Socio-Demographic and Related Indicators of Underwent Hysterectomy: A Cross-Sectional Study Conducted among the Women of District Bilaspur (CG), India

Socio-Demographic and Related Indicators of Underwent Hysterectomy: A Cross-Sectional Study Conducted among the Women of District Bilaspur (CG), India | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Socio-Demographic and Related Indicators of Underwent Hysterectomy: A Cross-Sectional Study Conducted among the Women of District Bilaspur (CG), India Suman Sahu, Rajesh K. Gautam This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4728495/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The advancement of medical science and newer technologies has witnessed the prevalence of hysterectomy in recent times. Consequently, an attempt has been made to find out the socio-demographical and related issued of women who have undergone hysterectomies from the district of Bilaspur, Chhatisgarh, India. A sub-sample of 105 respondents from rural and urban (≤ 30 years of age) who had undergone hysterectomy, included through a cross-sectional study. Data collection was carried out using a culturally validated semi-structured schedule. Body composition, related health issued and Socio-demographic data were collected using standard tools and techniques. Statistical analysis of the data was done by using MS Excel and SPSS Software. The prevalence of hysterectomy was higher among women in urban areas (57.1%) than the rural ones (42.9%). The mean age was 39.70 ± 26.86 years. Hysterectomy at an early age was observed among the women of OBC (36.2%) followed by the General category (35.2%), SC (25.7%) and ST (2.9%). It can be concluded that women who underwent hysterectomy were from a particular socio-demographic background, reproductive history and ethnic background. Further most of the common indicators for underwent hysterectomy who had undergone hysterectomy were excessive menstrual bleeding, frequent menstruation and uterus infection. Hysterectomy Health Issues Kaplan Meier and Odds Ratio Estimate Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Hysterectomy is a clinical removal of the uterus including female reproductive part i.e. fallopian tube, ovaries and cervix, the term is derived from Greek word ‘hysteros’ which means ‘uterus’. The numbers of hysterectomies are increasing day by day with long-term effect on body functioning during post-hysterectomy life. Advancement of medical science and newer technologies has also associated with the increasing prevalence of hysterectomy in contemporary world (Hasia, 2003). 1 Simultaneously, hysterectomy is also related to privatization of health services and profit-making by health professionals (Bala, et al., 2015). 2 Biological constitution of women’s body and their reproductive organ makes their body more sensible and disquiet which need supplementary concern and proper supervision. Lack of proper education among women makes them more susceptible to health issues related to reproductive health, which leads to deprived health status (Nilangi, 2015). 3 Life style of women has a great impact on the reproductive health of women leading to increase in cardiovascular disease, disorder related to sleep, digestion and bad temper. Experience during pre and post hysterectomy varies from different racial, ethnic groups and geographical areas among the women. Physical activity and dietary habit may also influence the overall health indication (Silva, et al., 2021). 4 Problems become manifold with any kind of surgery. When we talk about uterus surgery the complication rises more as bowel, nerves and vessels are closely related to uterus, and they are interrelated with each other to perform many life processes (Bahadur et al., 2021). 5 Women undergoing hysterectomy face a major and sudden change in the body relating to the physical, psychological, emotional and hormonal changes (Essa, 2017). 6 Post-hysterectomy health concerns have also been severe during the last few years, going through multiple health issues. Change in attitude among the respondents included negative thoughts and feelings of missing organs or emptiness within the body (Turan et al., 2024). 7 Endometriosis, fibroids and heavy menstrual bleeding, severe pelvic pain, polycystic ovaries and uterus prolapse were some of the commonly reported indications for women who underwent hysterectomy (Rout et al., 2023; Kumari & Kundu, 2022). 8 – 9 According to a worldwide study among 22 countries by Nurfauzia, (2023) 10 placental pathology, placental accerta spectrum, uterine atony and uterine rupture are common problems leading to hysterectomy. It was evident from a study conducted among South Korea that colorectal cancer was a reason for undergoing hysterectomy as compared to non-hysterectomy women (Yuk et al., 2023). 11 A study carried out by Tebeu (2019) 12 in Cameroon in South Africa, reported that uterine fibroid, cervical dysplasia, endometrial hyperplasia and pelvis organ prolapsed were the main reason of hysterectomy among women. Oophorectomy among women effect their life in every way due to reduction in progesterone and estrogen hormones including hormonal changes, reduction in sensuality and decrease in intelligence (Erekson, 2013) 13 . In this way there are several studies around the globe mentioned reasons for Hysterectomy. Studies have been conducted in India too, with the objectives to understand the indications and probable reasons for hysterectomy. In studies conducted in Mumbai, it was observed that women who had undergone hysterectomy were at utmost threat of having vault prolapsed; the number of pregnancies over and beyond increased the chances of vault propulsion (Kansaria & Chouhan, 2023; Shekhar et al., 2019). 14 – 15 Another study from South Indian state, Karnataka during the year 2014 to 2018 it was observed that 1041 women underwent postpartum hysterectomy out of 20405 deliveries (Mudashi, 2019) 16 . According to the study conducted by Meher and Sahoo (2019) 17 , based on NFHS-4 it was observed that excessive menstrual bleeding, fibroids, uterine disorder were the common indication for hysterectomy. Many other studies were conducted in Chhattisgarh associated to reproductive health. Based on the literature updated, there is no any such study especially from Bilaspur district of Chhattisgarh state, hence a micro level study was conducted to find out the reason and socio-demographic factors of hysterectomy among the women underwent hysterectomy from the district Bilaspur, Chhattisgarh, India. Material and Method Research Design: This was a cross-sectional and descriptive study based on three main stages i.e. 1. Selection of the Study Area, 2. Field work and Data Collection, 3. Data analysis and Interpretation. Stratification of the Study Universe: On the basis of review of literature the district Bilashpur of the state of Chhattisgarh was selected as there was reporting of hysterectomy without the consent of the patients. In the next step rural and urban areas were selected randomly from the map to ensure the coverage of the district headquarter i.e. Bilashpur town and villages were selected from two tehsils i.e. Masturi and Bilha. A total of 20 villages, 10 from each of the tehsil were selected, similarly, 10 wards from Bilaspur Municipal Corporation of Bilaspur district were selected as per the need for the present study. Sample Selection and Sample Size: The respondents were recruited from a total of 800 households, a sub-sample of 105 women who had undergone hysterectomy during November 2022 to June 2023 was considered for present analysis. Data Collection: A culturally validated semi-structured interview schedule was used for data collection. The interview schedule was mainly divided into three parts the first section encompasses questions related to socio-demographic characteristics and reproductive history, the subsequent section was accounting self-reported indication for undergoing hysterectomy and the third part of the interview schedule covered variables related to post-hysterectomy indicators and experience of the respondents. Description of the Variables: The information a series of socio-demographic variables, viz. current age, age at menarche, age at marriage, age at which underwent hysterectomy, educational status, marital status, years of education, place of residence, economic status, ethnic category and occupation were collected. The reason for undergoing hysterectomy was self-reported. Information on post hysterectomy complication and experiences were also collected. Statistical Analysis: Statistical analysis of the data was done by using MS Excel and SPSS Software (version 25). Kaplan Meier curve was to understand the probability of surviving after undergoing hysterectomy based on the socio-demographic characteristics i.e. education, economic status, category and place of residence. The variability of the selected variables were calculated using one-way ANOVA keeping age at hysterectomy as dependent variable. Inclusion Criteria For present study, the data was filtered and only those women were included who had undergone hysterectomy and currently ≤ 30 years of age. Exclusion Criteria Women who did not undergo hysterectomy and attained menopause were excluded from the study. Flow Diagram for Sampling Process: Result Socio-demographic characteristics Socio-demographic information of the respondents is presented in Table 1 . It is apparent that most of the women who had undergone hysterectomy belong to 41 to 60 years of age (68.57%), whereas 16.19% belong to below 40 years of age and 15.24% were ≥ 61years of age. The average of current age was 50.95 ± 9.12 (Fig. 1 ) Among these women, 81.90% attained education for ≤ 10 years and only few (18.10%) were attained education for ≥ 11 years. It is evident that 20% were illiterate, whereas 37.14% were completed their basic and primary education, followed by Middle and secondary education (25.71%), and higher secondary and above (17.14%). A total of 62.9% of respondent have attained menarche ≤ 14 years of age and 37.15% attained late menarche after the age of ≥ 15 years further the mean age at menarche was 14.14 ± 1.34Years (Fig. 1 ). Out of the total number of respondents 59% were married before 18 years of the age and 41% of women were married after the age of 18 years. It was observed that a total of 82.86% of women were married, whereas 14.29% were widow and 2.86% were unmarried. Average age at marriage was 18.03 ± 3.80 years (Fig. 1 ). The Table 1 also revealed that 57.10% of the respondents were from urban area and 42.90% were from rural area. Most of the respondents (82.86%) belongs poor socio-economic status as they live below