Hysterectomy remains the definitive treatment for uterine bleeding, carrying with it the risk of serious complications. 1 Medical and surgical advances in gynecologic practice now offer several alternative treatments to be considered before hysterectomy. Symptoms can be controlled by less-invasive, less-risky, less-painful, and often less-costly approaches, and hysterectomy is now less common. There has been a decline by two-thirds in the number of hysterectomies performed for menorrhagia in the UK over the last decade, attributed to the increased use of the levonorgestrel-releasing intrauterine device and endometrial ablative techniques. 2 Interestingly, this may lead to an increase in the operative difficulty of hysterectomy. 3 Over half a million hysterectomies are performed annually in the USA, 4 although there is evidence from regional reports that the rate of hysterectomy for benign conditions is on the decline. 5 Nevertheless hysterectomy has a firmly established place. As alternative therapies to hysterectomy have developed, so too have methods for hysterectomy advanced. Abdominal, abdominal via mini-laparotomy, laparoscopic (in part or total), laparoscopic robotic, and vaginal hysterectomy are available. Whereas bias, experience, and skill may partly determine the route taken, the method of hysterectomy should be selected on safety and the most satisfactory outcome for the patient.