Change is a fundamental characteristic of evolution, shaping adaptations that enable survival in evolving environments. However, rapid changes, while evolutionarily advantageous, may sometimes create new challenges. Over time, shifts in occupation, activities, dietary habits, and societal priorities have significantly impacted health, including women’s health during the postmenopausal phase. Geriatric gynaecology focuses on diagnosing and managing gynaecological conditions in women aged 60 years and above, aiming to promote early detection and enhance their quality of life1. The ageing population is a significant global challenge of the 21st century, with the elderly population in India growing rapidly. Women aged 60 years and above comprised 7.8% of the population in 2001, a figure projected to increase to 12.4% by 20262. This demographic shift, coupled with increasing life expectancy, has brought age-related gynaecological issues into sharp focus. Changes in the hormonal milieu due to ageing result in physiological transformations in reproductive organs, contributing to a unique spectrum of gynaecological disorders in elderly women3. Elderly women face vasomotor, urogenital, psychosomatic, and psychological symptoms, alongside sexual dysfunction. Common gynaecological issues include postmenopausal bleeding, pelvic organ prolapse, gynaecological malignancies, urinary incontinence, genital tract infections, and vulvovaginal disorders4. These issues often remain undiagnosed until symptomatic, leading to delayed treatment and higher morbidity. Notably, the risk of gynaecological cancers, such as uterine, ovarian, and cervical cancers, is significantly higher in women over 65, often diagnosed at advanced stages5. Despite the rising burden of geriatric gynaecological disorders, healthcare delivery systems in India lack dedicated geriatric units and robust screening programs for early detection6. This underscores the need for targeted interventions, including the establishment of geriatric units, widespread cancer screening initiatives, and multidisciplinary approaches to postmenopausal health. Addressing these gaps is crucial for improving the quality of life for elderly women in India. This study focuses on understanding the spectrum of gynaecological disorders in women aged 60 years and above in Kashmir, analyzing their diagnosis and treatment while advocating for enhanced screening programs and the establishment of geriatric units to cater to the unique healthcare needs of this demographic. AIMS AND OBJECTIVES 1. Spectrum of various gynaecological disorders in women of Kashmir above 60 years. 2. To analyse diagnosis and treatment of gynaecological disorders in females above 60 years. 3. To emphasize the need of establishment of geriatric units for women to give better quality of life to elderly women. 4. To emphasize on increasing the different screening programs for early detection and management of different gynaecological disorders in elderly age group.

This prospective observational study was conducted in the Postgraduate Department of Gynaecology and Obstetrics, Government Lalla Ded Hospital, an associated hospital of Government Medical College, Srinagar, over a period of one and a half years. Written informed consent was obtained from all recruited participants. The study included women above the age of 60 years who attended the Gynaecology Outpatient Department (OPD) or were admitted to the Gynaecology wards of Lalla Ded Hospital. Women with breast disorders were excluded from the study. Patient demographics and a detailed medical history were recorded. A general physical and systemic examination was conducted, with a specific focus on gynaecological assessment. Associated comorbidities such as hypertension, anaemia, diabetes mellitus, thyroid disorders, heart disease, chronic obstructive pulmonary disease (COPD), and asthma were also evaluated. Baseline investigations were performed for all patients, including complete blood count, kidney function test, liver function test, urine analysis, ECG, X-ray, and ultrasound. Additional diagnostic tools such as Pap smear, Doppler study, CT scan, MRI, diagnostic dilation and curettage (D&C), and examinations under anesthesia were utilized in indicated cases. Treatment and management were carried out according to the diagnosed conditions. Medical management included pharmacologic treatment and non-surgical interventions like pelvic muscle exercises (e.g., Kegel exercises) and the use of pessaries. Surgical interventions included total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO), Wertheim’s hysterectomy for gynaecological malignancies, and vaginal hysterectomy with sacrocolpopexy (Ward Mayo’s operation) for uterovaginal prolapse. Procedures like transobturator tape (TOT) and tension-free vaginal tape (TVT) were employed for stress urinary incontinence (SUI). The recorded data was compiled in Microsoft Excel and then exported to the data editor of SPSS Version 20.0 (SPSS Inc., Chicago, Illinois, USA) for analysis. Continuous variables were expressed as Mean ± SD, while categorical variables were summarized as frequencies and percentages. Graphical representation of the data was done using bar and pie diagrams.