to poverty line (BPL), and only 17.14% were above poverty line (APL). The mean age at Hysterectomy was 38.09 ± 6.59 years (Fig. 1 ). It is apparent from composition of the respondents that 36.19% belong to Other Backward Class (OBC), 35.24% were General castes whereas Schedule Caste and schedule tribe includes only 25.71% and 2.86% respectively. As it is common in India, 94.29% of the respondents were housewives and only 5.71% were working women. Table 1 Socio- Demographic profile of the respondents. Current Age (Years) f % ≤ 40 17 16.19 41–50 43 40.95 51–60 29 27.62 ≥ 61 16 15.24 Age at Menarche ≤ 14 66 62.9 ≥ 15 39 37.1 Age at Marriage ≤ 18 62 59 ≥ 18 43 41 Age at Hysterectomy ≤ 30 21 20.00 30–40 50 47.60 ≥ 41 34 32.40 Education Status Illiterate 21 20 Basic and Primary 39 37.14 Middle and Secondary 27 25.71 Higher Secondary and above 18 17.14 Marital Status Married 87 82.86 Unmarried 3 2.86 Widow 15 14.29 Years of Education ≤ 10 86 81.90 ≥ 11 19 18.10 Place of Residence Urban 60 57.10 Rural 45 42.90 Economic Status APL 18 17.14 BPL 87 82.86 Ethnic Category General 37 35.24 OBC 38 36.19 SC 27 25.71 ST 3 2.86 Occupation Status of Women House Wife 99 94.29 Working Women/Job 6 5.71 Differential age at Hysterectomy There is variation in the age at hysterectomy hence to find out the variability between age at hysterectomy and socio-demographic variables, F value were calculated using one-way-ANOVA and the findings were displayed in Table 2 . It is apparent that there were significant variation between age at hysterectomy and residence type (F = 3.994*), ethnic category (F = 3.935**), age at first pregnancy (F = 2.270*), age at marriage (F = 1.921*) and current age (F = 1.804*) at p ≤ 0.05, although, the variations were not very high, it was only 1–4%; whereas there was no significant variation between age at hysterectomy and education, total years of education and marital status. Table 2 One-way ANOVA for age at hysterectomy and socio-demographic variables Variable Sum of Squares df Mean Square F value Sig. Residence (Urban & Rural) Between Groups 168.667 1 168.667 3.994 p ≤ 0.05* Within Groups 4349.561 103 42.229 Total 4518.229 104 Ethnic Group Between Groups 472.789 3 157.596 3.935 p ≤ 0.01** Within Groups 4045.439 101 40.054 Total 4518.229 104 Age at First Pregnancy Between Groups 718.697 8 89.837 Within Groups 3799.531 96 39.578 2.270 p ≤ 0.05* Total 4518.229 104 Education Between Groups 276.164 3 92.055 2.192 Ns Within Groups 4242.064 101 42.001 Total 4518.229 104 Age at Marriage Between Groups 1233.130 17 72.537 1.921 p ≤ 0.05* Within Groups 3285.098 87 37.760 Total 4518.229 104 Current Age Between Groups 1641.181 25 65.687 1.804 p ≤ 0.05* Within Groups 2876.048 79 36.406 Total 4518.229 104 Total Year of Education Between Groups 981.780 15 65.452 1.647 Ns Within Groups 3536.448 89 39.725 Total 4518.229 104 Marital Status Between Groups 43.553 2 21.776 0.496 Ns Within Groups 4474.676 102 43.869 Total 4518.229 104 p ≤ 0.05, significant at the 0.05 level (*) p ≤ 0.01 significant at the 0.01 level (**) Reason of Hysterectomy In the present study an attempt was made to explore the reason for underwent hysterectomy (Fig. 2). It was found that majority of the respondent (87%) had trouble of excessive menstrual bleeding as the prime reason for hysterectomy. And, the second major cause was frequent menstruation (49.52%), followed by uterus infection (37.14%), ovarian tumor or cyst (17.14%), fibroid (14.29%), cancer (11.43%), uterus hemorrhage (8.57%) and other problems like ossification, ovarian stone, urethral injury and bowel injury together accounting 10.47%. Type and technique of Hysterectomy Table 3 Distribution of respondents as per types and procedure of Hysterectomy Type of Hysterectomy N % 1. Total Abdominal Hysterectomy (TAH) 4 3.81 2. Sub-total Hysterectomy 94 89.52 3. Abdominal hysterectomy with bilateral salpingo -oophorectomy (TAH-BSO) 7 6.67 Technique for Hysterectomy 1. Abdominal Hysterectomy 91 86.67 2. Vaginal Hysterectomy 5 4.76 3. Laparoscopic Hysterectomy 9 8.57 Information related to type of hysterectomy was analyzed to understand which reproductive organ (fallopian tube, ovaries and cervix) was removed from the body along with uterus of the respondents. It is evident from Table 3 that majority of the respondent (89.52%) underwent sub-total hysterectomy followed by TAH-BSO (6.67%) and very few of them underwent for the total abdominal hysterectomy (3.81%). The most common procedure for hysterectomy was abdominal hysterectomy (86.67%) followed by laparoscopic hysterectomy (8.57%) and vaginal hysterectomy (4.76%). Differential probability of Hysterectomy as per background characteristics To find out the differential probability of age at hysterectomy, Kaplan Meier curve (Fig. 3) was drawn for socio-demographic characteristics. Probability of early hysterectomy was observed among poor (BPL), illiterate, rural and OBC women. It was observed that the participants from rural areas were more susceptible and prone to early hysterectomy as they are not conversant about post-surgical health consequences, besides that they were misguided by the health professionals to undergo hysterectomy even though it was not required and the condition and can be treated with appropriate medication. It is apparent from K-M curve that Schedule Caste and Schedule Tribe had delayed hysterectomy because they primarily prefer home treatment and avoid approaching to doctors. Respondents who were well educated or completed basic education were probably found to have hysterectomy at later age due to awareness about post-surgical health consequence and avoid undergoing any surgery unless the condition is uncontrolled. It was also noticeable that the probability of hysterectomy was delayed among richer participants and urban dwellers, as they have easy availability of medical facilities and they avail treatment, when it can be treated; whereas the rural and poor peasant delay the treatment until the condition get worst. The urban and rich participants have practice to consult a single doctor (family doctor) for longer duration and continuous treatment; hence the problems are taken care properly and well in advance. Determinants of Hysterectomy Table 4 Odds Ratio showing the Estimation of Vulnerability for Underwent Hysterectomy: Estimate for Age at Hysterectomy Odds Ratio (CI 95%) For cohort Age at Menarche 1.72 (0.74–3.95) ≤ 14 1.23 (0.87–1.74) ≥ 15 0.71 (0.43–1.17) For cohort Age at Marriage 1.12 (0.49–2.56) ≤ 18 years 1.05 (0.74–1.48) ≥ 19 years 0.93 (0.57–1.50) For cohort Age at First Pregnancy 1.12 (0.49–2.54) ≤ 20 1.05 (0.73–1.51) ≥ 21 0.93 (0.59–1.47) For cohort Total Number Of Pregnancy 0.82 (0.28–2.38) ≤ 4 0.96 (0.79–1.16) ≥ 5 1.16 (0.49–2.77) To find out the determinants of hysterectomy, odds ratio was calculated and displayed in the Table 4 . It is evident that respondents who had attained early menarche (≤ 14 years of age) were higher odds of undergoing hysterectomy (OR = 1.23, 0.87–1.74) than respondents who had delayed menarche (≥ 15 years of age) (OR = 0.71, 0.43–1.17). Moreover, the respondents who had early marriage (≤ 18 years of age) had a higher probability of hysterectomy at an early age (OR = 1.05, 0.74–1.48) whereas; for respondents who had marriage ≥ 19 years of age, the odds were less (OR = 0.93, 0.57–1.50). Similarly early first pregnancy at the age of 20 years or earlier had higher odds of undergoing hysterectomy (OR = 1.05, 0.73–1.51) as compared to the respondents who had first pregnancy at a later age i.e. ≥ 21 years (OR = 0.93, 0.59–1.47). Further, higher number of pregnancies i.e. ≥ 5 also have a higher risk for undergoing hysterectomy (OR = 1.16, 0.49–2.77) than the respondents who had less than 4 or 4 pregnancies (OR = 0.96, 0.79–1.16). Post-Hysterectomy Indicators Women underwent hysterectomy experience numerous long term and short term health problems which is displayed through a column graph (Fig. 4). It is evident that majority of the respondent feel Weakness (91.43%) after undergoing hysterectomy, whereas 77.14% of respondent were suffering from Backache. Another major problem was improper Sleep (64.76%) followed by sagginess at lower abdomen after surgery (62.86%), around half of the respondent faced abdominal distension (accumulation of gas/fluid) (53.33%) and Urinary incontinences (52.38%). Urinary tract infection (UTI) was also reported by 41.90% of the respondents. Other problems were: osteoporosis (Weak Bones) (32.38%), problem in passing urine (18.10%), urinary retention (Unable to empty all the urine) (12.38%), wound disruption (reopen of surgery) (11.43%). A few of the respondent face problems of bladder disturbances (urinate that may be difficult to control) (9.52%), bowel disturbances (Diarrhea/ constipation) (6.67%), bowel injury (during surgery ) (5.71%), fever (4.76%), surgical site infection (4.76%), deep vein thrombosis (blood clot forms in a deep vein) (4.76%), cardiovascular disease (4.76%), pulmonary embolism (blockage in one of the pulmonary arteries) (1.90%), thromboembolism disease (blood clot that causes an obstruction) (1.90%) and Fistula (abnormal connection between the organs) (1.90%). Discussion Hysterectomy is a biological and social problem leading to disparity among race, religion, region and socio-economic status (Anne and Kasper, 1985) 18 . As it is apparent that illness is a social state and health professionals of the society decide which type of illness and how it can cured, they use diplomatic talking, in contrast, patients who are ill have no acquaintance to it, and the situation makes them completely dependent on the health care professionals and end up highly reliant on decisions that the health care professionals provide them (Anne and Kasper, 1985) 18 . Hysterectomy became a controversial issue at the beginning of the 19th century, when a prominent gynecologist of the time, Diana Scully has advertised the surgical technique. Now a day, it is common among the women of 15 to 49 years of age, while the statistical prevalence of hysterectomy has decreased with ageing (Anne and Kasper, 1985) 18 . Hysterectomy is common among both rural and urban women despite the fact that menstruation is unclean, stigmatized and unacceptable in the country like India. During menstruation a woman cannot perform any rituals, prohibited from entering the kitchen, use rags as absorbent during menstruation, which makes them feel uncomfortable and prohibit the capacity to work as the majority of the rural women engaged in agricultural work, lift heavy thing and so on. Hence, as a result undergoing hysterectomy was an easy solution and the immediate substitute to all the troubles of menstruation. Further, private hospitals and health professionals also encourage them to undergo hysterectomy (Desai, 2011) 19 . According to Meilahn, (1989) 20 there was a significant difference on the basis of age at hysterectomy, ethnic affinity, residence (rural/urban), educational status and economic profile. Another study have also reported that race, education, caste, religion age and parity of the women has an association with the age at hysterectomy among the women India (Shekhar et al., 2019) 21 . Similarly in the present study, the determinants of hysterectomy were investigated which are: early marriage, low level of education, early age at menarche, early age at first pregnancy, higher number of pregnancies and residence (Rural). Study conducted by Byles et al. (2000) 22 and Chen et al. (2017) 23 have reported that factors like residence, low education status, marriage and number of children were more were significantly associated with undergoing hysterectomy similar finding was also observed in the present study that early marriage (< 15 year of age), low education and ≥ 5 pregnancies lead to higher chances of undergoing hysterectomy. The probability of undergoing hysterectomy at early age was found associated with ethnic origin, education and economic status. Here, the women belonging to poor economic status, particular ethnic affinity i.e. OBCs were found to undergone hysterectomy in early age as compared to Schedule Castes (SCs) and Schedule Tribe (ST). Similar findings were also reported by Singh et al. (2021). 