Background: Uterine fibroids (leiomyomas) are among the most common benign tumors affecting women during their reproductive years. Despite their high prevalence, public understanding of fibroids and their treatment—especially surgical options—remains limited, particularly in rural and semi-urban areas. This study aimed to assess public knowledge and attitudes toward uterine fibroids and surgical interventions in Kangra district, Himachal Pradesh. Materials and Methods: A descriptive cross-sectional study was conducted from October to December 2024 among 400 adults in Kangra. Participants were selected through purposive and convenience sampling to ensure representation across age, gender, education and geography. A structured bilingual questionnaire was used to collect data on socio-demographics, fibroid-related knowledge and treatment perceptions. Data were gathered online, then analyzed using SPSS v26.0. Descriptive statistics and chi-square tests (p < 0.05) were applied. Results: Among 400 participants, 78.5% were female and 55% lived in rural areas. While 77.3% identified fibroids as non-cancerous growths and 73.3% were aware of ultrasound as a diagnostic tool, only 67.0% knew hysterectomy is not the only treatment option. Awareness of symptoms like heavy bleeding (71.5%) and treatment options like myomectomy (67.8%) was moderate. Encouragingly, 79.3% were open to surgery if needed and 80.5% supported routine screening. Overall, 39.0% had “Very Good” knowledge, 40.0% had “Good” knowledge, while 21.0% demonstrated “Fair” to “Poor” understanding. Conclusion: While general awareness of uterine fibroids in Kangra is promising, gaps persist in understanding treatment alternatives and overcoming surgical fear. Targeted education campaigns and accessible gynecological services are essential to foster informed choices and improve reproductive health outcomes in rural and underserved communities.
Uterine fibroids—also known as leiomyomas—are among the most common benign tumors affecting the female reproductive system, with global estimates suggesting that up to 70–80% of women will develop fibroids at some point during their reproductive years. While many fibroids remain asymptomatic, a significant proportion of women experience symptoms such as heavy menstrual bleeding, pelvic pain, pressure symptoms and reproductive complications that can impair their quality of life and necessitate medical or surgical intervention. Despite their high prevalence, uterine fibroids remain poorly understood by the general public, often perceived as a rare or exaggerated condition, especially in rural and semi-urban areas [1-5].
In India, public discourse around gynecological health is often overshadowed by cultural silence, stigma and misconceptions—conditions that allow misinformation to flourish and delay timely care. Uterine fibroids are no exception. Women may dismiss symptoms as a normal part of aging or menstruation and fear of surgery—especially hysterectomy—can further discourage them from seeking clinical evaluation. The choice between conservative management, medical therapy and surgical options such as myomectomy or hysterectomy is often made without full awareness of risks, benefits, or long-term implications. This disconnect between symptom burden and care-seeking behavior highlights a critical gap in reproductive health education and shared decision-making [6-9].
In a district like Kangra in Himachal Pradesh, where a significant proportion of the population resides in rural settings, understanding public knowledge and attitudes toward uterine fibroids and their treatment options is essential. Cultural beliefs, health literacy and access to specialized care all influence whether women seek timely help or live with preventable complications. As uterine fibroids are a leading cause of hysterectomy in India, the implications of uninformed decision-making are profound—not just medically, but also psychosocially and economically [10-12].
This study aims to assess the level of public awareness, understanding and perception regarding uterine fibroids and available surgical interventions among adults in Kangra. By identifying prevailing myths, treatment hesitancies and sources of information, the findings will support targeted educational initiatives and more patient-centered approaches to gynecological care in resource-limited settings.
Study Design
This research utilized a descriptive, cross-sectional study design to evaluate public knowledge and attitudes toward uterine fibroids and their surgical management in Kangra district, Himachal Pradesh. The cross-sectional approach allowed for the collection of data at a single point in time, providing a snapshot of prevailing awareness levels, perceptions and decision-making influences within the community.
