Indications for hysterectomy and for oophorectomy in various adult age groups - in audit.

Hysterectomy is indicated for specific diseases of the uterus and for sterilization. Now that modern methods of contraception are available and abortion laws have been liberalized it should be possible in many instances to avoid sterilization procedures. Oophorectomy is indicated in the presence of ovarian disease, for castration in selected patients with carcinoma of the breast, and as prophylaxis against the potential development of carcinoma of the ovary. Incidental oophorectomy at the time of pelvic surgery generally should be reserved for women in their 40s in whom the anticipated functional lifetime of the ovary is less than 5-10 years and who may receive supplemental exogenous hormones. The operative risk of hysterectomy is greater than for tubal ligations, but comparisons usually fail to consider the risk of the disease for which the hysterectomy is performed. Generally, women in their 20s who wish only sterilization should be able to retain their uteri. A careful history should be taken and a physical examination given in order to eliminate the possibility of pelvic abnorm alities such as fibroids, adenomyosis, endometriosis, and dysplasia that may necessitate a future hysterectomy.