Introduction Hysterectomy is the surgical procedure of removing the uterus. It is one of the most common gynaecological operations and second most common after caesarean section. It can be performed by abdominal route, vaginal route, by applying minimally invasive techniques, or by a combination of the later two. The route chosen depends on the pathology and size of the uterus, presence or absence of adnexalpathology, surgeon's preference and expertise, patient's body habitus and medical co-morbidities, and hospital infrastructure. Methods The study was a hospital-based time bound prospective and observational study conducted in the Department of Obstetrics and Gynaecology at Gauhati Medical College and Hospital, Guwahati, Assam. 150 patients in the age group from 35-85 years with symptomatic benign uterine pathology excluding uterine descent and uterine size less than 16weeks were selected randomly. All the three routes of hysterectomy: Abdominal, Laparoscopic and Non Descent Vaginal Hysterectomy were assigned 50 cases each. Outcomes measured were operating time, intraoperative complications, requirement of blood transfusions, post-operative VAS score, post-operative mobility, post-operative complications (febrile morbidity, bowel distension, urinary retention, wound infection) and duration of hospital stay. Result The most common age group undergoing hysterectomy was 40-49yrs with AUB-L being the most common indication. The mean operating time in NDVH (82.8±22.29) minutes was significantly less than TAH and TLH. Post operative VAS score was significantly lower in NDVH. All the post-operative complications were significantly higher in the TAH group. Mean duration of hospital stay was least in NDVH(3.28±0.70) days. Conclusion From this study we have concluded that vaginal approach should be the procedure of choice for benign causes unless contraindicated, but at the end, route of hysterectomy is dependant on multiple factors and should be individualized.