CURRENT INDICATIONS FOR HYSTERECTOMY IN BENIGN DISEASES: TRENDS AND CONTROVERSIES

Abstract

Hysterectomy is one of the most frequently performed surgical procedures in gynecological practice, widely used in the treatment of various benign diseases that compromise women's quality of life. Despite its effectiveness as a definitive treatment, the development of conservative therapies and minimally invasive techniques has generated discussions about its current indications and the need for therapeutic individualization. This study aimed to analyze the available scientific evidence on the main indications for hysterectomy in benign diseases, as well as to discuss contemporary trends and controversies related to its performance. This is an integrative literature review conducted in the PubMed and Virtual Health Library (VHL) databases, using descriptors related to hysterectomy, uterine fibroids, adenomyosis, abnormal uterine bleeding, endometriosis, and pelvic organ prolapse. Studies published between 2021 and 2026, available in full text and compatible with the established eligibility criteria, were included. The results demonstrated that symptomatic uterine fibroids remain the main indication for hysterectomy, followed by adenomyosis, refractory abnormal uterine bleeding, deep endometriosis, and pelvic organ prolapse. A growing adoption of minimally invasive approaches, especially laparoscopic and robotic procedures, was also observed, associated with reduced morbidity and recovery time. Among the main controversies identified are uterine preservation in selected cases, the choice of surgical approach, ovarian preservation, and the impact of the procedure on quality of life and sexual function. It is concluded that hysterectomy remains an important therapeutic option for benign gynecological diseases; however, its indication should be based on individualized clinical criteria, considering the patient's characteristics, available therapeutic alternatives, and the most recent scientific evidence.