Hysterectomies in Private nursing homes

Removing uterus at young age, even if ovaries are preserved, predisposes women to so many serious diseases

Grave Matter

DR. BASHIR AHMAD LAWAY

BACKGROUND:
Everything has proper time. A baby has to deliver at a proper time, he has to grow at a defined pace and become an adult at a proper time. Similarly aging also starts at a proper time. All these stages nature has segregated keeping in view the needs of a human being. It means if a baby grows at a faster than defined speed or goes into puberty at early age is an abnormality or a disease state. If we talk of women, age of maturity of girls into an adult (puberty) has advanced by a few years in last few decades. A girl at present time can normally start developing into puberty at the age of 8 years which a few decades back was 9 years.  The phenomenon of advancing a normal puberty over the decades commensurate with the improvement in socioeconomic status is known as “secular trend’’.  Surprisingly the age of menopause (cessation of menses) has not changed despite increase in life span and marked improvements in socioeconomic status across the nations. It means nature wants to be productive at a young age.
How female hormone (estrogen) is essential for women and up to what age?
Ovary - female sex organ - produces estrogen and has many functions which are extremely important for keeping a woman in good health. Estrogen keeps a woman in good mood and mentally balanced, assists in protecting her heart, body physique, keeps blood pressure virtually away, keeps her sexually active and productive. Most important thing it keeps her bones healthy. It means if estrogen is not being produced,  a woman is predisposed to all the ill effects like  heart diseases, high blood pressure, high cholesterol levels in blood, irritability and weak bones (osteoporosis). If a woman is deprived of estrogen suddenly she will develop severe symptoms of menopause like hot flushes and irritability.
If estrogen is so important for a woman, can we give it to women after the age of menopause (>50years)?
This experiment was tried in west few years back and failed miserably; it means we cannot go against nature.  A study was terminated in USA few years back and was a great disappointment for scientist but the study taught us that don’t try to disturb the nature.  The study was named as Women Health Initiative (WHI). The study took two groups of women after the age of menopause; one group was given estrogen and other group was not given. More women in the group receiving estrogen died of brain stroke and heart attacks. The study was terminated prematurely and was a great disappointment. The study taught that everything suits at a proper time and we should not try to disturb the nature. It does not mean that estrogen causes problems in people where it is indicated. This is a subject of debate but broad consensus is that every woman needs estrogen up to the age of 50 years and if menopause causes severe menopausal symptoms can be given for 1-2 years under supervision.
What are the consequences of estrogen deficiency at young age (<50 years)?
A woman deprived of estrogen at a young age will develop lot of problems. First of all they develop severe menopausal symptoms like hot flushes and irritability. In addition thy develop heart diseases and osteoporosis and premature aging, breast atrophy and sexual dysfunction. This is in addition to losing their feminine figure.

Comments on the GK story:
Coming to the recent story “Nursing homes commercialize hysterectomy- gullible women fall prey to medico’s greed” by Muddasir Ali published in Greater Kashmir, August 28. It is shocking to know that more than 22581 hysterectomies have been carried in 10 districts and out of which 15000 have been carried in nursing homes. Kulgam district tops the list where 4196 hysterectomies have been done. Most of these surgeries have been carried by general surgeons and not by gynaecologists. This is the tip of the iceberg and is a serious matter; we do not know how many must be unreported. It means so many young women have been deprived of female sex hormones for rest of their life. For the Kulgam district where maximum number of surgeries have been carried there used to be a slogan “no uterus by 2020”, thanks to few surgeons and anaesthetists from the area, some retired and some working. Recently similar thing surfaced in Bihar where increased number of hysterectomies carried in government hospitals was reported. The matter was discussed in Parliament and government ordered probe into it.

SUGGESTIONS:
1. In future we need to be very vigilant and people need to be educated about the ill effects of removing uterus at a young age.
2. Uterus to be removed only when indicated, which gynaecologists know better (bulky uterus is not an indication of surgery).
3. We need to take an opinion from a gynaecologist before removing uterus.
4. Surgery needs preferably to be done in government hospital where the indications for removal will be respected.
5.  If we allow the malpractice to continue, young women will be predisposed to serious diseases for the rest of their life.

Author is Additional Professor & Head, Department of Endocrinology. SKIMS, Soura, Srinagar. Reach him at laway@rediffmail.com    

Lastupdate on : Thu, 6 Dec 2012 21:30:00 Makkah time
Lastupdate on : Thu, 6 Dec 2012 18:30:00 GMT
Lastupdate on : Fri, 7 Dec 2012 00:00:00 IST




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