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The Hindu
09-07-2025
- Health
- The Hindu
Advances in treatment improve outcomes for women with uterine fibroids, but access remains a challenge, experts say
Uterine fibroid prevalence in India varies across studies, with some reporting rates between 20% and 40% in women of reproductive age, while others show higher percentages, even up to 77% developing fibroids during their childbearing years. While there isn't a specific national health programme in India directly targeting uterine fibroids, they are addressed within the broader framework of reproductive health and maternal care programmes. As the world observes Fibroid Awareness Month this July, clinicians and public health professionals in India are drawing attention to how uterine fibroids -- non-cancerous tumours of the uterus that while not life-threatening, can severely affect a woman's quality of life, especially when symptoms are left unaddressed or misunderstood. Understanding fibroids 'Fibroids are growths arising from the muscle wall of the uterus. They are not cancerous,' explains A. Jaishree Gajaraj, head of obstetrics and gynaecology at MGM Healthcare, Chennai. 'They are fairly common. Across all age groups, 5 to 6 out of 10 women may have fibroids, with peak occurrence in the late 30s and 40s.' Also known as leiomyomas, fibroids are the most common benign tumours in women. Their presentation varies widely from a single asymptomatic growth detected incidentally on an ultrasound, to multiple large fibroids causing severe pain and bleeding. Fibroids are classified based on location -- intramural (within the uterine wall), submucosal (into the cavity) and subserosal (towards the outer surface). Submucosal fibroids are more likely to cause heavy bleeding and fertility issues, while subserosal ones are typically associated with pressure symptoms. Symptoms and consequences of delay While many fibroids are asymptomatic, a sizeable number of women experience distressing symptoms such as heavy and prolonged menstrual bleeding, pelvic pain, bloating and fatigue. Depending on their location, fibroids can also exert pressure on adjacent organs, leading to urinary frequency, bowel irregularities, and in some cases, difficulty in conceiving or carrying a pregnancy to term. 'The symptom depends on the size and site of the fibroid,' says Dhivya Sharona, consultant, obstetrics and gynaecology, Rela Hospital, Chennai. 'Anterior fibroids can cause urinary issues, while posterior ones may result in constipation and pelvic pressure that radiates to the back and legs.' Short-term consequences include anaemia, fatigue, and reduced work capacity. Long-term effects, if untreated, may range from reproductive complications to chronic discomfort and repeated surgical interventions. In rare cases, fibroids may undergo degeneration or, very rarely, progress to leiomyosarcoma, a malignant variant seen in 0.4 to 0.5% of cases. A spectrum of treatment pathways Management of fibroids is highly individualised and depends on the woman's age, severity of symptoms, fibroid size and location, and her reproductive plans. 'Need for future childbearing is an important factor in decision-making,' says Dr. Gajaraj. 'Medical management focuses on controlling bleeding and pain. Surgery is considered when symptoms are significant.' Small, asymptomatic fibroids often require no immediate treatment, with periodic follow-up and ultrasound monitoring. For women nearing menopause, medical therapy may suffice, as fibroids tend to regress after hormonal changes associated with menopause. Hormonal therapy, including the levonorgestrel intrauterine system (LNG-IUS), is commonly used to control bleeding and reduce fibroid volume. Surgical interventions remain standard for moderate to large fibroids, or when medical therapy is ineffective. These include myomectomy -- either open or laparoscopic for uterus-sparing fibroid removal, and hysterectomy for women who have completed childbearing. Minimally invasive procedures such as hysteroscopic resection are offered when fibroids are within the uterine cavity. Among the newer non-surgical options is Uterine Fibroid Embolisation (UFE), a minimally invasive image-guided procedure that offers an alternative to traditional surgery. 'UFE involves guiding a catheter to the uterine arteries and injecting particles to block blood supply to the fibroids,' explains Basavaraj Biradar, consultant, interventional radiologist at Narayana Health, Bengaluru. 'This causes the fibroids to shrink over time, significantly reducing symptoms. Most patients return to normal activities within a week.' Despite over two decades of global use and recognition by the American College of Obstetricians and Gynecologists (ACOG), awareness about UFE in India remains limited. 'Most women have never heard of it,' says Dr. Biradar. 'It is essential that all treatment options, including UFE, are discussed with patients.' Access, awareness and the role of primary care As treatment options expand from conventional surgery to hormone therapies, minimally invasive techniques, and interventional radiology the need for timely diagnosis and patient-centred care has never been more pressing. 