Hysterectomy is the most commonly performed major gynecologic surgery in the United States. Over 400,000 hysterectomies are performed annually in the United States and it is estimated that 1 in 3 women will have had a hysterectomy by age 60 years. Of the benign hysterectomies performed in the United States, 68% are done for the primary indication of abnormal uterine bleeding (AUB), uterine leiomyomata, and endometriosis. The American Congress of Obstetricians and Gynecologists (ACOG) supports the use of alternatives to hysterectomy.
Over the past decade, there has been a substantial decline in the number of hysterectomies performed annually in the United States. Wright et al analyzed annual inpatient hysterectomy rates in the United States and found a 36.4% decrease in number of hysterectomies performed in 2010 (433,621) as compared to 2002 (681,234). One explanation for these results is an increase in utilization of uterine-sparing alternatives to hysterectomy. However, despite the decrease in numbers of hysterectomies in the United States, appropriateness of hysterectomy is still an area of concern. In 1 study of 497 hysterectomies in California, 76% of those done for endometriosis, AUB or chronic pelvic pain failed to meet ACOG criteria.
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