Each year about 600 000 hysterectomies are performed in the USA, representing the most common non-pregnancyrelated surgical procedure performed. 3,4 About 100 000 hysterectomies are performed yearly in the UK, 5 69 000 in Italy, 6 60 000 in France, 7 30 000 in Australia, 10 000 in Finland, 8 and more than 5 000 in Denmark. 9
In the developed countries, marked national differences in the prevalence rates were reported from a high of 5.4 per 1000 women in the USA 4 through intermediate rates such as 3.7/1000 in Italy 10 to a low of 1.2/1000 in Norway. 11 On the other hand, in developing countries, the rate of hysterectomy is poorly documented but is likely to be much lower than that in the more economically developed parts of the world. 12
There is no reason to suppose that women in different countries suffer different rates of menstrual disturbance, such as menorrhagia (the presenting symptom in the majority of cases of hysterectomies), yet there are widely different hysterectomy rates across the world. 13
Currently, it is not possible to give an ideal hysterectomy rate or to know what factors influence the different rates. Thus, doubts remain if women in countries with lower hysterectomy rates are undertreated, or if women in countries with higher rates are unnecessarily subjected to a major operation in the presence of equally, or more, effective alternative treatments. In fact, excluding the case of malignancies, hysterectomy is a surgical procedure performed to improve the woman’s quality of life rather than to save her life.