Introduction

Hysterectomy is the most common major gynaecological operation in the UK and the USA. Prevalence rates vary in different countries and range from 8% in France, 10% in the UK and 22% in Australia to approximately one-third of women in the Netherlands and the USA. Hysterectomies are usually carried out for benign conditions, such as abnormal menstrual bleeding, fibroids and endometriosis and are therefore elective operations. In the USA, for example, approximately 90% of hysterectomies are elective operations. However, approximately 10% of hysterectomies are carried out for malignant conditions such as cancer of the cervix or uterus (see ‘Cancer: gynaecological’).

There are three main types of hysterectomy: a subtotal hysterectomy, in which only the uterus is removed; a total hysterectomy, in which both the uterus and the cervix are removed; and a radical hysterectomy, in which the uterus, cervix, surrounding tissue, upper vagina and sometimes the pelvic lymph nodes are removed. Radical hysterectomies are usually only done in extreme circumstances such as cancer of the uterus or cervix. In addition, some women will have their fallopian tubes and ovaries removed at the same time, which initiates menopause. In these cases women have to decide about whether or not to use hormone replacement therapy (see ‘Hormone replacement therapy’). Currently, the most common hysterectomy carried out is the total hysterectomy, which is thought to be preferable for benign conditions because it avoids later complications with the cervix such as cervical cancer.