Objective: Women historically had a hysterectomy for benign gynaecological indications (fibroids, abnormal uterine bleeding, pelvic organ prolapse and chronic pelvic pain). Multiple effective medical therapies now exist for all of these indications, with variable use. As various provinces in Canada move towards a quality-based model of funding, this study aimed to understand trends in usage of these medical therapies prior to proceeding to hysterectomy to identify potential areas for quality improvement.

Methods: A retrospective chart review was conducted of all hysterectomies performed for benign indications over a 6-month period at a tertiary care institution focusing on three major areas: medical management prior to proceeding to hysterectomy (how many therapies tried and for how long), pre-operative optimization once hysterectomy was decided and surgical approach (vaginal, laparoscopic or abdominal).

Results: Thirteen percent of women did not have documentation of receiving any counseling about alternative medical therapies. When women were counseled regarding one or more medical therapies, 30% declined to try any of the options and 57% tried at least one. Only 19.9% of women tried more than one form of medical management prior to proceeding to hysterectomy.

Conclusion: Our study indicates that medical management is not being adequately discussed, trialed, and documented in women undergoing hysterectomy for benign indications.