Fewer women are undergoing hysterectomies in the U.S, due to the rise of simpler, less-invasive procedures.

That finding and more are detailed in the study “Nationwide Trends in the Utilization of and Payments for Hysterectomy in the United States Among Commercially Insured Women,” which was published in the American Journal of Obstetrics & Gynecology.

Laparoscopy was the most common surgical approach for hysterectomy. It is a less-invasive procedure than abdominal hysterectomy and does not require hospitalization.

The largest decline in hysterectomies was seen in women under 55 years old and in women seeking care for endometriosis, uterine fibroids, or abnormal uterine bleeding.

The researchers suggest that the decline in numbers of hysterectomies is due to choices made by more patients with pelvic pain and fibroids to undergo minimally invasive procedures or other alternatives, rather than hysterectomies.

Also, women may be turning to intrauterine devices, hormonal therapies, and other alternatives. More women also may be considering embolization therapy (a treatment that blocks small blood vessels in order to “starve” an unwanted tissue formation) for fibroids and endometrial ablation (a treatment that destroys the uterine lining) for abnormal bleeding.

Researchers focused on hysterectomies performed in the U.S. between 2010 and 2013 at the Health Care Cost Institute, which manages a national database that includes private insurance claims for more than 25 million women. Total payments for hysterectomies decreased by 6.3 percent during that period, from $823.4 million to $771.3 million.

After cesarean section, hysterectomy comes in second as the most common surgery performed on women of reproductive age in the U.S. Hysterectomies performed for conditions such as endometriosis, abnormal uterine bleeding, and uterine fibroids accounted for almost 68 percent of the more than 400,000 hysterectomies done each year.

“Our findings suggest that minimally invasive procedures and other alternatives are now more common than a traditional hysterectomy requiring a hospital stay,” lead author Daniel Morgan, MD, said in a press release. Morgan is a professor in the Department of Obstetrics and Gynecology at the University of Michigan Medical School and Von Voigtlander Women’s Hospital.

“Hospitals have been reporting declines in hysterectomies for some time, but we wanted to learn how big the decrease actually was and the most common way hysterectomy is performed today. As more alternatives become available, more women seem to be choosing these other options,” he said.

“We are seeing more women utilize treatment with lower complication rates that are also less expensive,” he added.