1. How to decrease
Hysterectomy Rate
in India?
Dr. Sharda Jain
Director :-
Founder Chairman PCH OBST/ Gynae Dpt.
Sec General : Delhi Gynaecology Forum

3. TOI Sept. 2010
Landmark article
80% of Andhra Village women are minus
their uterus

4. Uterus chopping States
Andhara Pradesh , Madhya
Pradesh,Punjab
Bihar, Delhi
Modus Operandi Same as
Female Foeticide

5. 22 Sept.2012 appealed to Gynaecologists
To be kind to uterus

6. Why Did he say so about
Hysterectomy ?
• Second most frequent
surgical procedure in
women of reproductive
age group
• 90% for benign reasons
• Promptly offered
following a
diagnosis.
• Hysterectomy should not
be taken up lightly.

7. BIG FACT !!
Women AGE early even if
ovaries
are retained
At
Hysterectomy
All Elders endorse this fact

8. KJ Carlson, NEJM 328:856,
1993
DisadvantagesDisadvantages
• Performed under general or regional
anesthesia
• Long hospitalization and recovery time
• Mortality 0.6-1/1,000
• Major complications 3%
• Morbidity 24-43%
• Psychological 25-35%
• Long period of convalescence
Hysterectomy is
Not 100% safe

9. Do You want to guess
the
Number
of
HYSTERECTOMY
done in India ?

10. USA 5.9 lac
UK 1.3 lac
Russia 3.12 lac
India 23.2 lac
CDC
Numbers of
Hysterectomies Per year

11. 1990-2000
Life time risk
Of
Uterus Removal

12. 1:5
Women before 60 years
had Hysterectomy
U.K.

13. 1:3
Women before 60 years
had Hysterectomy
USA

14. DUB 20%DUB 20%
FibroidsFibroids 30%30%
Endometriosis/Endometriosis/
Adenomyosis 20%Adenomyosis 20%
(Pre) cancer(Pre) cancer
10%10%
Chronic pelvic pain 10%Chronic pelvic pain 10%ProlapseProlapse 15%15%
Indications of HysterectomyIndications of Hysterectomy
In USAIn USA
Indications of HysterectomyIndications of Hysterectomy
In USAIn USA
1990 - 2000

15. Hysterectomy Rate
↓↓
To 1/10th
(20 years)
In western world

16. Causes of Hysterectomy
in USA now
5 per 1000
%
• Uterine leiomyoma 40.7
• Endometriosis 17.7
• Uterine Prolapse 14.5
• Cancer 9.2
• Endometrium hyperplasia 2.7
• Misc. 15.2
(Includes CERVICAL DYSPHASIA)
Obstat Gvnecol 2008;34.e1-e7

17. Bilateral
Salpingo- Oopherectpomy Rate
65%
↓↓↓
45%
Uterus Retained (Bad PID)

18. Average AGE of Hysterectomy in
USA
46 yrs
(40 – 50 yrs)
Uterus Removal In India
10 to15 yrs. earlier

19. Menace of Uterus Removal is on

20. GOVT enquiry in Many states

21. Who has Caused this
Menace in India ?
Gynaecologists
&
Surgeons

22. How western world has
↓↓↓ Hysterectomy Rate?
Big Question
ACOG / Royal College

24. February, 2000, Vol 95,February, 2000, Vol 95,
No. 2, Pages 199-205No. 2, Pages 199-205
The Appropriateness of RecommendationsThe Appropriateness of Recommendations
for Hysterectomyfor Hysterectomy
Michael S. Broder, MD, David E. Kanouse, PhD,Michael S. Broder, MD, David E. Kanouse, PhD,
Brian S. Mittman, PhD, and Steven J. Bernstein, MD, MPHBrian S. Mittman, PhD, and Steven J. Bernstein, MD, MPH

25. 76%76% of the patients who were takenof the patients who were taken
up for hysterectomyup for hysterectomy did not meetdid not meet
ACOGACOG
criteria for hysterectomycriteria for hysterectomy
*Obstet Gynecol 2000;95:199-205*Obstet Gynecol 2000;95:199-205
The Appropriateness of
Recommendations for Hysterectomy*
Michael S. Broder, MD, David E. Kanouse,
PhD,
Brian S. Mittman, PhD, and Steven J.
Bernstein MD, MPH

