How to Prepare for a Hysterectomy: Questions & Checklist

The weeks before a hysterectomy are often a mix of relief that something is finally being done and worry about the operation and recovery. Good preparation will not take all of that away, but it does make a difference: being in better health before surgery lowers the risk of complications and can speed up recovery.^[2] This guide brings together what women who have been through it say they wish they had known, the questions worth asking your surgeon, and the practical steps that guidelines support in the weeks and days before your operation.

Hospitals have their own routines, and your team knows your health history. If their instructions differ from anything here, follow theirs.

What women say they wish they had known

Researchers at Henry Ford Health in Detroit held focus groups with 24 women who had had a hysterectomy, and asked them about the decision, the operation, the recovery, and what advice they would give their past selves and other women.^[1] It is a small study from one region, so it cannot speak for everyone, but the themes will sound familiar to anyone who has read patient forums:

• Recovery took longer and felt harder than expected. Many women felt they had not been told enough about it. Low energy and a slow return to normal routines were common frustrations, especially for women who had complications.
• They needed more help at home than they planned for, with chores, shopping and driving, and found the temporary loss of independence hard.
• Plan for more time off work than you think you need.
• Ask more questions beforehand, including about possible complications, and do not let embarrassment stop you from talking openly with your doctor.
• Do your own reading and talk to women who have had the operation, so you know which questions to ask. Several women also suggested getting a second opinion and making the decision for yourself, based on how your symptoms affect your life.
• Many wished they had not waited so long. Looking back, most said they wished they had had the operation sooner, rather than living with symptoms or trying other procedures first. Nearly all were satisfied with the result.

The rest of this guide is built around those points: getting good information, getting your body ready, and setting up the help you will need afterwards.

Questions to ask your surgeon

Your pre-surgery consultation and pre-assessment appointment are good opportunities to discuss concerns and ask questions.^[2] It helps to write your questions down and bring someone with you to take notes. These are the ones that most often change what happens, or what you expect:

About the operation

• Exactly what will be removed? The uterus only, or also the cervix? A partial (supracervical) hysterectomy keeps the cervix, a total hysterectomy removes it. Our guide to partial vs total hysterectomy explains the differences.
• Will my ovaries be kept? If both ovaries are removed before menopause, menopause starts straight away. Ask what that would mean for you and whether hormone therapy would be an option. Our article on hysterectomy and hormones covers this in more detail.
• Will my fallopian tubes be removed? In August 2026 the American College of Obstetricians and Gynecologists (ACOG) recommended that both tubes be routinely removed during hysterectomy, because this lowers the risk of the most common type of ovarian cancer.^[11] Our tubal ligation vs hysterectomy guide explains what salpingectomy involves.
• Which approach will you use, and why? Vaginal, laparoscopic (keyhole), robotic or abdominal. The approach affects the size and position of the scars, the hospital stay and the recovery time. You can see what the different hysterectomy incisions look like.
• Are there alternatives I could still try? Depending on the reason for surgery, options such as a hormonal IUD, medication or fibroid procedures may be worth discussing. See hysterectomy alternatives for fibroids and Mirena IUD vs hysterectomy.
• What are the main risks for someone like me, and what happens if a complication occurs?

About recovery

• How long will I probably stay in hospital?
• How will my pain be managed in hospital and at home?
• How much time off work should I plan for, given the kind of work I do?
• When can I expect to drive, exercise and have sex again?
• Who do I call if I have a problem after I go home, including at night or on weekends?

In the weeks before: getting your body ready

Most of these steps are part of “enhanced recovery” (ERAS) programs, which hospitals use to help people recover faster and with fewer complications. ACOG and the ERAS Society both recommend them for gynecologic surgery.^[5][6][7]

Stop smoking and cut down on alcohol

Stopping smoking makes the anesthetic safer and lowers the risk of wound infection and blood clots.^[4] Enhanced recovery guidance suggests stopping smoking and heavy drinking at least four weeks before surgery.^[6] Any time without smoking helps, so it is still worth stopping if your operation is sooner than that. Ask your doctor about nicotine replacement or a stop-smoking service.

Stay active

The NHS advises exercising regularly from the moment you know you are having a hysterectomy.^[2] You do not need a training plan. If you are not active at the moment, a daily walk that you build up gradually is a realistic goal, and staying as fit as you can makes it easier to get moving again after surgery. Learning pelvic floor exercises before the operation also means you will know what to do when it is time to start them again.

