India's national health survey asks women whether they have ever been screened for cancer. Almost all of them say no.
It also asks whether they have had a hysterectomy. Rather more of them say yes.
How many Indian women are screened for cancer
Indian women aged 15 to 49 who have never been screened:
98.8%
never had a cervical cancer screening
99.4%
never had a breast examination
The National Family Health Survey is the largest and most representative picture of Indian women's health that exists.
How common it is, and at what age
3.3% of women the same age have had a hysterectomy, the surgical removal of the uterus.
34.6
the median age at that operation
More than twice as many Indian women have had the surgery as have ever had the screening.
Indian women aged 15 to 49 who have ever had:
3.3%
a hysterectomy, the surgical removal of the uterus
1.2%
a cervical cancer examination
Thirty-four is not the end of a reproductive life by any biological measure. It is the middle of one.
Why hysterectomies are done in India
The survey also asks women why. In the three states with the highest rates, the answer is the same one, and it is not cancer.
Heavy menstrual bleeding or pain, given as the single reason for the operation:
33.5%
Andhra Pradesh
36.8%
Telangana
43.7%
Bihar
In Bihar, heavy bleeding alone accounts for nearly half of every hysterectomy performed.
Heavy bleeding is a symptom with a long list of possible causes and a long list of treatments that are not surgery. Which of those someone is offered depends a great deal on where they go. The questions worth asking about those options are here.
Hysterectomies performed in private hospitals:
84%
Andhra Pradesh
86%
Telangana
88%
Bihar
Who it reaches
The pattern is not evenly spread, and this is where it stops being a story about medicine and becomes one about who gets offered what.
Premature menopause runs at 6.85% among Indian women aged 30 to 39 with the least education, against 0.94% among the most educated (Babbar and colleagues, 2024). That is around seven times higher.
Hysterectomy accounts for 73% of that difference. It is not that less educated women's bodies behave differently. It is that they are far more likely to have had the operation that ends their periods.
The authors suggest a reason. It is their interpretation, not a finding. They write that women with poor education are more likely to have a hysterectomy younger, and that this "perhaps indicates a lack of awareness, lack of alternative treatment options, and over-reliance on surgical care while neglecting conservative management."
It would be easy to read that as a problem belonging to poor and uneducated women. It is not. Between the two most recent rounds of the survey, the modelled increase in hysterectomy was larger among more educated women in Andhra Pradesh and Telangana, and largest among women with no schooling only in Bihar. The rate is highest among the least educated. The increase is not.
Geography compounds it. In Bihar, 8.41% of currently married women aged 30 to 34 are already in menopause, against a national figure of 2.36% (Babbar and colleagues, 2024).
The two numbers move differently
There is a sharper version of all this, and it sits inside the same survey.
The same two procedures, by years of schooling:
So for the most educated women in India, the comparison this article opened with runs the other way round. They are slightly more likely to have been screened than to have had the operation.
Who someone is changes their chances of being operated on. It barely changes their chances of being screened.
Why you will find different numbers
If you go looking for how many Indian women reach menopause early, you will find answers that do not match each other. It is worth knowing why, because the reason is not that one of them is wrong.
Two large studies used the same national survey and came back with different figures.
2.23%
of women aged 15 to 39, counting only menopause that arrived on its own
4.73%
of rural women aged 30 to 39, counting surgery as well
The lower figure leaves out women whose periods ended because of an operation. The higher one counts them. That is one difference, and it is the one most people spot.
The second difference is easier to miss. The lower figure also starts counting at age 15. The higher one starts at 30. Almost nobody is in menopause in their teens or twenties, so including them pulls the figure down. Move the age you start counting from and the number moves with it, without anything having changed about anyone's health.
Both of those figures are right. They answer two different questions.
When you come across a number for early menopause in India, two things are worth checking. Which women were counted, and from what age. A figure with neither of those attached is telling you less than it looks like.
What this does not tell you
Nothing here says any individual operation was unwarranted. Whether a hysterectomy was the right decision is a clinical judgment made between a patient and their doctor, with information neither this page nor a national survey has. Some of these operations were necessary. The survey cannot tell you which.
What the survey can say is what is being provided across a population, and in what proportion. Screening that would find something early reaches fewer than two women in a hundred. Surgery that ends a reproductive life reaches three, at a median age of thirty-four, mostly outside the public system, and most often for heavy bleeding.
We have written separately about what happens when an Indian woman goes looking for care, and why it usually takes more than one try.
Sources
- National Family Health Survey (NFHS-5), 2019–21. Government of India. India national report. Screening figures from Table 12.7 and section 12.4; hysterectomy figures from Table 5.21 and section 5.7. Both cover women aged 15 to 49. The two tables draw on different questionnaires, so their bases are not identical, and fact sheets reporting an older age band give higher screening figures. All of these are correct and answer different questions.
- Kundu S, Acharya SS. "Exploring the triggers of premature and early menopause in India: a comprehensive analysis based on National Family Health Survey, 2019–2021." Scientific Reports. 2024;14:3040. doi:10.1038/s41598-024-53536-9
- Babbar K, Singh V, Sivakami M. "Rising premature menopause and variations by education level in India." Scientific Reports. 2024;14:18238. doi:10.1038/s41598-024-67730-2
- Singh SK, Chauhan K, Tripathi V. "Key drivers of hysterectomy among women of reproductive age in three states in India: comparative evidence from NFHS-4 and NFHS-5." BMC Women's Health. 2024;24:107. doi:10.1186/s12905-024-02886-7 The comparison between survey rounds by education level is based on modelled predicted probabilities rather than observed prevalence, which is why it is described that way above.
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