24 Further, it was found that the illiterate women were undergone hysterectomy in early age as compared to their well educated counterparts. Respondent who were from poor economic background (BPL) and living in rural areas with low income have higher probability to undergoing hysterectomy; similar findings were reported by Gartner et al., (2018) 25 ; Kumari and Kundu, (2022). 26 A study among the women of Germany also supported the finding of the present study that the prevalence of hysterectomy was higher for poor educational qualification (Stang et al. 2014). 27 In the present study almost half of the respondents have underwent hysterectomy in between 30 to 40 years of age (47.60%). Similar findings were reported by Dharmalingam and Dickson (2000) 28 and Meilahn (1989) 20 according to them the majority of the women had undergone hysterectomy between 35–50. In the present study mean age at hysterectomy was found to be 38.09 ± 6.59 years of age whereas it varies from 35.8 to 50.5 in other studies conducted by Desai et.al. (2011) 29 , Sievert (2018) 30 and Casarin et al. (2020). 31 In the present findings, it was observed that common technique among most of the respondent was abdominal hysterectomy with increased risk for major health complications like Weakness (91.43%), improper Sleep (64.76%), abdominal distension (53.33%) and Urinary incontinences (52.38%) similar findings were also reported by Hakim (2004) 32 as they found that large number of participants undergone abdominal hysterectomy rather than vaginal and radical hysterectomy and most of them have developed numerous health complication. Additionally, a study conducted by Zhang, (2023) 33 among the Chinese women found that abdominal radical hysterectomy and robot-assisted radical hysterectomy was the safest procedure for caring out hysterectomy with less health complications. According to the findings of the present study subtotal hysterectomy was common type among the rural and urban respondents. The major cause of hysterectomy was excessive menstrual bleeding (87%) and frequent menstruation (49.52%). In contrary, based on the literature total hysterectomy was found in larger portion among the women in Greece and, the south eastern region of Europe. The reason behind the hysterectomy was problem in uterus including placental hemorrhage (73.3%) and uterine atony (26.6%) reported by Christopoulos et al. (2011). 34 In the present study, excessive menstrual bleeding (82.86%), frequent menstruation (49.52%), Uterus infection (37.14%), Ovarian tumor or cyst (17.14%), Fibroid (14.29%), Cancer (11.43%), Uterus hemorrhage (8.57%), Ossification (3.81%), Ovarian Stone (2.86%), Urethral injury (1.90%) and Bowel injury (1.90%) were reasons for hysterectomy. Many other studies have widely reported similar reason for undergoing hysterectomy for example, Singh and Arora (2008) 35 have reported excessive menstrual bleeding, fibroids/cysts, uterine disorders, uterine prolapsed as a major cause of hysterectomy. Additionally Learman (2007) 36 has identified the common reasons including fibromatosis, endometrosis, pelvis organ prolapsed, abdominal uterine bleeding and endometrial hyperplasia for hysterectomy. Similar results were also observed by Singh and Govil (2021) 37 that the common reason for undergoing hysterectomy was being diagnosed with excessive menstrual bleeding, fibroids/cysts, uterine disorder, uterine prolapsed. Kumari and Kundu (2022) 26 have reported excessive menstrual bleeding, fibroids/cysts, uterine disorder, cancer, uterine prolapsed, severe post-partum hemorrhage and cervical discharge. Settnes and Jorgensen (1996) 38 have reported bleeding disorder and uterine fibroids was the two major reason undergoing hysterectomy. Another consistent observation was analyzed by (Desai et al., 2023) 39 that the common reason for underwent hysterectomy was excessive menstrual bleeding (65.7%) and uterine prolapsed (29.6%) among women from Andhra Pradesh and Panjab. On the basis of NFHS-4 and NFHS-5 Singh, (2024) 40 has revealed that highest cases of hysterectomy was among the residence of Andhra Pradesh, Telangana and Bihar. It was also evident that respondents from urban areas had high number hysterectomy than the women from rural areas. The rationale for the hysterectomy was excessive menstrual bleeding, fibroids, uterine disorder, post partum hemorrhage, cervical discharge, uterine prolapsed and cancer, these findings corroborate with the present investigation that the prevalence of hysterectomy was high among the respondents from urban residence (57.10%). Conclusion The escalating prevalence of hysterectomy is a trend in contemporary society. In a state like Chhattisgarh; migration from rural to urban is increasing with predominant rural culture. As per finding of present study a total of 57.10% of urban and 42.90% of rural women from the district Bilaspur had undergone Hysterectomy. The dominance of subtotal hysterectomy along with abdominal procedures was common. The study clearly reveals that hysterectomy is associated with poverty, illiteracy and ethnic affinity Major reasons for hysterectomy were excessive bleeding, frequent menstruation and uterus infection. Additionally, early puberty, early nuptials as well as first pregnancy was also found associated with hysterectomy. Further the probability of hysterectomy was also increases with the increase in the number of pregnancies. The findings shows that clinical issues, physiological symptoms and reproductive history have positive association with hysterectomy among both rural and urban women. The increasing prevalence of hysterectomy is also strongly determined due to profit making attitude of health practitioners. The mitigation strategy should be focused on poverty elimination, female education and awareness among women through healthcare initiatives. Declarations Acknowledgment: The authors express gratitude to the respondents who have eagerly provided information for this study. Authors are also thankful to the authorities of Dr, Harisingh Gour Vishwavidyalaya (A Central University), Sagar, Madhya Pradesh, India. Funding: The study is part of doctoral work which was supported by Dr. Harisingh Gour Vishwavidyalaya (A Central Uviversity), Sagar, Madhya Pradesh, India by granting fellowship to the first author. Conflict of Interest: There is no conflict of interest. Ethical Approval: This study is approved by Institutional Ethical Committee (IEC) of Dr. Harisigh Gour Vishwavidyalaya (A Central University), Sagar, Madhya Pradesh, India, vide Approval Number: DHSGV/IEC/2022/12 Notes on contributors: The study was designed and planned by SS under the supervision of RKG. Data collection, digitization, analyse as well as preparation of first draft was carried out by SS. The manuscript is thoroughly revised by RKG. Both the author read and approved the final draft. References Hsia, J. et al. 2003. Usefulness of prior hysterectomy as an independent predictor of Framingham risk score (The Women’s Health Initiative). American Journal of Cardiology ; 92 (3): 264–269. Bala, S., M.L.S. Prabha, G. Sudeera. 2017. Menopausal problems of urban postmenopausal women of Hyderabad. The Journal of Community Helath Management ; 4: 170–174. Nilangi S. 2015. 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Scientific Reports , 13 (1), 14569. https://doi.org/10.1038/s41598-023-41863-2. Kumari, P., J. Kundu. 2022. Prevalence, socio-demographic determinants, and self-reported reasons for hysterectomy and choice of hospitalization in India. BMC Women’s Health , 22 (1), 514. https://doi.org/10.1186/s12905-022-02072-7 Nurfauzia, Y.P. 2023. Incidence, indications, risk factors, and outcomes of emergency peripartum hysterectomy worldwide: a systematic review, Journal of Advance Research in Medical & Health Science, N. N. Publication, 9(8), ISSN: 2208-2425, https://doi.org/10.53555/nnmhs.v9i8.1791 Yuk, J.S., S.-W. Yang, S.H. Yoon, M. H. Kim, Y.S. Seo, Y. Lee, , J. Kim, K. Yang., G. Gwak, H. Cho. 2023. The increased risk of colorectal cancer in the women who underwent hysterectomy from the South Korean National Health Insurance Database. BMC Women’s Health , 23 (1), 519. https://doi.org/10.1186/s12905-023-02642-3 Tebeu P M, Tayou R, Antaon J S S, Mawamba Y N, Koh V M, Ngou-MveNgou J P.2019. Clinical determinants of vaginal and abdominal hysterectomy for benign conditions at the University Teaching Hospital, Yaounde-Cameroon. J West Afr Coll Surg ;9:1-7. Elisabeth A. Erekson, Deanna K. Martin, and Elena S. Ratner, M 2013. Menopause: The Journal of The North American Menopause Society, 20(1),110/114, 10.1097/gme.0b013e31825a27ab Kansaria, H. J., T. Chouhan .2023. Study of Post-hysterectomy Vault Prolapse and Surgical Management. The Journal of Obstetrics and Gynecology of India , 73 (S1), 124–129. https://doi.org/10.1007/s13224-023-01757-9 Shekhar, C., B. Paswan, A. Singh. 