis, hyperplasia, severe pelvic inflammatory disease etc.

"The responsibility of the doctor is not just to operate but also to counsel and inform the patient about the procedure comprehensively. Scientifically, folks should be directed to go ahead with a hysterectomy at early ages only if they show risk of disease or certain conditions and not just as contraception. However, sharing information about potential risks and side effects puts at least some amount of power in the hands of the patient to make an informed decision about their bodies," comments Singh.

Other methods of contraception

If the only reason for hysterectomy is contraception, it is helpful to be informed of all alternatives at your disposal:

Vasectomy: For people with a penis, vasectomy is a minor surgery that involves cutting off the supply of sperm in their semen flow, thereby preventing pregnancy. It is a reversible process, though expensive.
Tubal ligation: Commonly called "getting your tubes tied", this surgical procedure involves sealing off of one's fallopian tubes, which prevents sperm from making contact with the ovum or egg.
Hysteroscopic sterilisation: Though not very common in India, this non-surgical procedure involves placing a device in the fallopian tubes which results in tissue growth that blocks eggs from passing to the uterus.
Saheli/Chhaya: The only non-hormonal contraceptive pill produced and available in India, Saheli is also solely produced and distributed in India. It requires a prescription, but is available over the counter and for free in government hospitals. It is effective up to 93 to 100 per cent with perfect dosage intake and only as long as one takes it. Though non-steroidal, Saheli does contain trace amounts of hormones, which may lead to mild nausea, dizziness or weight gain. However, the side effects are much lesser than OTC hormonal medications. Also called Ormeloxifene or centchroman, Saheli was developed in the 1990s at the CSIR-Central Drugs Research Institute (CDRI), Lucknow. It has also been suggested that it may be effective against uterine/breast/ovarian cancer, uterine bleeding and bone decay as well.
Chemical contraception: These involve oral birth control pills, hormonal injections, spermicide creams and intrauterine devices (IUD).
Barrier contraception: Internal and external condoms and diaphragms are temporary barriers used during sex to prevent unwanted pregnancies as well as to lower the risk of urinary tract infections (UTI) and sexually transmitted diseases (STD). This does not hold true for the previous methods, which are used solely for contraception.

For a more in-depth look into different kinds of birth control, their costs, side effects and usage, click here.

Related story: How To Practice Safe Sex

What's the bottom line?

Hysterectomy is a permanent surgery, which may be opted for due to certain prior ailments (as discussed above) or as a gender reaffirming surgery. It is to be noted that surgery is optional when it comes to a gender-affirming journey—depending entirely on the preference of different individuals. Every surgery has its own side effects and recovery process, which doesn't mean the procedure is dangerous. However, your doctor must go over the symptoms, risks and all your options to minimise the risks from the get-go. It is necessary to ask important questions like "Does my medical history support a safe hysterectomy or are there risks?", "Will this surgery alleviate my symptoms?", "Are there existing alternatives which will be effective but simpler?", "What symptoms may I experience post-op and what can I do about them?" etc.