A total of 200 patients were included in the study, comprising 115 patients from the Outpatient Department (OPD) and 85 patients from the Inpatient Department (IPD). The mean age of the participants was 67.1 ± 7.28 years, with the youngest being 60 years old and the oldest 85 years old. The majority (51%) of patients were in the age group of 60–64 years, followed by 25.5% in the 65–69 years category. Most participants resided in rural areas (74.5%), and a significant proportion belonged to lower socioeconomic classes, with 40% from Class IV and 20% from Class V. The literacy rate among participants was low, with 76.5% being illiterate. Marital status revealed that 98.5% were married, while only 1.5% were unmarried. Regarding parity, 57% of women were para 4–6, and 28% were para >6, indicating a higher number of children among the majority of participants. The mean age of menopause was 51.6 ± 2.56 years, with most women (65%) experiencing menopause between 50 and 54 years. The average duration of menopause was 17.1 ± 6.87 years, with 31% of participants having been menopausal for 10–14 years. A majority of women (94.5%) achieved natural menopause, while 5.5% underwent surgical menopause. The most common associated comorbidity was diabetes mellitus, observed in 21% of participants, followed by hypertension (16.5%) and hypothyroidism (6.5%). Only 1.5% of patients had a family history of cervical, ovarian, or endometrial cancers. The most frequent complaint was “something coming out of the introitus,” reported by 28% of women, indicative of pelvic organ prolapse. This was followed by postmenopausal bleeding (25%), pain abdomen/distension (21.5%), and urinary symptoms (15%). Other less common complaints included discharge per vaginum (7.5%), itching/hot flashes (6%), and dyspareunia (3%). Least number of patients (15%) presented with multiple symptoms. The most common gynaecological disorder was uterovaginal prolapse, seen in 28% of patients, followed by malignancies in 16%. Among malignancies, endometrial carcinoma (7.5%) was the most common, followed by ovarian carcinoma (5%) and cervical carcinoma (3%). Vulval carcinoma was rare, affecting only 0.5% of participants. Benign ovarian lesions and urinary incontinence were each observed in 4.5% of cases. Urogenital infections accounted for 20% of disorders, with atrophic vaginitis and endometrial polyps each contributing 6.5%. The majority of patients (51.5%) were managed conservatively. Surgical interventions included Diagnostic D&C with polypectomy in 7.5% of cases. The comprehensive approach included both pharmacological management and surgical procedures tailored to the specific gynaecological conditions. The study highlights a significant burden of gynaecological disorders among women aged 60 years and above, with uterovaginal prolapse and malignancies being the predominant issues. Rural residence, low literacy, and limited access to healthcare contribute to delayed presentation and advanced disease stages. The findings emphasize the urgent need for regular screening programs, dedicated geriatric units, and awareness campaigns to improve the quality of life and health outcomes for elderly women. Table 1: Demographic Distribution, Reproductive History and Menopausal Characteristics of Study Participants Variable Category No. of Patients (n=200) Percentage (%) Source Outpatient Department (OPD) 115 57.5 Inpatient Department (IPD) 85 42.5 Age Groups (Years) 60–64 102 51 65–69 51 25.5 70–74 28 14 >75 19 9.5 Mean Age 67.1 ± 7.28 years Residence Rural 149 74.5 Urban 51 25.5 Socioeconomic Class Class I 10 5 Class II 22 11 Class III 48 24 Class IV 80 40 Class V 40 20 Literacy Illiterate 153 76.5 Literate 47 23.5 Marital Status Married 197 98.5 Unmarried 3 1.5 Parity Nulliparous 4 2 Para 1–3 26 13 Para 4–6 114 57 Para >6 56 28 Age at Menopause (Years) 41–45 4 2 46–49 34 17 50–54 131 65 >55 31 15.5 Mean Age at Menopause 51.6 ± 2.56 years Type of Menopause Natural 189 94.5 Surgical 11 5.5 Duration of Menopause (Years) 5–9 17 8.5 10–14 62 31 15–19 47 23.5 20–24 43 21.5 >20 31 15.5 Mean