26. ““The most common reasons for whichThe most common reasons for which
hysterectomies were consideredhysterectomies were considered
inappropriate wereinappropriate were
• lack of adequate diagnostic evaluationlack of adequate diagnostic evaluation
• failure to try alternative treatmentsfailure to try alternative treatments
before hysterectomy.”before hysterectomy.”
*Obstet Gynecol 2000;95:199-205*Obstet Gynecol 2000;95:199-205

27. KJ Carlson, NEJM 328:856,
1993
HYSTERECTOMY
as Treatment
Should be last resort

28. •20-40 yrs – 10 / lac
•40-50 yrs - 36 / lac
Risk of Endometrial Carcinoma

29. More than 1 in 5
30s & 40s suffer from
HEAVY PERIODS
(Unmanageable)

30. PALM - COEIN
FIGO

31. TVS
Gold Standard

32. Gold standard for HMB but not cost effective
as first line diagnostic tool.
Office Hysteroscopy

33. • Has replaced conventional
D & C under GA
• No therapeutic value
Office EB - Diag. Procedure
Gold Standard

34. Treatment

35. IsIs Not HysterectomyNot Hysterectomy
THE IDEAL TREATMENTTHE IDEAL TREATMENT
FOR HMBFOR HMB

36. Current TreatmentCurrent Treatment
Recommended for HMBRecommended for HMB
Drug therapyDrug therapy
HysterectomyHysterectomy
20%-30% after
35 years
Global Endo.
Ablation/
Mirena

37. Medical management of DUBMedical management of DUB
EffectivenessEffectiveness Side effectsSide effects CostsCosts
Contraceptive PillContraceptive Pill 50%50% ++
ProgestagensProgestagens 20%20% + ++ +
DanazolDanazol 100% (100% (dose!)dose!) + +++ ++
GnRH`agonistGnRH`agonist 100%100% + + +++ + ++
NSAIDNSAID 30% +30% +
Antifibronilytic agentsAntifibronilytic agents 50% + ++50% + ++
IUD with Progesteron 65%-97%IUD with Progesteron 65%-97% + +++ ++
20-30% success after 35 years

38. Mirena (LNG IUS)
(5 yrs)
is a
Magic Stick

39. • Mirena 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
Conclusions about Mirena

40. We have largest Number of
cases
of MIRENA
in Delhi & NCR
(2013 upto 30th
June)

41. •
SuccessSuccess isis 8080 toto 90%90%
•Repeat procedure / HysterectomyRepeat procedure / Hysterectomy ––
10 to 20%10 to 20%
Amenorrhea, ↓↓ bleeding in overAmenorrhea, ↓↓ bleeding in over 90%90%
GLOBAL ENDO.GLOBAL ENDO.
ABLATIONABLATION TECHNIQUESTECHNIQUES
(10-15 years)(10-15 years)

42. Pooled Results
UBT
Pooled Results
UBT
Amenorrhea/ spotting
36%
Eumenorrhea
22%
Minimal or no
Reduction in
Menses 4.0%
Hypomenorrhea

43. For Treatment of DUB
Uterine Balloon Therapy
(Many Types)

44. GYNECARE*
THERMACHOICE*
Performance
> OVER 20,00,000
procedures worldwide

45. 10 minute
Solution
for
‘Heavy
Periods’
Very Effective

46. We Have Largest No. of Cases
of UBT in India
Our cases : till March 2013
N - ↑ 1300
(24 months F/U completed – Over 1000
cases)

47. UBT’s
Biggest Use
Is In
Bad Surgical
Risk cases

48. ° Think rationally yourself.
° Vow yourself &
° Join the Movement for
motivating 10 other
gynaecologists to do the
same
Let us come forward to stop this
menace of uterus removal.

49. No way should
SURGEONS be
allowed to do
hysterectomy in
India ……
Such practices
should become
history !!

50. Thanks