'Treatment should be individualised, but access should be universal,' says Dr. Sharona. Socio-economic and cultural factors continue to influence fibroid diagnosis and treatment in India. Women from lower-income groups often face delayed diagnosis due to limited access to healthcare and lack of awareness about menstrual abnormalities. 'Socio-economic background may delay access but doesn't change the approach to treatment,' says Dr. Gajaraj. Early diagnosis remains a challenge in India, particularly due to the asymptomatic nature of many cases. 'A significant number of women only seek care when symptoms become unmanageable,' says Dheeraj Tiwari, head of interventional radiology at Narayana Health City, Bengaluru. 'We should aim to bridge this gap through targeted screening camps and community outreach, which help identify fibroids at an earlier, more manageable stage.' He also emphasises the role of patient counselling in improving uptake of less invasive treatments such as UFE, especially among women hesitant about surgery. Mannan Gupta, chairman and head of obstetrics and gynaecology at Elantis Healthcare, New Delhi, says: 'Fibroids are present in almost 25–30% of Indian women, but many remain undiagnosed due to low symptom recognition or lack of access,' he says. 'Women from lower socio-economic backgrounds often suffer longer before seeking help, and by then, treatment options may become more invasive. This makes education, both at the primary care level and among the public, absolutely critical.' Additionally, cultural sensitivities and social beliefs also influence treatment choices, particularly when discussing options like hysterectomy. 'Informed and personalised decision-making is key,' says Dr. Sharona. 'The patient's belief systems and family situation must be taken into account.' Primary care physicians must play a central role, say experts. 'They are the first point of contact and often enjoy the trust of patients and their families,' says Dr. Gajaraj. 'Education on menstrual health and early referral to specialists can make a significant difference.' Despite the prevalence of fibroids, there is no national screening programme dedicated to their detection or management. However, tertiary care hospitals and professional bodies such as the Federation of Obstetric and Gynaecological Societies of India (FOGSI) have stepped in with anaemia awareness drives and women's health camps. These often include routine gynaecological evaluations and ultrasound screenings that help identify fibroids early. Experts say that fibroid awareness month should be a call to action for healthcare systems to prioritise early intervention to ensure that every individual has access to informed appropriate and compassionate care.
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Business Standard
09-06-2025
- Health
- Business Standard
The silent struggle: PCOS and PCOD on the rise among young Indian women
Across India, an increasing number of adolescent girls and young women are grappling with Polycystic Ovary Syndrome (PCOS) and Polycystic Ovarian Disease (PCOD) – two hormonal disorders that often go undetected but can have significant long-term health consequences. Affecting reproductive, metabolic, and psychological well-being, these conditions are becoming more prevalent in the 15–25 age group, largely due to lifestyle factors, urban stress, and lack of awareness. Health experts estimate that PCOS now affects between 3.7% and 22.5% of Indian women, depending on diagnostic criteria and location. Globally, it is among the most common endocrine disorders, impacting 8–13% of women of reproductive age. Understanding PCOS and PCOD Today, the terms PCOS and PCOD are often used interchangeably but medically they are two distinct entities. Dr. Dhivya Sharona, Consultant – Gynaecology, Rela Hospital Chennai, explains: 'PCOD is a condition where ovulation is affected and there is formation of cysts in the ovaries. Here, the ovaries produce immature and partially mature eggs in large quantities leading to the formation of cysts secreting excess amounts of androgen (male hormone).' 'It is associated with irregular periods, excessive bleeding and painful periods. It is more common than PCOS and affects around 1/3rd women of reproductive age worldwide. It is also less severe than PCOS and has less impact on fertility compared to PCOS. Around 80% women with PCOD are able to conceive with help,' Dr Sharona adds. On the other hand, PCOS is a syndrome with a spectrum of signs and symptoms including painful periods, weight gain, excessive hair growth, mental health disorder and both presence and absence of cyst formation in the ovaries. The incidence of PCOS is quoted to be between 5-20% in actively menstruating women. It has a high association with obesity along with hypertension, diabetes and heart diseases. Dr. Nidhi Thakur, Consultant Obstetrician & Gynaecologist, Ujala Cygnus Group of Hospitals says that in some cases, ovaries form fluid-filled cysts when the egg is not released properly, leading to amenorrhea (absence of menstruation), hormonal disruption, and fertility issues. Despite the name, not all women with PCOS have visible ovarian cysts, which often makes diagnosis difficult. Recent studies show that most people with PCOS have insulin resistance, where the body's cells don't respond properly to insulin, disrupting hormone balance. Testing for this can help rule out other conditions often mistaken for PCOS. The challenges Many young women with PCOS or PCOD go undiagnosed for years. Symptoms