This study was to identify hysterectomy prevalence across urban, rural and remote areas of Australia and across states, to separate geographic variation from the effect of sociodemographic influences, and also to compare the quality of life of women who have and have not had hysterectomy. Data were collected from 14,072 women aged 45-50 years participating in the baseline survey of the Australian Longitudinal Study on Women's Health. The estimated prevalence of hysterectomy was 22%. Factors significantly associated with hysterectomy included living in a rural or remote area, state of residence, having private health insurance, lower levels of education, being married and having more than two children, having had other gynaecological and non-gynaecological surgical procedures, and more visits to general practitioners. Compared with women who had not had hysterectomy, women who had had hysterectomy had significantly poorer physical and mental health as measured by the SF-36 quality of life profile (adjusted mean PCS=45.7 vs 49.3, p<0.0001; adjusted mean MCS=46.9 vs 48.2, p<0.0001).