**3. Hysterectomy complications**

The most common complications of hysterectomy may include infection in up to 13% of patients, venous thromboembolism in up to 12% of patients, and genitourinary and gastrointestinal tract injuries in up to 0.6% of patients [3–5].

Blood loss at hysterectomy is about 500 ml; vaginal cuff dehiscence occurs in up to 4% of patients; serious anesthetic complications such as neuropathy, allergy, and death occur in 0.00001% of cases of general anesthesia [3–5].

Hysterectomy may affect the blood supply to the ovaries that may predispose to menopausal symptoms, osteoporosis and ischemic heart disease, lower libido, depression, loss of reproductive capability, negative effect on femininity perception, and a mortality rate of up 1.6 per 1000 hysterectomies [3–5].

In a study that assessed the costs, hospital admission rates, and mortality of 376,246 total hysterectomies, the mortality rates were 0.26%, 0.09%, 0.07%, and 0.05% for supracervical, total abdominal, laparoscopic, and vaginal hysterectomies, respectively [6].

In the same study, total abdominal hysterectomy was financially the costliest of all types, followed by vaginal hysterectomy, supracervical abdominal hysterectomy, and laparoscopic hysterectomy. It was concluded that total abdominal hysterectomy had the highest overall financial cost [6].

## **4. Alternatives to hysterectomy**

Dysfunctional uterine bleeding can be treated medically or surgically. Medical treatment includes non-steroidal anti-inflammatory drugs, the combined oral contraceptive pills, progestogens, the synthetic androgen danazol, analogs of gonadotrophin-releasing hormone (GnRH agonists), and the anti-fibrinolytic tranexamic acid.