Study Area and Population
The study was conducted in Kangra, a district located in the northern Indian state of Himachal Pradesh. Characterized by a blend of rural settlements and semi-urban hubs, the region presents an ideal setting to explore health literacy on gynecological conditions in underserved populations. The target population included adult individuals aged 18 years and above, with a specific focus on individuals assigned female at birth. Males were also included to gauge broader community-level attitudes and knowledge influences on women's health decisions.
Table 1: Socio-Demographic Characteristics of Participants (Kangra)
Variable | Category | Frequency (n) | Percentage |
Age Group (Years) | 18–25 | 81 | 20.3% |
26–35 | 138 | 34.5% | |
36–45 | 119 | 29.8% | |
46 and above | 62 | 15.5% | |
Gender | Female | 314 | 78.5% |
Male | 86 | 21.5% | |
Education Level | No formal education | 19 | 4.8% |
Primary school | 51 | 12.8% | |
Secondary school | 123 | 30.8% | |
Undergraduate degree | 146 | 36.5% | |
Postgraduate degree | 61 | 15.3% | |
Occupation | Homemaker | 101 | 25.3% |
Office Worker | 94 | 23.5% | |
Teacher | 59 | 14.8% | |
Healthcare Professional | 52 | 13.0% | |
Student | 58 | 14.5% | |
Other | 36 | 9.0% | |
Residential Setting | Urban | 180 | 45.0% |
Rural | 220 | 55.0% |
Study Duration
The study was conducted over a three-month period, from October to December 2024. This timeline enabled a balanced outreach strategy across winter and early spring, ensuring broad participation across occupational and educational groups.
Sample Size and Sampling Technique
A total of 400 participants were included in the study. The sample size was calculated using a 95% confidence level, a 5% margin of error and an assumed awareness prevalence of 50%, with an additional 10% added to account for potential non-responses and incomplete data.
Inclusion and Exclusion Criteria
Inclusion Criteria:
Adults aged 18 years and above
Permanent residents of Kangra district
Individuals who could read and respond in Hindi or English
Provided informed consent for voluntary participation
Exclusion Criteria:
Healthcare professionals or those with specialized training in gynecology or obstetrics
Individuals with cognitive or language impairments
Duplicate or incomplete questionnaire responses
Data Collection Tool
A structured, pre-validated questionnaire was developed in collaboration with gynecologists, public health experts and behavioral scientists. The questionnaire was bilingual (Hindi and English) and divided into three key sections.
Socio-Demographic Information
Age, gender, education level, marital status, occupation and residence type (urban/rural).
Knowledge Assessment
Multiple-choice and true/false questions focused on symptoms, causes, diagnosis and treatment of uterine fibroids, including awareness of surgical options like myomectomy and hysterectomy.
Attitude and Perception
Items exploring beliefs about fibroids, fears related to surgery, preference for traditional or modern medicine and willingness to seek care or undergo surgical intervention.
The tool was piloted among a small group of 30 individuals to ensure clarity, relevance and reliability before full-scale administration.
