Introduction: Hysterectomy is one of the most common gynecological surgeries, with vaginal hysterectomy (VH) and total abdominal hysterectomy (TAH) being the two primary approaches. This study compares the outcomes of VH and TAH in women with a non-descent uterus. Despite these advancements, there remains a lack of consensus on the optimal approach for non-descent uterus, particularly in resource-limited settings where surgical expertise and infrastructure may be limited⁶. This study aims to compare the outcomes of VH and TAH in women with a non-descent uterus, focusing on operative parameters, postoperative recovery, and complications. Material and Methods: A prospective comparative study was conducted on 120 women undergoing hysterectomy for benign conditions, divided equally into VH and TAH groups. Inclusion criteria included non-descent uterus, benign indications for hysterectomy, and no contraindications for either approach. Exclusion criteria included uterine descent, malignancy, and previous pelvic surgery. Data on operative time, blood loss, postoperative pain, hospital stay, and complications were collected and analyzed. Results: VH was associated with shorter operative time (65.2 ± 10.3 minutes vs. 92.4 ± 15.6 minutes, p < 0.001), less blood loss (150.5 ± 30.2 mL vs. 280.3 ± 45.6 mL, p < 0.001), and shorter hospital stay (3.1 ± 0.8 days vs. 5.2 ± 1.1 days, p < 0.001) compared to TAH. Postoperative pain scores were lower in the VH group (p < 0.05). Complication rates were comparable between the two groups. Conclusion: Vaginal hysterectomy is a safer and more effective approach for non-descent uterus, offering advantages in terms of operative time, blood loss, postoperative recovery, and hospital stay.