2019. Prevalence, sociodemographic determinants and self-reported reasons for hysterectomy in India. Reproductive Health , 16 (1), 118. https://doi.org/10.1186/s12978-019-0780-z Mudashi, P., Shivanagappa, M,. Veerabhadrappa v.K., Madhumitha Mahesh. Emergency peripartum hysterectomy: A five year study from a tertiary care hospital in Mysore, South India. Int J Clin Obstet Gynaecol 2019;3(1):159-161. DOI: 10.33545/gynae.2019.v3.i1c.28 Meher, T. and Sahoo, H. 2019. Regional pattern of hysterectomy among women in India: Evidence from a recent large scale survey, Women & Health , 10.1080/03630242.2019.1687634 Anne S., Kasper, M.A. 1985. Hysterectomy as Social Process, Women & Health , 10:1, 109-128, DOI: 10.1300/J013v10n01_10 Desai S, Campbell O, Sinha T, Mahal A & Cousens S. Incidence and determinants of hysterectomy in a low-income setting in Gujarat , India. Health Policy and Planning 2017; 32 (1): 68–78. Meilahn E.N., K.A. Matthews, S.F. Kelse, G. Egeland. 1989. Characteristics of women wit hysterectomy. Maturitas ; 11: 319–329. Shekhar, C., Paswan, B., & Singh, A. 2019. Prevalence, socio demographic determinants and self-reported reasons for hysterectomy in India. Reproductive Health , 16 (1), 118. https://doi.org/10.1186/s12978-019-0780-z Byles J.E., G. Mishra, M. Scho. 2000. Factors associated with hysterectomy among women in Australia Factors associated with hysterectomy among women in Australia. Health & Place ; 6 : 301-308. Chen I, M.R. Wise, S. Dunn, G. Anderson, N. Degani, G. Lefebvre,A.S. Bierman. 2017. Social and Geographic Determinants of Hysterectomy in Ontario : A Population-Based Retrospective Cross-Sectional Analysis. Gynaecology ; 1–9 Singh, A., D. Govil. 2021. Hysterectomy in India : Spatial and multilevel analysis. Women’s Health ; 17 : 1–13. Gartner, D.R., K.M. Doll, R.A. Hummer, W.R. Robinson, C. Hill. 2018.HHS Public Access. South Med J ; 111(10): 585–590. Kumari, P., J. Kundu. 2022. Prevalence, socio-demographic determinants, and self-reported reasons for hysterectomy and choice of hospitalization in India. BMC Women’s Health , 22 (1), 514. https://doi.org/10.1186/s12905-022-02072-7 Stang, A., A. Kluttig, S. Moebus, H. Völzke, K. Berger, K. H. Greiser, D. Stöckl, K.-H. Jöckel, C. Meisinger. 2014. Educational level, prevalence of hysterectomy, and age at amenorrhoea: A cross-sectional analysis of 9536 women from six population-based cohort studies in Germany. Dharmalingam A, I. Pool, J. Dickson. 2000. Biosocial Determinants of Hysterectomy in New Zealand. American Journal of Public Health ; 90 (9), 1455–1458. Desai S., Sinha, T. & Mahal, A. 2011. Prevalence of hysterectomy among rural and urban women with and without health insurance in Gujarat, India, Reproductive Health Matters , 19:37, 42-51, DOI:10.1016/S0968-8080(11)37553-2 Sievert L.L, L. Murphy, L.A. Morrison, A.M. Reza, D.E. Brown. 2013. Age at menopause and determinants of hysterectomy and menopause in a multi-ethnic community: The Hilo Women’s Health Study. Maturitas ; 76 (4): 334–341. Casarin J. 2020. Post-traumatic stress following total hysterectomy for benign disease : an observational prospective study. Journal of Psychosomatic Obstetrics & Gynecology ; 1–7. Hakim R.B., M.B. Benedict, N.J. Merrick. 2004. Quality of Care for Women Undergoing a Hysterectomy : Effects of Insurance and Race / Ethnicity. Research and Practice ; 94 (8): 1399–1405. Zhang, N.2023. Survival outcomes of abdominal radical hysterectomy, laparoscopic radical hysterectomy, robot-assisted radical hysterectomy and vaginal radical hysterectomy approaches for early-stage cervical cancer: A retrospective study. Christopoulos, P., D. Hassiakos, A. Tsitoura, , K. Panoulis, K. Papadias, N. Vitoratos. 2011. Obstetric hysterectomy: A review of cases over 16 years. Singh, A., A.K. Arora. 2008. Why Hysterectomy Rate are Lower in India. Indian Journal of Community Medicine ;33(3):196–197. Learman, L.A. 2007. Predictors of Hysterectomy in Women with Common Pelvic Problems : A Uterine Survival Analysis. American College of Surgeons ; 204 (4): 633–641. Singh, A., D. Govil. 2021. Hysterectomy in India : Spatial and multilevel analysis. Women’s Health ; 17 : 1–13. Settnes, A. 1996. Hvsterectomv in a Danish cohort . Prevalence , iniidence and socio-demographic characteristics. Acta Obstetricia et Gynecologica Scandinavica ; 75 : 10–13. Desai, S., , R. J. Singh, D. Govil, D. Nambiar, A. Shukla, H. H. Sinha, , Ved, R., Bhatla, N., & Mishra, G. D. (2023). Hysterectomy and women’s health in India: Evidence from a nationally representative, cross-sectional survey of older women. Women’s Midlife Health , 9 (1), 1-10. https://doi.org/10.1186/s40695-022-00084-9 Singh, S. K. 2024. Key drivers of hysterectomy among women of reproductive age in three states in India: Comparative evidence from NFHS-4 and NFHS-5 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4728495","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":330489944,"identity":"e028978d-9cc0-4ff1-aabb-a8bcf2e1f6cf","order_by":0,"name":"Suman Sahu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYBACCQkIXd/P3gCkDCyI18I4s+cASIsECVo2zEgA8wlrkZzd/kzqRs0dZgPJ51c3/CiQYOBv707Aq0Va5oyZdM6xZ2zm0jllN3uADpM4c3YDXi1yEjls0jlsh3ksZ+ek3eABajGQyCWkJf2ZdM6/wxIGN8+k3fxDjBZpiQQz6dy2wwYGN9iP3SbKFsk5Z4ytc/sOJ0j25LDdljGQ4CHoF4nb7Q9v53w7nMDPfvzZzTd/bOT423vxa0ECPAZgkljlIMD+gBTVo2AUjIJRMIIAALYXRs7NOFuzAAAAAElFTkSuQmCC","orcid":"","institution":"Dr. Hari Singh Gour University","correspondingAuthor":true,"prefix":"","firstName":"Suman","middleName":"","lastName":"Sahu","suffix":""},{"id":330489945,"identity":"060c64d2-aaa8-42ea-93ba-f70bb6d9da05","order_by":1,"name":"Rajesh K. Gautam","email":"","orcid":"","institution":"Dr. Hari Singh Gour University","correspondingAuthor":false,"prefix":"","firstName":"Rajesh","middleName":"K.","lastName":"Gautam","suffix":""}],"badges":[],"createdAt":"2024-07-12 06:59:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4728495/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4728495/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":61978660,"identity":"b7731cfd-b453-4fe3-b7c1-1614573f9aa5","added_by":"auto","created_at":"2024-08-07 19:48:31","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":22052,"visible":true,"origin":"","legend":"\u003cp\u003eStandard Deviation and Mean for the Selected Age Variables\u003c/p\u003e","description":"","filename":"11.png","url":"https://assets-eu.researchsquare.com/files/rs-4728495/v1/26547d8bdf200be61d8100b7.png"},{"id":61978658,"identity":"504f92ba-37dd-4f85-a253-f11d69ac364e","added_by":"auto","created_at":"2024-08-07 19:48:31","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":28100,"visible":true,"origin":"","legend":"\u003cp\u003eReasons for undergoing hysterectomy\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4728495/v1/76d6b3035a0eb2f56c323f99.png"},{"id":61979019,"identity":"dc2e3d43-3635-442e-bf36-ea8836d5ea7e","added_by":"auto","created_at":"2024-08-07 19:56:31","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":311618,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan Meier curve for age at hysterectomy and its probability of occurrence\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4728495/v1/b872c0e05320a6271902a99e.png"},{"id":61978661,"identity":"c0771acc-d8bf-4dea-8a8b-a73ae901f16d","added_by":"auto","created_at":"2024-08-07 19:48:31","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":170446,"visible":true,"origin":"","legend":"\u003cp\u003ePost-Hysterectomy Complications and Experiences\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-4728495/v1/bc407f45635dfcba85f324a9.png"},{"id":61978659,"identity":"1d81bd08-0740-4db3-92af-fb770c1ee8d9","added_by":"auto","created_at":"2024-08-07 19:48:31","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":95939,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Material and Method section.\u003c/p\u003e\n\u003cp\u003eFlow Diagram for Sampling Process\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4728495/v1/6f79086b5a08603a8efa23fe.png"},{"id":62232008,"identity":"12dca622-bb94-4540-9aa9-d6b51d293dd2","added_by":"auto","created_at":"2024-08-11 19:46:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1348058,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4728495/v1/410fc159-aca0-46e6-a795-cf04fe31f5ad.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Socio-Demographic and Related Indicators of Underwent Hysterectomy: A Cross-Sectional Study Conducted among the Women of District Bilaspur (CG), India","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHysterectomy is a clinical removal of the uterus including female reproductive part i.e. fallopian tube, ovaries and cervix, the term is derived from Greek word \u0026lsquo;hysteros\u0026rsquo; which means \u0026lsquo;uterus\u0026rsquo;. The numbers of hysterectomies are increasing day by day with long-term effect on body functioning during post-hysterectomy life. Advancement of medical science and newer technologies has also associated with the increasing prevalence of hysterectomy in contemporary world (Hasia, 2003).\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Simultaneously, hysterectomy is also related to privatization of health services and profit-making by health professionals (Bala, et al., 2015).\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eBiological constitution of women\u0026rsquo;s body and their reproductive organ makes their body more sensible and disquiet which need supplementary concern and proper supervision. Lack of proper education among women makes them more susceptible to health issues related to reproductive health, which leads to deprived health status (Nilangi, 2015).\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Life style of women has a great impact on the reproductive health of women leading to increase in cardiovascular disease, disorder related to sleep, digestion and bad temper. Experience during pre and post hysterectomy varies from different racial, ethnic groups and geographical areas among the women. Physical activity and dietary habit may also influence the overall health indication (Silva, et al., 2021).\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eProblems become manifold with any kind of surgery. When we talk about uterus surgery the complication rises more as bowel, nerves and vessels are closely related to uterus, and they are interrelated with each other to perform many life processes (Bahadur et al., 2021).\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Women undergoing hysterectomy face a major and sudden change in the body relating to the physical, psychological, emotional and hormonal changes (Essa, 2017).\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Post-hysterectomy health concerns have also been severe during the last few years, going through multiple health issues. Change in attitude among the respondents included negative thoughts and feelings of missing organs or emptiness within the body (Turan et al., 2024).