Table 2: Public Knowledge and Attitudes Toward Uterine Fibroids and Surgical Interventions
No. | Question | Options | Correct Responses (n) | Percentage |
1 | What are uterine fibroids? | a) Ovarian cysts, b) Non-cancerous uterine growths, c) Menstrual tissue, d) Fallopian blockage | 309 | 77.3 |
2 | Are fibroids usually cancerous? | a) No, b) Yes, c) Often turn cancerous, d) Always | 301 | 75.3 |
3 | Which symptom is commonly associated with fibroids? | a) Nausea, b) Back rash, c) Heavy menstrual bleeding, d) Shortness of breath | 286 | 71.5 |
4 | Can fibroids cause infertility? | a) No, b) Yes, c) Only during menopause, d) Rarely | 279 | 69.8 |
5 | Are fibroids common in reproductive-aged women? | a) No, b) Yes, c) Only after 40, d) Only post-menopause | 284 | 71.0 |
6 | Can fibroids be detected through ultrasound? | a) No, b) Yes, c) Only MRI, d) Only during surgery | 293 | 73.3 |
7 | What is a myomectomy? | a) Hormonal treatment, b) Menstrual therapy, c) Surgical removal of fibroids, d) Painkiller injection | 271 | 67.8 |
8 | What is a hysterectomy? | a) Period regulation, b) Cancer biopsy, c) Surgical removal of the uterus, d) Fibroid extraction | 316 | 79.0 |
9 | Is hysterectomy the only option for fibroid treatment? | a) Yes, b) No, c) Always recommended, d) If unmarried | 268 | 67.0 |
10 | Can fibroids shrink without surgery? | a) Never, b) Only after childbirth, c) Sometimes with medication or menopause, d) Only in teens | 283 | 70.8 |
11 | Are fibroids painful for all women? | a) Yes, b) No, c) Only during ovulation, d) Only if ruptured | 261 | 65.3 |
12 | Can hormonal therapy manage fibroid symptoms? | a) No, b) Yes, c) Only in cities, d) Only with surgery | 276 | 69.0 |
13 | Can large fibroids press on other organs? | a) No, b) Yes, c) Only during pregnancy, d) Only in twins | 274 | 68.5 |
14 | Do fibroids always need treatment? | a) Yes, b) Not if asymptomatic, c) Only during periods, d) With weight gain | 270 | 67.5 |
15 | Would you consider surgery if fibroids caused health issues? | a) No, b) Maybe, c) Yes, d) Only after menopause | 317 | 79.3 |
16 | Do you believe uterine surgery causes permanent damage? | a) Yes, b) Always, c) Not necessarily, d) In all women | 263 | 65.8 |
17 | Can fibroids return after surgery? | a) Never, b) Yes, c) Only in menopause, d) Only if unmarried | 278 | 69.5 |
18 | Should fibroid screening be a part of routine check-ups? | a) No, b) Yes, c) Only in urban clinics, d) Only with family history | 322 | 80.5 |
19 | Can diet and weight impact fibroid development? | a) No, b) Yes, c) Only in pregnancy, d) Not at all | 267 | 66.8 |
20 | Do you think public awareness about fibroids is adequate? | a) No, b) Yes, c) Only among educated women, d) In cities only | 285 | 71.3 |
Scoring and Classification
Knowledge questions were scored with one point for each correct answer. Total knowledge scores were converted into percentage values and categorized into the following levels:
Very Good Knowledge: ≥80%
Good Knowledge: 60–79%
Fair Knowledge: 41–59%
Poor Knowledge: <40%
Perception and attitude responses were analyzed using Likert scales and thematic grouping.
Data Collection Procedure
Data were collected digitally (Google Forms). Digital outreach leveraged community WhatsApp groups, local women’s collectives and regional Facebook forums. Informed consent was obtained from all participants prior to inclusion and anonymity was strictly maintained.
Data Analysis
Collected data were entered into Microsoft Excel and statistically analyzed using IBM SPSS version 26.0. Descriptive statistics such as frequencies and percentages were calculated for categorical variables.
Ethical Considerations
Participation was voluntary and all respondents were informed of their right to decline or withdraw without consequence. No personally identifiable data were collected and confidentiality was maintained throughout the study.
The study sample consisted of 400 participants from Kangra district, with a diverse representation across age, gender, education, occupation and residential setting. A majority (34.5%) were between 26–35 years, followed by 29.8% in the 36–45 age group and 20.3% aged 18–25, indicating a predominance of reproductive-aged adults—relevant to the topic of uterine fibroids. Female participants accounted for 78.5% of the sample, reflecting the focus on gynecological health, while male participation (21.5%) provided valuable community-level perspectives. Educational status was notably strong, with 36.5% having undergraduate degrees and 30.8% possessing secondary-level education; only 4.8% had no formal schooling. Occupation-wise, the sample was varied: homemakers (25.3%) and office workers (23.5%) formed the largest segments, followed by teachers (14.8%), healthcare professionals (13.0%) and students (14.5%). Rural residents comprised 55.0% of the sample, while 45.0% resided in urban areas, offering a balanced view of awareness levels across geographic divides.
