1170 consecutive hysterectomies: indications and pathology

An analysis of consecutive hysterectomies during 1997-99 exploring the relationship between histological findings, operation performed and clinical indication was conducted to observe any trends.

A retrospective review of histology reports for hysterectomies performed in a large district teaching hospital.

The rate of hysterectomy for women aged over 25 years was 23 per 10,000 women. Menstrual disturbance including endometriosis was the indication in 45%, pelvic tumours including fibroids in 21%, prolapse in 17% and malignant or pre-malignant conditions in 15%; 1% were performed in relation to childbirth. 79% were total abdominal hysterectomies, 4% subtotal and 17% vaginal. 50% included removal of both ovaries and in 8% omentectomy was also performed. The uterus was histologically normal in 20% of abdominal hysterectomies, the rate rising to 70% for vaginal hysterectomies.

The rate of hysterectomy has not changed over the past 15 years, despite the introduction of alternative medical and surgical therapies for managing menstrual problems and fibroids. There may have been a greater proportion performed for malignant and premalignant conditions and genital tract prolapse. There were fewer specimens with no evidence of pathology than is often suggested.