Aim: To assess and compare accuracy of the clinical indications and histopathological diagnoses from hysterectomy specimens in Zaria. Methods: All hysterectomy specimens received in the department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria from January 1995 to December 2005 were analyzed. The specimens were fixed in formalin, processed in paraffin wax and histology slides stained with haematoxylin and eosin were studied. Frequency of clinical indications were compiled and compared with histopathological diagnoses. Results: 317 hysterectomies were analyzed. Of these 288 (90.9%) were associated with salpingo-oophrectomies. Median age of patients’ was 45 years and mean age was 44.6 years. Parity of the women ranged from 0-11 with an average of 4. The clinical indications comprised non-neoplastic- 47 (14.8%) and neoplastic-226 (71.3%) causes. The commonest benign neoplastic indication was uterine fibroid 196 (61.8%). Malignant neoplastic indication included cervical cancer 12 (3.8%) and endometrial cancer 6 (1.9%). Cervical intraepithelial neoplasia (CIN), a preneoplastic lesion accounted for 44 (13.9%). Histopathological diagnosis of leiomyoma was made in 218 (68.8%), cervical cancer –20 (6.3%) and CIN- 49 (15.5%). Incidental pathologies seen included chronic cervicitis -24, adenomyosis- 13 and cystadenoma – 8. Clinical indications in 14 (4.4%) patients were at variance with histological diagnosis. Conclusion: The clinical indication for hysterectomy and histopathological outcome are comparable in over 90% of cases. The commonest indication and histological finding in our setting is leiomyoma.