Table 3: Knowledge Score Classification on Uterine Fibroids and Surgical Awareness
Knowledge Level | Score Range (% Correct) | Number of Respondents (n) | Percentage |
Very Good Knowledge | ≥80% | 156 | 39.0% |
Good Knowledge | 60–79% | 160 | 40.0% |
Fair Knowledge | 41–59% | 62 | 15.5% |
Poor Knowledge | <40% | 22 | 5.5% |
The knowledge assessment revealed encouraging yet uneven levels of understanding regarding uterine fibroids and related treatment options. A large majority correctly identified fibroids as non-cancerous uterine growths (77.3%) and knew they are not usually cancerous (75.3%). Awareness of symptoms was fair, with 71.5% linking fibroids to heavy menstrual bleeding and 69.8% acknowledging their role in infertility. Most participants recognized ultrasound as a diagnostic tool (73.3%) and had heard of myomectomy (67.8%) and hysterectomy (79.0%) as treatment options. However, knowledge gaps emerged around treatment flexibility—only 67.0% knew hysterectomy is not the only option and 70.8% understood that fibroids can shrink with medication or menopause. Perceptions of fibroid-related pain (65.3%) and hormonal therapy effectiveness (69.0%) also reflected moderate understanding. Reassuringly, 79.3% said they would consider surgery if needed, yet concerns persist: only 65.8% dismissed the belief that uterine surgery always causes permanent damage. Notably, 80.5% supported routine fibroid screening and 71.3% believed public awareness remains inadequate—indicating strong interest but room for deeper education and destigmatization.
Overall knowledge scores suggest a promising but incomplete understanding of uterine fibroids and their management in Kangra. Of the 400 respondents, 156 (39.0%) demonstrated “Very Good” knowledge (≥80%), while 160 (40.0%) achieved “Good” scores (60–79%), collectively representing nearly 80% of the sample with satisfactory awareness. However, 15.5% of participants fell into the “Fair” category (41–59%) and 5.5% showed “Poor” knowledge (<40%), indicating vulnerable subgroups with significant informational gaps. These findings highlight the need for targeted education efforts, particularly for individuals from lower educational backgrounds or rural regions, to improve understanding of both fibroid pathology and the range of available treatment pathways. The high levels of willingness to seek care present a valuable opportunity for public health programs to bridge these knowledge gaps with culturally sensitive, accessible and evidence-based information.
This study provides a timely and in-depth examination of public awareness, attitudes and knowledge regarding uterine fibroids and surgical interventions among adults in Kangra district, Himachal Pradesh. As uterine fibroids represent one of the most common gynecological conditions globally, their widespread impact on women’s health—particularly in reproductive age groups—demands focused public health attention. The findings of this study highlight a dual narrative: while a strong foundation of general awareness exists in the population, critical gaps persist in the understanding of symptoms, treatment pathways and the implications of surgical interventions. These gaps are especially pronounced in rural settings and among individuals with lower educational attainment.
The socio-demographic distribution of the study population aligns with the profile of women most likely to be affected by fibroids. Over 64% of the participants fell within the 26–45 age group, corresponding with the peak incidence of symptomatic fibroids. A significant majority were women (78.5%), reflecting the gender-specific focus of the study, but the inclusion of male respondents (21.5%) is notable. In patriarchal communities, men often influence health-seeking behavior, financial decisions and family healthcare priorities; thus, their awareness levels can directly impact women’s access to treatment. Educational levels were encouraging, with more than two-thirds of participants having attained secondary or higher education. This level of literacy likely contributed to the high proportion of respondents scoring in the “Good” to “Very Good” knowledge categories. However, the 17.6% of participants with only primary or no formal education are more likely to fall into the lower knowledge brackets, suggesting the need for simplified, language-accessible education materials tailored to their needs.