Duration 17.1 ± 6.87 years Table 2: Comorbidity, Family History, Symptoms and Gynaecological Diagnosis Variables Category No. of Patients Percentage Comorbidities Diabetes Mellitus 42 21.0 Hypertension 33 16.5 Hypothyroidism 13 6.5 COPD 5 2.5 Multiple Comorbidities 3 1.5 No comorbidities 104 52.0 Family History of Cancer Yes 3 1.5 No 197 98.5 Symptoms Something coming out of introitus 56 28 Postmenopausal Bleeding 50 25 Pain Abdomen/Distension 43 21.5 Urinary Symptoms 30 15 Discharge per Vaginum 15 7.5 Itching/Hot Flashes 12 6 Dyspareunia 6 3 Vulval Growth 1 0.5 Multiple Symptoms 30 15 Gynaecological Disorders Uterovaginal Prolapse 56 28 Malignancies 32 16 Endometrial Carcinoma 15 7.5 Ovarian Carcinoma 10 5 Cervical Carcinoma 6 3 Vulval Carcinoma 1 0.5 Benign Ovarian Lesions 9 4.5 Urinary Incontinence 9 4.5 Urogenital Infection 40 20 Atrophic Vaginitis 13 6.5 Endometrial Polyp 13 6.5

The study highlights the spectrum of gynaecological disorders among elderly women in a tertiary care hospital, providing a basis for comparison with existing literature. Demographics and Sociocultural Factors: The mean age of participants (67.1 ± 7.28 years) aligns closely with findings by Kaur B et al. (2017), where the mean age was 69.64 ± 4.97 years, and Sood N et al. (2018), who reported 52.23% of patients in the 60–65 age group. Rural residence predominated, consistent with Kaur B et al. (2017) (56% rural) but significantly higher than in urban-based studies. The low literacy rate (76.5% illiterates) was comparable to Kumari BA et al. (2016) (75.45% illiterates), underscoring the need for targeted education programs for rural, underprivileged women. The mean menopausal age (51.6 ± 2.56 years) was slightly higher than in studies by Avin Alva BR et al. (2016) (45.32 years) and Shah R et al. (2004) (44.7 years). The high parity in this study (57% with parity 4–6) corroborates findings by Kaur B et al. (2017) (52%) and Kumari BA et al. (2016) (64.46%), highlighting a strong association between high parity and pelvic organ prolapse. Uterovaginal prolapse (28%) emerged as the most prevalent disorder, closely matching findings by Sood N et al. (2018) (30.35%). Advanced age, high parity, and rural residence were identified as significant contributors, consistent with Oslen AL et al. (1997) and Swift SE (2000). However, Kaur B et al. (2017) reported genital tract malignancies as the leading disorder, demonstrating regional variation. The study reported endometrial carcinoma as the most common malignancy (7.5%), followed by ovarian carcinoma (5%) and cervical carcinoma (3%). This trend aligns with Dey R et al. (2013) (2.2% cervical carcinoma) and Yeole BB (2008), who observed a shift toward corpus uterine and ovarian cancers in India. In contrast, Sood N et al. (2018) found ovarian carcinoma (47.93%) to be the most common, highlighting regional disparities. The low incidence of cervical cancer could be attributed to increased screening and prevention efforts, as corroborated by Mitchell H et al. (1996). Pelvic organ prolapse (28%) and postmenopausal bleeding (25%) were the most common complaints, aligning with Kaur B et al. (2017), who reported similar patterns. However, Sood N et al. (2018) noted postmenopausal bleeding as the leading complaint, likely reflecting differences in disease prevalence and healthcare-seeking behavior. Most patients were managed conservatively (51.5%), and surgical interventions were tailored to specific conditions. Prolapse management predominantly involved vaginal hysterectomy and pelvic floor repair. Malignancies were addressed with tailored surgical approaches, including total abdominal hysterectomy and staging laparotomy, consistent with oncology protocols in other studies. This study’s findings closely align with existing literature while underscoring regional and institutional variations in demographics, disease prevalence, and management strategies. Comprehensive screening and education programs, particularly in rural areas, are critical to addressing the healthcare needs of elderly women and improving outcomes.

