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Hysterectomy is the final decision after all the alternative treatments like medical management have been taken. There are different reasons for hysterectomy, common reason is uterine fibroids seen in 30-40% of ladies in Indian community. In young patients we opt for fibroid removal, if they have multiple fibroids we suggest to remove the uterus. Other common factor is hormonal imbalance, we treat this with various modalities like hormonal pills and hormonal injections, when all these fails we suggest last option as hysterectomy. The next common factor is endometriosis, when this is severe and recurrent with unbearable pain we give last option of hysterectomy depending on their age and condition. For endometriosis we have surgery for removal of the cyst, certain injections to temporarily postpone surgery depending on their symptoms. All these options can be tried alternatively to hysterectomy initially. Prolapse is another option usually seen in older age group due to hormonal deficiency where there is a pelvic relaxation, for a reasonable prolapse we suggest hysterectomy. All these are non-malignant causes. In malignancy we opt surgery depending on the patient's condition, in very late stage then we do chemotherapy symptomatically, its mainly surgical option in earlier stages. Depending on the causes we have alternative treatment.