Preparation starts the day you book, not the week before. The two biggest pieces aren't calendar items at all: settling exactly what's being removed and getting it written down, and lining up the help you'll need at home. Everything else is a short list, most of it for the last two weeks.
Search "how to prepare for a hysterectomy" and you get a month-by-month checklist: buy loose pyjamas, stock the freezer, arrange a ride. All fine, all true, and none of it is the part that will still be bothering you at 2am.
The part that will be bothering you (and should be) is what they're taking, whether anyone wrote your answer down, and who is going to help you stand up off the couch on day three.
What should I ask before a hysterectomy about my ovaries?
Ask whether your ovaries are staying, and get the reason. Taking the ovaries out is not a routine part of a hysterectomy for a benign problem, and it isn't the surgeon's call to make alone on the day. Every college that writes this down says the same thing: it's a decision the two of you make before the operation, depending on your specific situation.
The NHS, citing NICE, says a woman's ovaries should only be removed if there's a significant risk of disease like ovarian cancer, and that if you want to keep them, you make that clear to your surgeon beforehand. RANZCOG, the college for Australia and New Zealand, calls ovary removal "not routinely performed" and something to discuss for your own circumstances.
In Canada, the SOGC guideline goes further, and recommends against removing the ovaries in premenopausal women with no clinical reason, because it can raise the risk of heart disease.
Behind that guidance is a long line of research, and it's information for the conversation, not a verdict on anyone. The big one is the Nurses' Health Study, which followed tens of thousands of American women for decades after a hysterectomy for benign disease. It found slightly higher long-term mortality in the women who had their ovaries removed than in the women who kept them.
The effect showed up mainly in younger women who never took oestrogen afterward, and a UK review in 2022 that relayed those numbers is careful about the same point: the extra risk is largely offset by oestrogen therapy. If your ovaries are already out, none of this means you chose wrong. It's why you have that conversation before surgery, not after.
There's a second conversation that often gets skipped: taking the fallopian tubes while leaving the ovaries in. It's called opportunistic salpingectomy, and Canada pioneered it, with British Columbia offering it since 2010. Because many ovarian cancers are now thought to begin in the fallopian tubes, removing tubes you're finished with lowers that risk.
The SOGC strongly recommends at least raising the option, and adding it changes nothing about the operation you're already having. It adds a little surgical time and, on the evidence so far, no extra complications, no longer stay, no slower recovery.
One BC study published in 2026 found a large drop in one type of ovarian cancer among women who'd had it, though it rested on so few cancers that the true size of that drop is still uncertain, so treat it as promising rather than settled. You are not signing up for a bigger surgery by asking.
Keeping your ovaries is also not a guarantee they keep working. In some women they fade years earlier than they otherwise would have, sometimes within a few years of surgery, and most women are never told it's even possible. Ask your surgeon directly: what are the odds mine stop early, and how would I know? Early ovarian failure like that is a documented thing.
This is what happened to me, and at the time it was very confusing, menopause was the last thing on my mind being still under 40. Not one person had mentioned that this was a possibility, and two years later it happened anyway. Don't let that be your case too, make sure you fully understand what you're signing up for.
If your cervix is being removed, this is a separate line on the consent form and should list the reason. It can matter for sexual satisfaction afterward, though the research is mixed, so it's a decision that needs some thought and research first.
Get the ovary decision in writing
A verbal "don't worry, we're keeping them" is not the same as a documented instruction, and the gap between the two is where women get hurt.
The UK is the only place I found that spells out on paper what should happen. Its consent guidance says the form should name the exact procedure, including whether the ovaries and tubes are being removed, and that your wishes about unexpected findings should be written down.
The archived college advice is blunt: removing an ovary for disease found unexpectedly during surgery should not be done without consent. The current national NHS consent form has a checkbox for ovary removal and a line for your stated preference. Keeping the ovaries just means that box is left blank, which is exactly why it's better to confirm than assume.
This is UK paperwork, though, and that's the catch. I couldn't find a Canadian or American patient form that names an ovary line the same way, and the US college's own FAQ says only that the surgeon may not know until the operation what comes out.
So the move for a Canadian or American reader isn't to expect the same paperwork. It's to ask to see the consent form before the day, ask where your preference about your ovaries is recorded, and ask what happens if they find something unexpected in there.
Women have learned this the hard way, and they say so. One wrote that her surgeon "crossed it off of the consent form... and did it anyway." Another, after her own surgery, left the same warning for everyone behind her: "Please please please ask your surgeons more questions."
That's not paranoia. It's the difference between a preference someone remembered and a preference someone recorded.
A full list of what to ask at that appointment is on the way.
The wait nobody writes about
Between booking and surgery there's a stretch of time every prep article skips, probably because there's nothing to buy for it. In Canada it can be long.
Canada doesn't track hysterectomy wait times as a country. What exists is provincial, it mixes procedures together, and it swings from a few weeks to more than a year depending on where you live. British Columbia's public tool, for one, reports a category it calls "uterine surgery" that folds D&Cs, fibroid and polyp operations in with hysterectomies, so its figures can't be read as a hysterectomy wait at all.
