Hysterectomy is the most frequently performed major operation in the United States--and one of the most controversial. Although there are large regional differences in hysterectomy rates, the nationwide rate declined between 1975 and 1980. Leiomyomas, dysfunctional uterine bleeding, and pelvic relaxation are among the most frequent indications for hysterectomy. One fourth to one half of all women who undergo hysterectomy develop some morbidity, with fever and hemorrhage the most common types. Late sequelae may include the residual ovary syndrome, depression, and an increased risk of cardiovascular disease. The mortality rate appears to be about one death per 1000 operations. Neither prevention of cancer nor contraceptive sterilization appears to justify elective hysterectomy in asymptomatic women. Hysterectomy will continue to be an important component of women's health care. Ongoing peer review activities, improvements in surgical technique, and continued research should help ensure that each hysterectomy performed is both appropriate and safe.
