• Hysterectomy is the surgical removal of the uterus and may also involve removal of the cervix, fallopian tubes, and/or ovaries (oophorectomy). It is a major surgical procedure with a risk of serious complications. It requires weeks of physical recovery post-operatively and may have psychological complications.
• Hysterectomy was considered the only viable surgical treatment until the mid-1990s; however, since then, other effective techniques have become available. This is reflected in the numbers of hysterectomies performed in the UK: 24,355 in 1993 compared with 10,559 in 2002 (most of this reduction will have been due to alternative surgical treatments and improved pharmaceutical treatments for menorrhagia).
• In general, other less invasive techniques are preferred to hysterectomy for the surgical treatment of menorrhagia, as it is beneficial for most women to retain their uterus. The National Institute for Health and Clinical Excellence recommends that, after a thorough discussion with the woman about the benefits and disadvantages of hysterectomy, it should be considered when:
• The woman requests it.
• Other treatment options have failed, are contraindicated, or are declined by the woman.
• There is a wish for amenorrhoea, and the woman no longer wishes to retain her uterus or fertility.
• Removal of the ovaries (oophorectomy) at the same time as hysterectomy is not recommended unless:
• There is a family history of breast or ovarian cancer (refer for genetic counselling first).
• There are symptoms related to ovarian dysfunction such as premenstrual syndrome (a trial of pharmaceutical ovarian suppression should be used first).
• The woman expressly requests it (after appropriate counselling).

[National Collaborating Centre for Women's and Children's Health, 2007]