\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eEndometriosis, fibroids and heavy menstrual bleeding, severe pelvic pain, polycystic ovaries and uterus prolapse were some of the commonly reported indications for women who underwent hysterectomy (Rout et al., 2023; Kumari \u0026amp; Kundu, 2022).\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e According to a worldwide study among 22 countries by Nurfauzia, (2023)\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e placental pathology, placental accerta spectrum, uterine atony and uterine rupture are common problems leading to hysterectomy. It was evident from a study conducted among South Korea that colorectal cancer was a reason for undergoing hysterectomy as compared to non-hysterectomy women (Yuk et al., 2023).\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e A study carried out by Tebeu (2019)\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e in Cameroon in South Africa, reported that uterine fibroid, cervical dysplasia, endometrial hyperplasia and pelvis organ prolapsed were the main reason of hysterectomy among women. Oophorectomy among women effect their life in every way due to reduction in progesterone and estrogen hormones including hormonal changes, reduction in sensuality and decrease in intelligence (Erekson, 2013)\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. In this way there are several studies around the globe mentioned reasons for Hysterectomy.\u003c/p\u003e \u003cp\u003eStudies have been conducted in India too, with the objectives to understand the indications and probable reasons for hysterectomy. In studies conducted in Mumbai, it was observed that women who had undergone hysterectomy were at utmost threat of having vault prolapsed; the number of pregnancies over and beyond increased the chances of vault propulsion (Kansaria \u0026amp; Chouhan, 2023; Shekhar et al., 2019).\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Another study from South Indian state, Karnataka during the year 2014 to 2018 it was observed that 1041 women underwent postpartum hysterectomy out of 20405 deliveries (Mudashi, 2019)\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAccording to the study conducted by Meher and Sahoo (2019)\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e, based on NFHS-4 it was observed that excessive menstrual bleeding, fibroids, uterine disorder were the common indication for hysterectomy. Many other studies were conducted in Chhattisgarh associated to reproductive health. Based on the literature updated, there is no any such study especially from Bilaspur district of Chhattisgarh state, hence a micro level study was conducted to find out the reason and socio-demographic factors of hysterectomy among the women underwent hysterectomy from the district Bilaspur, Chhattisgarh, India.\u003c/p\u003e"},{"header":"Material and Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eResearch Design:\u003c/h2\u003e \u003cp\u003eThis was a cross-sectional and descriptive study based on three main stages i.e. 1. Selection of the Study Area, 2. Field work and Data Collection, 3. Data analysis and Interpretation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStratification of the Study Universe:\u003c/h2\u003e \u003cp\u003eOn the basis of review of literature the district Bilashpur of the state of Chhattisgarh was selected as there was reporting of hysterectomy without the consent of the patients. In the next step rural and urban areas were selected randomly from the map to ensure the coverage of the district headquarter i.e. Bilashpur town and villages were selected from two tehsils i.e. Masturi and Bilha. A total of 20 villages, 10 from each of the tehsil were selected, similarly, 10 wards from Bilaspur Municipal Corporation of Bilaspur district were selected as per the need for the present study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSample Selection and Sample Size:\u003c/h2\u003e \u003cp\u003eThe respondents were recruited from a total of 800 households, a sub-sample of 105 women who had undergone hysterectomy during November 2022 to June 2023 was considered for present analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData Collection:\u003c/h2\u003e \u003cp\u003eA culturally validated semi-structured interview schedule was used for data collection. The interview schedule was mainly divided into three parts the first section encompasses questions related to socio-demographic characteristics and reproductive history, the subsequent section was accounting self-reported indication for undergoing hysterectomy and the third part of the interview schedule covered variables related to post-hysterectomy indicators and experience of the respondents.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eDescription of the Variables:\u003c/h2\u003e \u003cp\u003eThe information a series of socio-demographic variables, viz. current age, age at menarche, age at marriage, age at which underwent hysterectomy, educational status, marital status, years of education, place of residence, economic status, ethnic category and occupation were collected. The reason for undergoing hysterectomy was self-reported. Information on post hysterectomy complication and experiences were also collected.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis:\u003c/h2\u003e \u003cp\u003eStatistical analysis of the data was done by using MS Excel and SPSS Software (version 25). Kaplan Meier curve was to understand the probability of surviving after undergoing hysterectomy based on the socio-demographic characteristics i.e. education, economic status, category and place of residence.\u003c/p\u003e \u003cp\u003eThe variability of the selected variables were calculated using one-way ANOVA keeping age at hysterectomy as dependent variable.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInclusion Criteria\u003c/strong\u003e \u003cp\u003eFor present study, the data was filtered and only those women were included who had undergone hysterectomy and currently\u0026thinsp;\u0026le;\u0026thinsp;30 years of age.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eExclusion Criteria\u003c/strong\u003e \u003cp\u003eWomen who did not undergo hysterectomy and attained menopause were excluded from the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eFlow Diagram for Sampling Process:\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cdiv id=\"Sec10\"\u003e\n \u003ch2\u003eSocio-demographic characteristics\u003c/h2\u003e\n \u003cp\u003eSocio-demographic information of the respondents is presented in Table\u0026nbsp;\u003cspan\u003e1\u003c/span\u003e. It is apparent that most of the women who had undergone hysterectomy belong to 41 to 60 years of age (68.57%), whereas 16.19% belong to below 40 years of age and 15.24% were \u0026ge;\u0026thinsp;61years of age. The average of current age was 50.95\u0026thinsp;\u0026plusmn;\u0026thinsp;9.12 (Fig.\u0026nbsp;\u003cspan\u003e1\u003c/span\u003e)\u003c/p\u003e\n \u003cp\u003eAmong these women, 81.90% attained education for \u0026le;\u0026thinsp;10 years and only few (18.10%) were attained education for \u0026ge;\u0026thinsp;11 years. It is evident that 20% were illiterate, whereas 37.14% were completed their basic and primary education, followed by Middle and secondary education (25.71%), and higher secondary and above (17.14%).\u003c/p\u003e\n \u003cp\u003eA total of 62.9% of respondent have attained menarche\u0026thinsp;\u0026le;\u0026thinsp;14 years of age and 37.15% attained late menarche after the age of \u0026ge;\u0026thinsp;15 years further the mean age at menarche was 14.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34Years (Fig.\u0026nbsp;\u003cspan\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eOut of the total number of respondents 59% were married before 18 years of the age and 41% of women were married after the age of 18 years. It was observed that a total of 82.86% of women were married, whereas 14.29% were widow and 2.86% were unmarried. Average age at marriage was 18.03\u0026thinsp;\u0026plusmn;\u0026thinsp;3.80 years (Fig.\u0026nbsp;\u003cspan\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eThe Table\u0026nbsp;\u003cspan\u003e1\u003c/span\u003e also revealed that 57.10% of the respondents were from urban area and 42.90% were from rural area. Most of the respondents (82.86%) belongs poor socio-economic status as they live below to poverty line (BPL), and only 17.14% were above poverty line (APL). The mean age at Hysterectomy was 38.09\u0026thinsp;\u0026plusmn;\u0026thinsp;6.59 years (Fig.\u0026nbsp;\u003cspan\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eIt is apparent from composition of the respondents that 36.19% belong to Other Backward Class (OBC), 35.24% were General castes whereas Schedule Caste and schedule tribe includes only 25.71% and 2.86% respectively. As it is common in India, 94.29% of the respondents were housewives and only 5.71% were working women.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eSocio- Demographic profile of the respondents.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCurrent Age (Years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ef\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e16.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41\u0026ndash;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e40.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51\u0026ndash;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e27.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e15.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge at Menarche\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge at Marriage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge at Hysterectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e20.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e47.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e32.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBasic and Primary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e37.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMiddle and Secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e25.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigher Secondary and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e17.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e82.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e14.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eYears of Education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e81.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e18.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of Residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e57.