Hysterectomy, the most common major gynaecological operation, is the only definitive cure for dysfunctional uterine bleeding, rates highest in satisfaction scores compared with other treatments, and improves quality of life. The majority are performed by the abdominal route, and uterine fibroids are the most common indication. The long standing debate on total vs subtotal hysterectomy has recently been resolved by a large trial showing no major advantage for one operation over the other. Overall mortality rates are 0.5–2 per thousand, and rates of visceral damage are 0.5–2%. Complications are most common in women treated for uterine fibroids, and overall rates decrease with increasing age of women. Conservative alternatives including endometrial ablative techniques, the Mirena IUS and uterine artery embolization for fibroids have not greatly reduced hysterectomy rates, which vary widely between regions and within the same geographical area. A major challenge is to establish the reasons for this variation in rates.
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