Women A, aged ≤ 50 years B, and > 50 years. The reference group is women ≤ 50 years who had a hysterectomy for uterine leiomyoma between 1965-1974. In women aged ≤ 50 years, endometriosis and inflammatory conditions were associated with increased odds, while uterine prolapse or menstrual or menopausal disorders were associated with lower odds for abdominal hysterectomy relative to the reference group. The most striking age-related difference was that older women undergoing a hysterectomy for cancer or for debulking were more likely than younger women to have an abdominal hysterectomy. Between 1965-2002, the utilization rate for hysterectomy in the population declined by 37%; the age distribution and indications for this procedure also changed over time.