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e42.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEconomic Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAPL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e17.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBPL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e82.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnic Category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGeneral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e35.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e36.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e25.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation Status of Women\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHouse Wife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e94.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWorking Women/Job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e5.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\"\u003e\n \u003ch2\u003eDifferential age at Hysterectomy\u003c/h2\u003e\n \u003cp\u003eThere is variation in the age at hysterectomy hence to find out the variability between age at hysterectomy and socio-demographic variables, F value were calculated using one-way-ANOVA and the findings were displayed in Table\u0026nbsp;\u003cspan\u003e2\u003c/span\u003e. It is apparent that there were significant variation between age at hysterectomy and residence type (F\u0026thinsp;=\u0026thinsp;3.994*), ethnic category (F\u0026thinsp;=\u0026thinsp;3.935**), age at first pregnancy (F\u0026thinsp;=\u0026thinsp;2.270*), age at marriage (F\u0026thinsp;=\u0026thinsp;1.921*) and current age (F\u0026thinsp;=\u0026thinsp;1.804*) at p\u0026thinsp;\u0026le;\u0026thinsp;0.05, although, the variations were not very high, it was only 1\u0026ndash;4%; whereas there was no significant variation between age at hysterectomy and education, total years of education and marital status.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eOne-way ANOVA for age at hysterectomy and socio-demographic variables\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSum of Squares\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean Square\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eResidence (Urban \u0026amp; Rural)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBetween Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e168.667\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e168.667\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.994\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u0026thinsp;\u0026le;\u0026thinsp;0.05*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithin Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4349.561\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4518.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eEthnic Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBetween Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e472.789\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e157.596\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u0026thinsp;\u0026le;\u0026thinsp;0.01**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithin Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4045.439\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4518.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eAge at First Pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBetween Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e718.697\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89.837\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithin Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3799.531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.578\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u0026thinsp;\u0026le;\u0026thinsp;0.05*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4518.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBetween Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e276.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithin Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4242.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4518.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eAge at Marriage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBetween Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1233.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.537\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.921\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u0026thinsp;\u0026le;\u0026thinsp;0.05*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithin Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3285.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.760\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4518.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eCurrent Age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBetween Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1641.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.804\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u0026thinsp;\u0026le;\u0026thinsp;0.05*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithin Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2876.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4518.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eTotal Year of Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBetween Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e981.780\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.452\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.647\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithin Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3536.448\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.725\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4518.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBetween Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.553\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.776\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.496\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithin Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4474.676\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.869\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4518.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003ep\u0026thinsp;\u0026le;\u0026thinsp;0.05, significant at the 0.05 level (*)\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003ep\u0026thinsp;\u0026le;\u0026thinsp;0.01 significant at the 0.01 level (**)\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\"\u003e\n \u003ch2\u003eReason of Hysterectomy\u003c/h2\u003e\n \u003cp\u003eIn the present study an attempt was made to explore the reason for underwent hysterectomy (Fig.\u0026nbsp;2).\u003c/p\u003e\n \u003cp\u003eIt was found that majority of the respondent (87%) had trouble of excessive menstrual bleeding as the prime reason for hysterectomy. And, the second major cause was frequent menstruation (49.52%), followed by uterus infection (37.14%), ovarian tumor or cyst (17.14%), fibroid (14.29%), cancer (11.43%), uterus hemorrhage (8.57%) and other problems like ossification, ovarian stone, urethral injury and bowel injury together accounting 10.47%.\u003c/p\u003e\n \u003cdiv\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\"\u003e\n \u003ch2\u003eType and technique of Hysterectomy\u003c/h2\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eDistribution of respondents as per types and procedure of Hysterectomy\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eType of Hysterectomy\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1. Total Abdominal Hysterectomy (TAH)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2. Sub-total Hysterectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3. Abdominal hysterectomy with bilateral salpingo -oophorectomy (TAH-BSO)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTechnique for Hysterectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1. Abdominal Hysterectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2. Vaginal Hysterectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3. Laparoscopic Hysterectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eInformation related to type of hysterectomy was analyzed to understand which reproductive organ (fallopian tube, ovaries and cervix) was removed from the body along with uterus of the respondents. It is evident from Table\u0026nbsp;\u003cspan\u003e3\u003c/span\u003e that majority of the respondent (89.52%) underwent sub-total hysterectomy followed by TAH-BSO (6.67%) and very few of them underwent for the total abdominal hysterectomy (3.81%).\u003c/p\u003e\n \u003cp\u003eThe most common procedure for hysterectomy was abdominal hysterectomy (86.67%) followed by laparoscopic hysterectomy (8.57%) and vaginal hysterectomy (4.76%).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\"\u003e\n \u003ch2\u003eDifferential probability of Hysterectomy as per background characteristics\u003c/h2\u003e\n \u003cdiv\u003e\n \u003c/div\u003e\n \u003cp\u003eTo find out the differential probability of age at hysterectomy, Kaplan Meier curve (Fig.\u0026nbsp;3) was drawn for socio-demographic characteristics. Probability of early hysterectomy was observed among poor (BPL), illiterate, rural and OBC women.\u003c/p\u003e\n \u003cp\u003eIt was observed that the participants from rural areas were more susceptible and prone to early hysterectomy as they are not conversant about post-surgical health consequences, besides that they were misguided by the health professionals to undergo hysterectomy even though it was not required and the condition and can be treated with appropriate medication.\u003c/p\u003e\n \u003cp\u003eIt is apparent from K-M curve that Schedule Caste and Schedule Tribe had delayed hysterectomy because they primarily prefer home treatment and avoid approaching to doctors. Respondents who were well educated or completed basic education were probably found to have hysterectomy at later age due to awareness about post-surgical health consequence and avoid undergoing any surgery unless the condition is uncontrolled.\u003c/p\u003e\n \u003cp\u003eIt was also noticeable that the probability of hysterectomy was delayed among richer participants and urban dwellers, as they have easy availability of medical facilities and they avail treatment, when it can be treated; whereas the rural and poor peasant delay the treatment until the condition get worst. The urban and rich participants have practice to consult a single doctor (family doctor) for longer duration and continuous treatment; hence the problems are taken care properly and well in advance.