Pelvic organ prolapse and malignancies are the most prevalent gynecological disorders among women aged 60 and above. Comprehensive strategies are necessary to improve their quality of life, including regular gynecological assessments, education on preventive measures (e.g., Kegel exercises, managing risk factors like cough and constipation), and timely surgical intervention for prolapse. Routine screening and early detection protocols, including TVS, pap smears, and endometrial biopsies, are critical for managing malignancies such as cervical, endometrial, and ovarian cancers. Establishing dedicated geriatric units and organizing screening camps can aid in early diagnosis and treatment, reducing advanced-stage cancer incidences and associated morbidities. Effective patient education, continuity of care through primary healthcare providers, and systematic follow-ups are essential to address the unique gynecological health challenges in aging women.

1. Takkar N, Goel P, Dua D, Mohan H, Huria A, Sehgal A. Spectrum of gynaecological disorders in older Indian women: a hospital based study. Asian J Gerontol Geriatr 2010; 5: 69-73. 2. Situation Analysis of the Elderly in India. Central Statistics Office, Ministry of Statistics and Programme Implementation. Government of India. 3. New Delhi: Census of India. Censusindia.gov.in. C2001. 4. Scott RB. Common problems in geriatric gynaecology. Am J Nursing. 1958;58:1275-7. 5. Ramin M, Wilberto N, Hervy AE. Gynaecological malignancy in older women. Oncology. 2001;5. 6. Kumari BA, Ramaiah A, Chandra AS. Spectrum of gynaecological disorders in elderly women. IAIIM. 2016;3(11):112-17. 7. Kaur B, Gupta S, Kumar S, Sharma S, Verma M. Spectrum of gynecological disorders in geriatric women: a tertiary care centre study. Int J Reprod Contracept Obstet Gynecol. 2017;6(11):4869-72. 8. Sood N, Chandra P, Dhiman B. Gynaecological disorders in geriatric women regarding their frequency, diagnosis and management in Himachal Pradesh, India. Int J Reprod Contracept Obstet Gynecol. 2018;7(1):297-302. 9. Kumari BA, Ramaiah A, Chandra AS. Spectrum of gynaecological disorders in elderly women. IAIIM. 2016;3(11):112-117. 10. Avin Alva BR, Chethan TK. A Study to Assess the Average Age of Menopause and Menopause Associated Symptoms among Rural Women in Mangalore, Karnataka. Ntl J Community Med. 2016;7(5):404-408. 11. Shah R, Kalgutkar S, Savardekar L, Chitlang S, Iddya U, Balaiah D. Menopausal symptoms in urban Indian women. Obstet Gynecol Today. 2004;11:667-70. 12. Oslen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501-6. 13. Swift SE. The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care. Am J Obstet Gynecol. 2000;183:277-85. 14. Dey R, Saha MM, Rakshit A, Biswas SC, Mukhopadhyay A. The epidemiology of gynecological disorders in geriatric population: a hospital based study. J Evol Med Dental Sci. 2013;14:23-9. 15. Yeole BB. Trends in cancer incidence in female breast, cervix uteri, corpus uteri, and ovary in India. Asian Pac J Cancer Prev. 2008;9:119-22. 16. Mitchell H, Medley G, Higgins V. An audit of the women who died during 1994 from cancer of the cervix in Victoria, Australia. Aust NZ J Obstet Gynecol. 1996;36:73-76.