The knowledge assessment results revealed that a majority of respondents were aware that fibroids are benign (non-cancerous) uterine growths and recognized heavy menstrual bleeding as a hallmark symptom. However, nuanced understanding—such as the potential for fibroids to cause infertility or press on adjacent organs—was less widespread. This is concerning, as unrecognized symptoms often lead to delayed diagnoses and worsening complications. Awareness of diagnostic tools like ultrasound was relatively high (73.3%), yet misconceptions around surgical treatment remain. Only 67% of respondents understood that hysterectomy is not the only treatment option for fibroids, suggesting a widespread belief in surgery as the default—and sometimes feared—solution. While many knew about myomectomy, fewer could distinguish it from hysterectomy or appreciated the contexts in which one is preferred over the other.
Importantly, the belief that uterine surgery causes permanent damage (held by nearly 35% of respondents) reflects a psychosocial barrier that may delay treatment. This belief may stem from fear of infertility, marital concerns, or societal narratives that associate gynecological surgery with loss of femininity or womanhood. In culturally conservative settings, these anxieties often override clinical advice and discourage women from pursuing even necessary interventions. Moreover, the notion that fibroids “must always be treated” was rejected by many, with 67.5% correctly noting that asymptomatic fibroids may not require active intervention. This indicates a growing awareness of individualized care approaches and may reflect improved health communication via doctors, online resources, or peer learning.
Encouragingly, nearly 80% of participants expressed willingness to undergo surgery if fibroids impacted their health, highlighting a pragmatic and increasingly informed approach to healthcare. Similarly, 80.5% believed fibroid screening should be included in routine checkups—a viewpoint that aligns with global efforts to integrate reproductive health screenings into primary care. However, this openness must be matched with system readiness: accessible diagnostic tools, culturally sensitive counseling and financial support for those requiring surgical care. The study also shed light on the role of lifestyle awareness, with 66.8% acknowledging that diet and weight may influence fibroid development. This connection between non-communicable risk factors and gynecological health is rarely emphasized in mainstream awareness campaigns and offers a valuable avenue for integrative education on women’s health.
Another salient finding is that more than 70% of participants felt public awareness about fibroids remains inadequate—particularly in rural or less-educated populations. This perception reinforces the urgent need for broad-based educational interventions that demystify fibroids, correct misconceptions about treatment and normalize conversations around reproductive health. Community health workers, school teachers, frontline ASHA workers and local media platforms can play a transformative role in this effort. Given the relatively high percentage of rural respondents (55.0%), deploying mobile health units and conducting screening and education camps in remote areas could have a significant impact.
The classification of knowledge levels (Table 3) substantiates the mixed awareness landscape: while nearly 80% of respondents scored in the “Very Good” or “Good” categories, over 20% still fell into the “Fair” or “Poor” ranges. This one-in-five proportion represents a substantial vulnerable group—individuals who are more likely to ignore symptoms, fall prey to misinformation, or opt for inappropriate or delayed treatment. Addressing their needs requires targeted strategies: culturally relevant communication, use of vernacular language, audio-visual tools for low-literacy populations and inclusion of men and family elders in awareness programs.
Ultimately, bridging the gap between knowledge and action requires a multi-pronged approach. Public health authorities must invest in community education campaigns that explain symptoms, treatment options and surgical procedures in relatable terms. Healthcare providers must be trained to offer patient-centered counseling that respects cultural concerns while advocating for medically sound decisions. Digital platforms, especially mobile apps and WhatsApp-based health groups, can be leveraged for myth-busting, especially among younger populations. In parallel, policy efforts should aim to ensure affordable access to fibroid screening, hormonal therapies and surgical services in government health facilities [8-12].
This study underscores that while public awareness of uterine fibroids in Kangra is generally strong—particularly regarding basic symptoms, diagnostic tools and surgical options—significant gaps remain in the deeper understanding of treatment alternatives, long-term implications and cultural perceptions. Misinformation, fear of surgery and limited health literacy still act as barriers, especially among rural and less-educated populations. Encouragingly, the high willingness to seek treatment and support for routine screening reflects a readiness for change. To translate awareness into action, targeted, culturally sensitive health education and accessible gynecological services must be prioritized to ensure informed decision-making and equitable reproductive healthcare.
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