Socioeconomic differentials in the association between hysterectomy and hypertension among women in Maharashtra

Background: Hysterectomy is a commonly performed gynecological surgery for conditions such as uterine fibroids, endometriosis, and abnormal uterine bleeding. However, the procedure provides therapeutic benefits, its increasing prevalence at older reproductive ages of women has raised concerns regarding long-term health outcomes, particularly hypertension and the associated risk of cardiovascular disease (CVD). This study explores the relationship between hysterectomy and hypertension, and acts as a contraindication among reproductive-aged women in Maharashtra. Methods: This study analysed data from the National Family Health Survey (NFHS-5, 2019-21) for 33,755 women aged 15-49 years in Maharashtra. Descriptive, Oaxaca decomposition and comparative analyses were conducted to assess the prevalence of hysterectomy among hypertensive and overall general women across socio-demographic, reproductive, and health-related characteristics. Results: The prevalence of hysterectomy among women with hypertension was 7.8 percent, more than double the overall prevalence among all women (3%). Higher prevalence was observed among women aged 40-49 years and those residing in rural areas. The majority of hysterectomies were performed in private healthcare facilities. Increased prevalence was associated with lower educational attainment, lower wealth quintiles, higher parity, obesity (11.6%), and female sterilization (13.7%) compared to their respective counter parts. Abnormal uterine bleeding emerged as the most common indication for hysterectomy, followed by uterine fibroids. The findings indicate a complex and potentially association between hysterectomy and hypertension. Conclusion: The research study highlights a significant association between hypertension and hysterectomy among reproductive-aged women in Maharashtra, suggesting that hypertension may act both as a risk factor and a postoperative complications. These findings underscore the need for comprehensive preoperative screening and careful postoperative monitoring of blood pressure. Addressing socioeconomic and rural-urban disparities through targeted public health interventions is essential to improve gynecological care and reduce long-term cardiovascular risks.