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\"\u003e\n \u003ch2\u003eDeterminants of Hysterectomy\u003c/h2\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 4\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eOdds Ratio showing the Estimation of Vulnerability for Underwent Hysterectomy:\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEstimate for Age at Hysterectomy\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOdds Ratio (CI 95%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFor cohort Age at Menarche\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.72 (0.74\u0026ndash;3.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.23 (0.87\u0026ndash;1.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.71 (0.43\u0026ndash;1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFor cohort Age at Marriage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.12 (0.49\u0026ndash;2.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;18 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.05 (0.74\u0026ndash;1.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;19 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.93 (0.57\u0026ndash;1.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFor cohort Age at First Pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.12 (0.49\u0026ndash;2.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.05 (0.73\u0026ndash;1.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.93 (0.59\u0026ndash;1.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFor cohort Total Number Of Pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.82 (0.28\u0026ndash;2.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.96 (0.79\u0026ndash;1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.16 (0.49\u0026ndash;2.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eTo find out the determinants of hysterectomy, odds ratio was calculated and displayed in the Table\u0026nbsp;\u003cspan\u003e4\u003c/span\u003e. It is evident that respondents who had attained early menarche (\u0026le;\u0026thinsp;14 years of age) were higher odds of undergoing hysterectomy (OR\u0026thinsp;=\u0026thinsp;1.23, 0.87\u0026ndash;1.74) than respondents who had delayed menarche (\u0026ge;\u0026thinsp;15 years of age) (OR\u0026thinsp;=\u0026thinsp;0.71, 0.43\u0026ndash;1.17).\u003c/p\u003e\n \u003cp\u003eMoreover, the respondents who had early marriage (\u0026le;\u0026thinsp;18 years of age) had a higher probability of hysterectomy at an early age (OR\u0026thinsp;=\u0026thinsp;1.05, 0.74\u0026ndash;1.48) whereas; for respondents who had marriage\u0026thinsp;\u0026ge;\u0026thinsp;19 years of age, the odds were less (OR\u0026thinsp;=\u0026thinsp;0.93, 0.57\u0026ndash;1.50).\u003c/p\u003e\n \u003cp\u003eSimilarly early first pregnancy at the age of 20 years or earlier had higher odds of undergoing hysterectomy (OR\u0026thinsp;=\u0026thinsp;1.05, 0.73\u0026ndash;1.51) as compared to the respondents who had first pregnancy at a later age i.e. \u0026ge; 21 years (OR\u0026thinsp;=\u0026thinsp;0.93, 0.59\u0026ndash;1.47). Further, higher number of pregnancies i.e. \u0026ge; 5 also have a higher risk for undergoing hysterectomy (OR\u0026thinsp;=\u0026thinsp;1.16, 0.49\u0026ndash;2.77) than the respondents who had less than 4 or 4 pregnancies (OR\u0026thinsp;=\u0026thinsp;0.96, 0.79\u0026ndash;1.16).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\"\u003e\n \u003ch2\u003ePost-Hysterectomy Indicators\u003c/h2\u003e\n \u003cdiv\u003e\n \u003c/div\u003e\n \u003cp\u003eWomen underwent hysterectomy experience numerous long term and short term health problems which is displayed through a column graph (Fig.\u0026nbsp;4). It is evident that majority of the respondent feel Weakness (91.43%) after undergoing hysterectomy, whereas 77.14% of respondent were suffering from Backache. Another major problem was improper Sleep (64.76%) followed by sagginess at lower abdomen after surgery (62.86%), around half of the respondent faced abdominal distension (accumulation of gas/fluid) (53.33%) and Urinary incontinences (52.38%). Urinary tract infection (UTI) was also reported by 41.90% of the respondents. Other problems were: osteoporosis (Weak Bones) (32.38%), problem in passing urine (18.10%), urinary retention (Unable to empty all the urine) (12.38%), wound disruption (reopen of surgery) (11.43%). A few of the respondent face problems of bladder disturbances (urinate that may be difficult to control) (9.52%), bowel disturbances (Diarrhea/ constipation) (6.67%), bowel injury (during surgery ) (5.71%), fever (4.76%), surgical site infection (4.76%), deep vein thrombosis (blood clot forms in a deep vein) (4.76%), cardiovascular disease (4.76%), pulmonary embolism (blockage in one of the pulmonary arteries) (1.90%), thromboembolism disease (blood clot that causes an obstruction) (1.90%) and Fistula (abnormal connection between the organs) (1.90%).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eHysterectomy is a biological and social problem leading to disparity among race, religion, region and socio-economic status (Anne and Kasper, 1985)\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. As it is apparent that illness is a social state and health professionals of the society decide which type of illness and how it can cured, they use diplomatic talking, in contrast, patients who are ill have no acquaintance to it, and the situation makes them completely dependent on the health care professionals and end up highly reliant on decisions that the health care professionals provide them (Anne and Kasper, 1985)\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHysterectomy became a controversial issue at the beginning of the 19th century, when a prominent gynecologist of the time, Diana Scully has advertised the surgical technique. Now a day, it is common among the women of 15 to 49 years of age, while the statistical prevalence of hysterectomy has decreased with ageing (Anne and Kasper, 1985)\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHysterectomy is common among both rural and urban women despite the fact that menstruation is unclean, stigmatized and unacceptable in the country like India. During menstruation a woman cannot perform any rituals, prohibited from entering the kitchen, use rags as absorbent during menstruation, which makes them feel uncomfortable and prohibit the capacity to work as the majority of the rural women engaged in agricultural work, lift heavy thing and so on. Hence, as a result undergoing hysterectomy was an easy solution and the immediate substitute to all the troubles of menstruation. Further, private hospitals and health professionals also encourage them to undergo hysterectomy (Desai, 2011)\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAccording to Meilahn, (1989)\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e there was a significant difference on the basis of age at hysterectomy, ethnic affinity, residence (rural/urban), educational status and economic profile. Another study have also reported that race, education, caste, religion age and parity of the women has an association with the age at hysterectomy among the women India (Shekhar et al., 2019)\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Similarly in the present study, the determinants of hysterectomy were investigated which are: early marriage, low level of education, early age at menarche, early age at first pregnancy, higher number of pregnancies and residence (Rural).\u003c/p\u003e \u003cp\u003eStudy conducted by Byles et al. (2000)\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e and Chen et al. (2017)\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e have reported that factors like residence, low education status, marriage and number of children were more were significantly associated with undergoing hysterectomy similar finding was also observed in the present study that early marriage (\u0026lt;\u0026thinsp;15 year of age), low education and \u0026ge;\u0026thinsp;5 pregnancies lead to higher chances of undergoing hysterectomy.\u003c/p\u003e \u003cp\u003eThe probability of undergoing hysterectomy at early age was found associated with ethnic origin, education and economic status. Here, the women belonging to poor economic status, particular ethnic affinity i.e. OBCs were found to undergone hysterectomy in early age as compared to Schedule Castes (SCs) and Schedule Tribe (ST). Similar findings were also reported by Singh et al. (2021).\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFurther, it was found that the illiterate women were undergone hysterectomy in early age as compared to their well educated counterparts. Respondent who were from poor economic background (BPL) and living in rural areas with low income have higher probability to undergoing hysterectomy; similar findings were reported by Gartner et al., (2018)\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e; Kumari and Kundu, (2022).\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e A study among the women of Germany also supported the finding of the present study that the prevalence of hysterectomy was higher for poor educational qualification (Stang et al. 2014).\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn the present study almost half of the respondents have underwent hysterectomy in between 30 to 40 years of age (47.60%). Similar findings were reported by Dharmalingam and Dickson (2000)\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e and Meilahn (1989)\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e according to them the majority of the women had undergone hysterectomy between 35\u0026ndash;50. In the present study mean age at hysterectomy was found to be 38.09\u0026thinsp;\u0026plusmn;\u0026thinsp;6.59 years of age whereas it varies from 35.8 to 50.5 in other studies conducted by Desai et.al. (2011)\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e, Sievert (2018)\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e and Casarin et al. (2020).\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn the present findings, it was observed that common technique among most of the respondent was abdominal hysterectomy with increased risk for major health complications like Weakness (91.43%), improper Sleep (64.76%), abdominal distension (53.33%) and Urinary incontinences (52.38%) similar findings were also reported by Hakim (2004)\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e as they found that large number of participants undergone abdominal hysterectomy rather than vaginal and radical hysterectomy and most of them have developed numerous health complication. Additionally, a study conducted by Zhang, (2023)\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e among the Chinese women found that abdominal radical hysterectomy and robot-assisted radical hysterectomy was the safest procedure for caring out hysterectomy with less health complications.