HYSTERECTOMY - INDICATIONS, ALTERNATIVES AND PREDICTORS

Hysterectomy, the most common major nonobstetric operation, is perform ed in more than 570,000 women in the United States each year. Although the number of hysterectomies has decreased in recent years, many auth orities believe that hysterectomy is often unnecessary and unjustified . There is no universally accepted set of criteria regarding the appro priate indications for hysterectomy. The main indications for hysterec tomy include the following conditions: uterine leiomyomas, dysfunction al uterine bleeding, endometriosis/adenomyosis, chronic pelvic pain an d genital prolapse. Current literature, however, routinely recommends conservative management of most nonmalignant gynecologic conditions, w ith hysterectomy reserved for refractory cases. Several nonmedical fac tors, such as patient race, age, geographic location, medical history and background, as well as health care provider characteristics, such as time since completion of training, gender, and affiliation with tea ching hospitals, are also associated with hysterectomy rates.