A woman with significant abnormal uterine may benefit from a hysterectomy. However, the patient should be carefully evaluated with demonstrated failure of alternative therapies before the surgery is performed.


Confirmation: all of the following:

(1) History of excessive uterine bleeding with at least 1 of the following

(1a) Profuse bleeding with flooding or clots or repetitive periods lasting for more than 8 days.

(1b) Anemia due to acute or chronic blood loss.

(2) Failure to find a uterine or cervical pathology on physical examination that would cause abnormal bleeding.

(3) No finding of remedial cause by dilation and curettage, hysteroscopy or hysterogram.

(4) No evidence of endometrial neoplasia.

(5) No evidence of cervical neoplasia.



(1) Desire to maintain fertility.

(2) Medical or psychologic contraindications are present.


Actions prior to performing hysterectomy:

(1) Consider patient's medical and psychologic risks concerning hysterectomy.

(2) Determine that attempted hormone therapy was not successful.

(3) Confirm no history of a bleeding diathesis or use of medications that may cause bleeding.

(4) Rule out pregnancy.

(5) Assess ovulatory status by obtaining a premenstrual endometrial sampling.

(6) Assess surgical risk from anemia and need for treatment.

(7) Rule out invasive carcinoma of the endometrium or cervix.


Alternative therapies:


(2) oral contraceptives

(3) progestins

(4) endometrial ablation or resection


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