\u003c/p\u003e \u003cp\u003eAccording to the findings of the present study subtotal hysterectomy was common type among the rural and urban respondents. The major cause of hysterectomy was excessive menstrual bleeding (87%) and frequent menstruation (49.52%). In contrary, based on the literature total hysterectomy was found in larger portion among the women in Greece and, the south eastern region of Europe. The reason behind the hysterectomy was problem in uterus including placental hemorrhage (73.3%) and uterine atony (26.6%) reported by Christopoulos et al. (2011).\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn the present study, excessive menstrual bleeding (82.86%), frequent menstruation (49.52%), Uterus infection (37.14%), Ovarian tumor or cyst (17.14%), Fibroid (14.29%), Cancer (11.43%), Uterus hemorrhage (8.57%), Ossification (3.81%), Ovarian Stone (2.86%), Urethral injury (1.90%) and Bowel injury (1.90%) were reasons for hysterectomy. Many other studies have widely reported similar reason for undergoing hysterectomy for example, Singh and Arora (2008)\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e have reported excessive menstrual bleeding, fibroids/cysts, uterine disorders, uterine prolapsed as a major cause of hysterectomy. Additionally Learman (2007)\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e has identified the common reasons including fibromatosis, endometrosis, pelvis organ prolapsed, abdominal uterine bleeding and endometrial hyperplasia for hysterectomy. Similar results were also observed by Singh and Govil (2021)\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e that the common reason for undergoing hysterectomy was being diagnosed with excessive menstrual bleeding, fibroids/cysts, uterine disorder, uterine prolapsed. Kumari and Kundu (2022)\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e have reported excessive menstrual bleeding, fibroids/cysts, uterine disorder, cancer, uterine prolapsed, severe post-partum hemorrhage and cervical discharge. Settnes and Jorgensen (1996)\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e have reported bleeding disorder and uterine fibroids was the two major reason undergoing hysterectomy. Another consistent observation was analyzed by (Desai et al., 2023)\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e that the common reason for underwent hysterectomy was excessive menstrual bleeding (65.7%) and uterine prolapsed (29.6%) among women from Andhra Pradesh and Panjab.\u003c/p\u003e \u003cp\u003eOn the basis of NFHS-4 and NFHS-5 Singh, (2024)\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e has revealed that highest cases of hysterectomy was among the residence of Andhra Pradesh, Telangana and Bihar. It was also evident that respondents from urban areas had high number hysterectomy than the women from rural areas. The rationale for the hysterectomy was excessive menstrual bleeding, fibroids, uterine disorder, post partum hemorrhage, cervical discharge, uterine prolapsed and cancer, these findings corroborate with the present investigation that the prevalence of hysterectomy was high among the respondents from urban residence (57.10%).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe escalating prevalence of hysterectomy is a trend in contemporary society. In a state like Chhattisgarh; migration from rural to urban is increasing with predominant rural culture. As per finding of present study a total of 57.10% of urban and 42.90% of rural women from the district Bilaspur had undergone Hysterectomy. The dominance of subtotal hysterectomy along with abdominal procedures was common. The study clearly reveals that hysterectomy is associated with poverty, illiteracy and ethnic affinity Major reasons for hysterectomy were excessive bleeding, frequent menstruation and uterus infection. Additionally, early puberty, early nuptials as well as first pregnancy was also found associated with hysterectomy. Further the probability of hysterectomy was also increases with the increase in the number of pregnancies. The findings shows that clinical issues, physiological symptoms and reproductive history have positive association with hysterectomy among both rural and urban women. The increasing prevalence of hysterectomy is also strongly determined due to profit making attitude of health practitioners. The mitigation strategy should be focused on poverty elimination, female education and awareness among women through healthcare initiatives.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgment: The authors express gratitude to the respondents who have eagerly provided information for this study. Authors are also thankful to the authorities of Dr, Harisingh Gour Vishwavidyalaya (A Central University), Sagar, Madhya Pradesh, India. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Funding: The study is part of doctoral work which was supported by Dr. Harisingh Gour Vishwavidyalaya (A Central Uviversity), Sagar, Madhya Pradesh, India by granting fellowship to the first author.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConflict of Interest: There is no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthical Approval: This study is approved by Institutional Ethical Committee (IEC) of Dr. Harisigh Gour Vishwavidyalaya (A Central University), Sagar, Madhya Pradesh, India, vide Approval Number: DHSGV/IEC/2022/12\u003c/p\u003e\n\u003cp\u003eNotes on contributors: The study was designed and planned by SS under the supervision of RKG. Data collection, digitization, analyse as well as preparation of first draft was carried out by SS. The manuscript is thoroughly revised by RKG. Both the author read and approved the final draft.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHsia, J. et al. 2003. Usefulness of prior hysterectomy as an independent predictor of Framingham risk score (The Women\u0026rsquo;s Health Initiative). \u003cem\u003eAmerican Journal of Cardiology\u003c/em\u003e;\u003cem\u003e92\u003c/em\u003e(3): 264\u0026ndash;269.\u003c/li\u003e\n\u003cli\u003eBala, S., M.L.S. Prabha, G. Sudeera. 2017. Menopausal problems of urban postmenopausal women of Hyderabad.\u003cem\u003eThe Journal of Community Helath Management\u003c/em\u003e; 4: 170\u0026ndash;174. \u003c/li\u003e\n\u003cli\u003eNilangi S. 2015. Hysterectomy among Premenopausal Women and its\u0026rsquo; impact on their Life- Findings from a study in rural parts of India. \u003cem\u003eInternational Research Journal of Social Sciences\u003c/em\u003e; 4(4): 8\u003c/li\u003e\n\u003cli\u003eSilva, T.R. 2021. 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Predictors of Hysterectomy in Women with Common Pelvic Problems : A Uterine Survival Analysis. \u003cem\u003eAmerican College of Surgeons\u003c/em\u003e;\u003cem\u003e204\u003c/em\u003e(4): 633\u0026ndash;641. \u003c/li\u003e\n\u003cli\u003eSingh, A., D. Govil. 2021. Hysterectomy in India : Spatial and multilevel analysis.\u003cem\u003e Women\u0026rsquo;s Health\u003c/em\u003e;\u003cem\u003e 17\u003c/em\u003e: 1\u0026ndash;13. \u003c/li\u003e\n\u003cli\u003eSettnes, A. 1996. Hvsterectomv in a Danish cohort . Prevalence , iniidence and socio-demographic characteristics. \u003cem\u003eActa Obstetricia et Gynecologica Scandinavica\u003c/em\u003e;\u003cem\u003e75\u003c/em\u003e: 10\u0026ndash;13.\u003c/li\u003e\n\u003cli\u003eDesai, S., , R. J. Singh, D. Govil, D. Nambiar, A. Shukla, H. H. Sinha, , Ved, R., Bhatla, N., \u0026amp; Mishra, G. D. (2023). Hysterectomy and women\u0026rsquo;s health in India: Evidence from a nationally representative, cross-sectional survey of older women. \u003cem\u003eWomen\u0026rsquo;s Midlife Health\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e(1), 1-10. https://doi.org/10.1186/s40695-022-00084-9\u003c/li\u003e\n\u003cli\u003eSingh, S. K. 2024. \u003cem\u003eKey drivers of hysterectomy among women of reproductive age in three states in India: Comparative evidence from NFHS-4 and NFHS-5\u003c/em\u003e.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hysterectomy, Health Issues, Kaplan Meier and Odds Ratio Estimate","lastPublishedDoi":"10.21203/rs.3.rs-4728495/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4728495/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe advancement of medical science and newer technologies has witnessed the prevalence of hysterectomy in recent times. Consequently, an attempt has been made to find out the socio-demographical and related issued of women who have undergone hysterectomies from the district of Bilaspur, Chhatisgarh, India. A sub-sample of 105 respondents from rural and urban (\u0026le;\u0026thinsp;30 years of age) who had undergone hysterectomy, included through a cross-sectional study. Data collection was carried out using a culturally validated semi-structured schedule. Body composition, related health issued and Socio-demographic data were collected using standard tools and techniques. Statistical analysis of the data was done by using MS Excel and SPSS Software. The prevalence of hysterectomy was higher among women in urban areas (57.1%) than the rural ones (42.9%). The mean age was 39.70\u0026thinsp;\u0026plusmn;\u0026thinsp;26.86 years. Hysterectomy at an early age was observed among the women of OBC (36.2%) followed by the General category (35.2%), SC (25.7%) and ST (2.9%). It can be concluded that women who underwent hysterectomy were from a particular socio-demographic background, reproductive history and ethnic background. Further most of the common indicators for underwent hysterectomy who had undergone hysterectomy were excessive menstrual bleeding, frequent menstruation and uterus infection.\u003c/p\u003e","manuscriptTitle":"Socio-Demographic and Related Indicators of Underwent Hysterectomy: A Cross-Sectional Study Conducted among the Women of District Bilaspur (CG), India","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-07 19:48:26","doi":"10.21203/rs.3.rs-4728495/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"914c70c0-db39-4029-836d-8ec1cb11a76c","owner":[],"postedDate":"August 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-11T19:38:28+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-07 19:48:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4728495","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4728495","identity":"rs-4728495","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}