Management of women requesting subtotal hysterectomy

Subtotal hysterectomy (SH), which is also referred to as supracervical hysterectomy, is a common gynaecological procedure in which the uterus is removed and the cervix is retained. There is continuing debate about the advantages and disadvantages of SH compared with total abdominal hysterectomy. Persistent vaginal bleeding and the need for continued cervical screening appear to be the main disadvantages of SH. The procedure is often combined with removal of the ovaries. Women should be counselled appropriately prior to removal of their ovaries. Following an internal audit of practice of hormone replacement therapy (HRT) prescription within our own unit, we discovered that there were inconsistencies in the prescription of HRT following SH which led us to investigate this matter further. We concluded that evidence is lacking to guide HRT prescription following SH and bilateral oophorectomy and propose content that can help produce guidelines for the counselling of women prior to SH and prescription of HRT.