Eat well and keep your bowels regular

A healthy, balanced diet is part of standard NHS advice before a hysterectomy.^[2] Fruit, vegetables, whole grains and plenty of fluids also help keep your bowels regular. This matters because constipation is common after surgery, and it is easier to deal with if you are not already constipated beforehand. If you are overweight, losing some weight lowers the risks of anesthesia, and your doctor can help you plan this.^[2][4]

Get checked for anemia

Heavy periods are one of the most common reasons for a hysterectomy, and they often cause iron-deficiency anemia. About one in four women scheduled for hysterectomy or myomectomy are anemic.^[6][8] Anemia before surgery is linked to more complications, longer hospital stays and a higher chance of needing a blood transfusion.^[8]

Ask for a blood count well before your operation date, not just at the pre-assessment. If your hemoglobin is low, iron tablets are usually tried first when there is time. Intravenous (IV) iron may be offered if tablets do not work, are not tolerated, or the operation cannot wait. Experts suggest aiming for a hemoglobin of at least 12 g/dL, and some recommend 13 g/dL, before planned surgery. A non-urgent operation may be postponed to give treatment time to work.^[6][8]

Review your medicines

Bring a full list of everything you take, including vitamins, herbal remedies and supplements. Some medicines need a specific plan:

• Blood thinners such as warfarin: tell your surgeon early. You will be told whether and when to stop, and how they will be restarted.^[4]
• The combined pill and HRT: advice varies. Some hospitals ask you to continue them as normal; others suggest stopping the combined pill about a month before major surgery because of the risk of blood clots. If you do stop it, use another form of contraception.^[4][6] Ask your team which applies to you.
• GLP-1 medicines for diabetes or weight loss (such as semaglutide or tirzepatide): under 2024 guidance from US anesthesia and surgery societies, most people can keep taking them, but some may be asked to follow a liquid diet for 24 hours before surgery or to delay a planned operation if they have just started the drug or have stomach side effects. Tell your team you take one.^[10]

The pre-assessment appointment

Most hospitals invite you to a pre-operative assessment a few days or weeks before the operation. It usually includes questions about your health, blood pressure, pulse and weight, and often blood and urine tests. Some women also need an ECG (heart tracing) or a chest X-ray. You can usually bring a partner or friend.^[2][4] This is where you will be given your personal instructions about eating, drinking and medicines on the day, so it is worth writing them down.

Your team will also check whether there is any chance you could be pregnant. UK guidance from NICE advises asking every woman who could become pregnant about this on the day of surgery, and offering a pregnancy test, with her consent, if there is any doubt. Each hospital sets its own way of checking.^[13] Some hospitals also ask you to avoid unprotected sex after your last period before the operation.^[4] If you think you could be pregnant, tell the hospital before your admission.

The day before and the morning of surgery

Eating and drinking

Older advice was to fast from midnight. Current guidelines are less strict: most adults can eat until about six hours before the anesthetic and drink clear fluids (water, black tea or coffee without milk, pulp-free juice) until about two hours before.^[6][9] Many enhanced recovery programs also give you a carbohydrate drink to take before surgery, which reduces the stress on your body and has been linked to earlier discharge.^[6] Always follow the exact times your hospital gives you, as they depend on your health and the time of your operation.

Do you need an enema or bowel preparation?

Usually not. Routine bowel preparation is not recommended for gynecologic surgery, because it can make you dehydrated and has not been shown to help.^[6] If you are constipated in the days before, mention it at your pre-assessment. Your surgeon may occasionally ask for bowel preparation for a specific reason, such as suspected severe endometriosis involving the bowel.

Chewing gum

Some hospitals ask you to bring chewing gum to use after the operation, because chewing can help the bowel get going again.^[4] Do not chew gum on the morning of surgery unless you have been told it is fine, and make sure it is out of your mouth before you go into the operating room.^[9]

Arranging help and getting your home ready

This is the step the women in the Henry Ford study most often underestimated.^[1] Some practical points:

• Help at home: plan for extra support for at least the first two weeks, and let family, friends and any services you use know your dates.^[4] If you live alone, ask the hospital what support is available locally.^[3]
• Getting home: you will not be able to drive yourself home. Most women are ready to drive again somewhere between two and six weeks, once they can wear a seatbelt comfortably and do an emergency stop.^[3]
• Time off work: after an abdominal hysterectomy, full recovery takes about six to eight weeks, and many women with desk jobs return around then. Recovery is often shorter after vaginal or laparoscopic surgery.^[3] Jobs with heavy lifting usually need longer. Talk to your employer before the operation rather than after.
• Your home: do a big grocery shop and some batch cooking beforehand, put things you use every day at waist height, and set up a comfortable upright chair and a place to rest downstairs if your bedroom is upstairs.
• Children and pets: arrange who will lift small children, walk the dog and take care of anything heavy for the first weeks.

