The most common indication for hysterectomy is uterine fibroids. It is estimated that approximately one-third of all hysterectomies are done for problems related to uterine fibroids. The clinical indications vary from merely the presence of fibroid to menorrhagia, pressure symptoms, infertility, or habitual abortion.

In many instances they are asymptomatic, but in some women they may be associated with heavy menstrual bleeding, infertility, pressure symptoms, and miscarriage. Hysterectomy can be performed abdominally, laparoscopically, or vaginally, and could be total or subtotal. The approach of the procedure is determined by the clinical situation, the preference and the expertise of the surgeon, and to a certain extent by the patient's desire. In this review we will discuss the risks and benefits of different types of hysterectomy in the treatment of uterine fibroid.

Abdominal hysterectomy

Total abdominal hysterectomy (TAH) remains the conventional treatment for uterine fibroids in women who have completed their family. In the United States, 75% of all hysterectomies are done by laparotomy, which is threefold higher than that for vaginal hysterectomy (VH). TAH is a major operation with three to five days of hospitalization and a convalescence time of several weeks. It is associated with major morbidity in 3% and minor morbidity in about 14% of cases. However, it is a well-received operation with as many as 85–90% of women being satisfied with the procedure and reporting improved quality of life.