Nicole Martinez was in near constant pain. At age 40, unable to have children and dogged by health problems, the Chicago woman had undergone two surgeries in five years for endometriosis and precancerous cervical cells.

“I also carry a gene that makes me 44 percent more likely to develop endometrial and uterine cancers,” she said.

When doctors recently discovered a mass in her uterus, the choice to have a hysterectomy seemed obvious.

“It was an easy decision,” Martinez told LifeZette of the successful surgery she had last October.

Hysterectomy, the removal of the uterus, is a necessary and welcome procedure by women who suffer pain, discomfort or other complications.

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It is not a procedure to undergo lightly, nor is it without risks. But thousands of women elect to have the surgery for myriad reasons. Nearly 500,000 women get hysterectomies each year, according to www.womenshealth.gov. And more than a third of all women have had a hysterectomy by the age of 60, according to the National Women’s Health Network.

“Hysterectomy is the eighth most common surgical procedure in the U.S. and the second most common performed on women. Cesarean is number one,” said Dr. Carolyn Thompson, an obstetrician-gynecologist in solo practice in Nashville, Tennessee.

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Yet there’s been a movement toward fewer procedures as medical management of women’s reproductive health issues have improved, said Dr. Bidisha Ray, a practicing OB/GYN and faculty member at Maricopa Integrated Health Systems in Phoenix, Arizona.

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There are several conditions in which the procedure is recommended, including cancer of the lining of the uterus, uterine wall or cervix. A hysterectomy is also advised for those who have had serious complications from childbirth, such as a ruptured uterus, or for those who have had unmanageable infections. Women suffering from painful fibroids, prolapse or abnormal uterine bleeding would also benefit from a hysterectomy, said Thompson.

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A woman’s pain and discomfort will be a factor in the decision to have this surgery. The only condition that absolutely requires a hysterectomy is a cancer diagnosis, Thompson said. Even fibroids can be treated medically, with conservative options,  she said.

“Most women who choose hysterectomy do so after completing childbearing, and most women, in my experience, are pleased with the decision,” Thompson told LifeZette. “Cessation of bleeding is a great benefit, as are resolution of pain and lack of need for ongoing contraception.”

Before deciding on this surgery (including the laparoscopic kind, which is increasingly an option), women should explore other options and be their own advocates, said Ray. The fact that women have been proactive is the main reason the rate of hysterectomies has decreased the past few years, she said.

“There’s been a big push from women who don’t want the increased risk if it is not necessary.”