What to pack for hospital

Depending on the type of surgery, most women stay in hospital for one to about five days.^[3] A small bag usually covers it:

• loose, comfortable clothes with a soft or high waistband that does not press on your lower belly, for the journey home too
• sanitary pads (not tampons), as some vaginal bleeding or discharge is normal afterwards
• your medicines in their original boxes, and your list of medicines
• slippers with a good grip, a robe and basic toiletries
• a phone charger with a long cable, something to read, and earplugs or an eye mask
• chewing gum, if your hospital recommends it^[4]
• a small pillow to hold against your belly in the car on the way home

Preparing emotionally

Feeling anxious before surgery is normal. Some women also feel a sense of loss, particularly if they had hoped for more children or if the operation means an earlier menopause, while others mainly feel relief after years of symptoms. Both reactions are common, and they can sit side by side.

• Know what to expect. Reading about recovery in advance, for example in our week-by-week recovery guide, helps many women feel more in control.
• Talk to the people around you about what you will need. Some women in the Henry Ford study did not discuss their recovery with family or friends because of embarrassment, and missed out on support as a result.^[1]
• If your ovaries will be removed, ask before surgery how menopause symptoms will be managed afterwards, so you have a plan in place. Our article on menopause after a total hysterectomy explains what to expect.
• If you have a history of depression or anxiety, let your doctor know so that support can be arranged for the weeks after surgery.

Warning signs after surgery

It helps to know these before you go into hospital, and to keep the number for your surgical team somewhere easy to find. Contact your surgeon or hospital if you have:^[12]

• a temperature above 38°C (100.5°F)
• a wound that is bleeding, red and warm, or leaking thick yellow or green fluid
• pain that your pain medicine does not control
• nausea or vomiting, being unable to eat or drink, or being unable to pass gas or have a bowel movement
• pain or burning when passing urine, or being unable to pass urine
• vaginal bleeding heavier than light spotting, or a bad-smelling or heavy watery discharge
• a cough that will not go away
• swelling, redness or pain in one leg

Call emergency services if you have chest pain or trouble breathing, as these can be signs of a blood clot in the lungs.^[12]

Frequently asked questions

How far in advance should I start preparing?

As soon as you know you are having a hysterectomy.^[2] Four weeks or more gives time to stop smoking, treat anemia and get a little fitter, but even a week or two of preparation is worthwhile.

Will I be able to walk straight after the operation?

You will be encouraged to get up and walk, with help at first, as soon as possible, often on the same day or the day after. Early movement is a core part of enhanced recovery and helps prevent blood clots.^[7]

Can I still get pregnant after a hysterectomy?

No. Once the uterus has been removed, pregnancy is no longer possible, whether or not the ovaries are kept. If you might want children in the future, raise this with your doctor before you agree to surgery. See our hysterectomy FAQ for other common questions, and our guide to partial hysterectomy for an overview of the operation.

Sources

1. Bossick AS, Sangha R, Olden H, Alexander GL, Wegienka G. Identifying what matters to hysterectomy patients: postsurgery perceptions, beliefs, and experiences. Journal of Patient-Centered Research and Reviews. 2018.
2. NHS. Hysterectomy: what happens.
3. NHS. Hysterectomy: recovery.
4. Royal Berkshire NHS Foundation Trust. Before you come to hospital (patient leaflet on preparing for a hysterectomy).
5. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations – 2019 update. International Journal of Gynecological Cancer. 2019.
6. Ibanoglu MC, Kinay T, Engin-Ustun Y. Enhanced recovery after gynecologic surgery: review of the literature. Clinical and Experimental Obstetrics & Gynecology. 2022.
7. American College of Obstetricians and Gynecologists. Committee Opinion No. 750: Perioperative pathways: enhanced recovery after surgery. 2018.
8. Serati M, Cetin I, Athanasiou S. Recovery after surgery: do not forget to check iron status before. International Journal of Women’s Health. 2019.
9. American Society of Anesthesiologists. 2023 practice guidelines for preoperative fasting (summary of the updated guidelines). 2023.
10. American Society of Anesthesiologists. New multi-society clinical practice guidance released (GLP-1 receptor agonists before surgery). 2024.
11. Healio. ACOG recommends bilateral salpingectomy for ovarian cancer prevention. 2026.
12. MedlinePlus (US National Library of Medicine). Hysterectomy – abdominal – discharge.
13. National Institute for Health and Care Excellence (NICE). Routine preoperative tests for elective surgery (NG45): recommendations. 2016.

This article is for general information and is not a substitute for medical advice. Always follow the instructions of your surgeon and care team, and contact a healthcare professional if you have any concerns before or after your operation.