Heavy periods? Don't rush for hysterectomy, advice experts, citing a British study.
They said perhaps women are not given enough information about the treatment options available.
Heavy menstrual bleeding, also called menorrhagia, can be caused by conditions such as endometriosis, fibroids and hormonal imbalance, and can severely impair a women's quality of life.
There are drug treatments available, but if the condition continues to be a problem, national guidance recommends a type of minor surgery which removes a layer from inside the womb.
This technique, known as endometrial ablation, is associated with less risk than a hysterectomy which is recommended only as "a last option".
The audit of over 50,000 women in English is published in BJOG: An International Journal of Obstetrics and Gynaecology. It looked at rates of surgery for both options between 2003 and 2006.
The researchers from the Royal College of Obstetricians and Gynaecologists (RCOG) found a four-fold difference overall in the use of surgery between different primary care trusts in England.
And the proportion of endometrial ablation operations varied from 46% to 75%.
It is estimated that around one in 20 women aged 30 to 49 years old go to their GP each year because of heavy periods.
The National Institute for Health and Clinical Excellence (NICE) say women should be given full information about the range of treatments available before considering irreversible operations such as hysterectomy.
But the researchers said the variation shown in the study suggests this is not happening.
Dr David Cromwell, from the Health Services Research Unit at the London School of Hygiene and Tropical Medicine, said: "The rates of hysterectomy have gone down in recent years but what we still find concerning is this four-fold variation between the regions."
The RCOG is due to begin a further national audit to look into the treatment women are getting.
Dr Tahir Mahmood, vice president of standards at the College, said there had been moves towards more conservative treatments.
"This research shows how current NICE guidelines may not always be followed.
"Women need to be informed of the risks and benefits of each surgical option before decisions are made."