like irregular periods, hair growth, or weight fluctuations are often normalised or overlooked. This delay in diagnosis means the condition progresses silently, potentially leading to infertility, insulin resistance, obesity, sleep apnea, and mental health issues like anxiety and depression. The social stigma around discussing menstrual or reproductive issues also contributes to underdiagnosis. In many cases, women only discover their condition while struggling to conceive or manage other related health complications. In 2021, a study was undertaken by the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh to assess treatment pathways that patients with PCOS have followed. It revealed that even after having initiated treatment, almost 45% of the patients knew nothing about PCOS. Only 9.1% learned anything from their doctors, and almost 85.5% had to visit multiple doctors to gather information. Some patients (approximately 37%) also took to the internet as their primary source of information in trying to learn about their condition. Many women, in a different ethnographic study, revealed that they received conflicting information from different health-care professionals about their condition, which generates a "trust deficit." That is, women have begun to lose trust in their doctors because they are not confident about the quality of the information provided to them. There is a disconnect that the patients feel, which can only be bridged through clear communication and helping them understand how the condition and its management go hand in hand. Lifestyle and prevention: The first line of defense While there's no permanent cure, PCOS and PCOD can be effectively managed through early intervention and lifestyle changes. A healthy diet, weight management, and regular exercise play a crucial role in restoring hormonal balance and improving insulin sensitivity. Reducing sugar and processed food intake helps control blood sugar and insulin levels. Moderate physical activity improves metabolism and regulates the menstrual cycle. Stress-reduction practices like yoga or meditation help manage hormonal fluctuations. Even a modest weight loss of 5–10% can significantly improve symptoms and restore ovulation in many cases, says Dr. Nidhi Thakur. Medical management and costs Medical treatment typically includes hormonal contraceptives to regulate periods and reduce androgen levels, as well as anti-androgen medications to manage symptoms like excess hair growth. In some cases, laparoscopic ovarian drilling is recommended when medications are ineffective. The cost of managing PCOS can vary: Hormonal medications: ₹400–₹800 per month Surgery (if needed): ₹35,000–₹50,000 Total treatment costs may range from ₹20,000 to ₹50,000, depending on the individual case Though affordable options are available, the cumulative long-term costs can be high if not managed early. Long-term impact on health and fertility If left unmanaged, these diseases can significantly affect a woman's long-term health. The risk of developing Type 2 diabetes, metabolic syndrome, cardiovascular diseases, and endometrial cancer increases with time. PCOS is also a leading cause of infertility, due to chronic anovulation and hormonal imbalance. Beyond physical symptoms, the condition can have a profound psychological impact. The frustration of dealing with chronic symptoms, weight issues, and fertility concerns can lead to low self-esteem, anxiety, and depression, making mental health support an important part of the treatment plan. Importance of early detection and regular check-ups PCOD and PCOS are on rise due to high stress, poor social and emotional relatedness, sedentary lifestyle, environmental toxins etc. Dr. Dhivya says that the lack of reproductive health education, taboo around discussing female reproduction along with social and cultural notions of women's ability to bear pain render women unable and unwilling to seek necessary help. Thus, both the conditions are significantly under-diagnosed by practitioners and there is a significant information gap that does not offer people the resources they need. Young women are encouraged to consult gynaecologists if they experience irregular menstrual cycles. Basic screening tests—such as fasting blood sugar, HbA1c, lipid profiles, BMI, and ultrasound scans—can help detect early signs of PCOS and prevent complications. In some cases, consultation with endocrinologists and nutritionists may also be needed for comprehensive care. To effectively tackle this health crisis, we need a major shift in how the conditions are understood and managed. Closing knowledge gaps, creating evidence-based treatment guidelines, and prioritizing lifestyle changes along with complementary therapies—supported by accessible patient education—are all critical steps forward. A manageable condition with the right support PCOS and PCOD are chronic but manageable conditions. With early diagnosis, lifestyle changes, and appropriate medical support, most women can live healthy, fulfilling lives. What's crucial is breaking the silence around menstrual and hormonal health and making gynaecological check ups a routine part of adolescent healthcare. Raising awareness, both at the family and institutional level, can help young Indian women recognise symptoms early, seek help without stigma, and take control of their health before complications set in.
