**1. Introduction**

Dysfunctional uterine bleeding is an aberration bleeding that is not related to the normal menstrual cycle. The normal cycle is controlled by hormones that are produced in the right concentration at the right time of the menstrual cycle. Dysfunctional uterine bleeding occurs when the cycle's hormones are imbalanced. In general, no clear etiology can be identified in most cases of dysfunctional uterine bleeding.

In the past, the broad term abnormal uterine bleeding was used to include various etiologies, causing changes in regularity and volume of the bleed, which have been present for 6 months or more, whereas dysfunctional uterine bleeding only covered ovulatory disorders.

Abnormal uterine bleeding, as defined by the Fédération International de Gynécologie et d'Obstétrique (FIGO), in 2011, included polyps, adenomyosis, leiomyomata, malignancy, hyperplasia, coagulopathy, ovulatory, endometrial, iatrogenic, and other unclassified disorders. The acronym PALM-COEIN was used to cover the causes of abnormal uterine bleeding. Bleeding associated with pregnancy was excluded.

Traditionally, various terms were used to describe abnormal uterine bleeding, such as menorrhagia for regular heavy menses, metrorrhagia for irregular menses, polymenorrhea for menses more frequent than every 21 days, and oligomenorrhea for menses that takes place every 35 days or more.

This chapter very briefly outlines hysterectomy and its most common complications, followed by alternatives that may be considered before embarking on this surgical option.

## **2. Hysterectomy**

Hysterectomy is a major procedure that is performed through either the abdominal or vaginal route. Abdominally, the procedure is performed through conventional laparotomy, laparoscopic and robotic surgery. Vaginal hysterectomy avoids abdominal wall incisions. In certain situations, both the abdominal and vaginal routes are used in combination.

Hysterectomy is indicated for malignancies of the uterus, uterine cervix, and ovaries; to reduce the risk of future malignancies as in cases of BRCA mutations; and in Lynch syndrome. In addition, it is indicated for benign conditions that include genital prolapse and for dysfunctional uterine bleeding [1, 2].

Although hysterectomy is a common routine, low-risk surgical procedure, it is associated with some comparatively rare serious complications, both operatively and post-operatively.