Ontario's often-quoted 71 days for a benign hysterectomy reaches the public only secondhand, through a 2026 policy paper rather than a page you can look up. Your best bet is your own province's wait-time tool, and even then its number usually covers more than just hysterectomies.
Whatever put you on the list is still there the whole time you wait, and living with it takes a toll. A small 2020 study of 22 women whose fibroid surgery was postponed by the pandemic found most of them measurably worse for it on scores of anxiety and low mood. It's tiny and specific, so it won't predict your own case, but it points at something concrete: months of untreated symptoms wear a person down.
Canada's own surgical backlog from that period ran to hundreds of thousands of delayed operations.
Mine was one of them. My surgery was booked for the week after we went into lockdown in March 2020, and it was cancelled by phone. I was told only that it would be rebooked "at a later date" and that they couldn't say when. The date I eventually got landed on the day I was due back at work, four months later.
While you wait, there are three fair questions to put to your team, drawn from British Columbia's older but sound guidance on it:
- Is there any sign my condition will get worse while I wait?
- What should I do if it does?
- Can I go on a cancellation list to be called if a slot opens up sooner?
Nerves in this stretch are ordinary. A 2023 umbrella review pulling together nearly 200 trials found that simple, low-risk things reduce pre-op anxiety, most consistently music, along with massage and guided relaxation. Those are anxiety scores rather than surgical outcomes, and the research isn't specific to gynaecology, but the measures cost nothing and the downside is close to none.
The simplest one is free: the conversation with your surgeon or anaesthetist, where the unknowns get smaller, helps on its own.
What should I do in the weeks before a hysterectomy?
Here the checklists get busy and the evidence gets thin. Most of what's sold as "prehab" hasn't been tested in this surgery. One thing has a proper recommendation behind it.
That one thing is stopping smoking. If you smoke, quitting beforehand does real work: smoking slows healing and raises the odds of wound and lung complications, and stopping before surgery brings that risk down. It's the one prep move with a real recommendation behind it: the 2019 ERAS guidelines call for stopping about four weeks out, rated high-quality and strong.
Don't fixate on the exact number. The patient leaflets range from one week to eight; any smoke-free stretch before surgery helps, and more time helps more.
Getting fitter is the advice everyone gives and almost nobody has tested here. Every college tells you to move more, eat well and drink less, and that's reasonable. What nobody has is proof: the trials that would show a pre-op fitness programme changes how this surgery goes haven't been done, and the specialty guideline rates the evidence for it low and its own recommendation weak.
So walk and eat your vegetables, but do it because it's good for you, not because a checklist promised an easier recovery it can't guarantee. If your pelvic floor is on your mind, the exercise side of recovery covers how to start it properly.
If you're on the pill or HRT, let your surgeon know ahead of time. UK guidance from NICE asks women on oestrogen-containing contraception or HRT to consider stopping it about four weeks before planned surgery, because of clot risk. It's a trade-off, not an order: stopping carries its own risk of pregnancy, so it's a call your surgeon or GP makes with you. Don't stop anything on your own.
Everything else in your medicine cabinet gets one instruction: bring the whole list to your team, supplements and over-the-counter medications included, and ask. Patient guidance gives a week as the usual stop-point for aspirin and anti-inflammatories, but the timing is theirs to set, not a rule to apply yourself.
Home, help, and the woman who lives alone
Every source, in every country, assumes someone will be at home with you for the first few days. Not one of them says how many days, and none breaks it down by the kind of hysterectomy you're having. So the short version is: you'll want help early on, and how much you'll need is yours to figure out.
The one thing that does scale the plan is the surgery type, because it sets what you can't do and for how long. After an abdominal hysterectomy, the RCOG's recovery leaflet says no heavy housework like vacuuming for three to four weeks, and to get down to your children rather than lifting them up. Keyhole surgery gives a shorter list. If you don't know which you're having, that's a fair thing to pin down, because what recovery asks of you is different for each.
Whatever the route, someone has to take you home. That's a hard rule after a general anaesthetic, and in Canada the guideline requires a responsible adult to go with you; the "someone stays 24 hours" version is a UK convention rather than a Canadian one. Ask your own hospital what it requires, especially if you're having keyhole surgery and going home the same day.
Then there's the reader every one of these pages forgets: the woman who lives alone. The guidance simply assumes help exists. The day-surgery research is more reassuring: it found no firm evidence of harm when no one is home, though there isn't much evidence either way.
If that's you, you can still stack the odds:
- Put food, water, medicine and your phone charger within arm's reach before you go.
- Set up to sleep and live on one floor.
- Line up people who'll check in by phone at set times.
- Ask the hospital directly what it needs to send you home safely, rather than waiting to be told.
On stairs, there's no guidance at all, in any source I checked. Don't read that blank as "stairs are fine." It's just a blank.
The recovery roadmap builds all this into a plan around your surgery date, something a generic checklist can't do. The warning signs to watch once you're home are in when to call your doctor; save those for after.
The help I needed caught me off guard. After same-day discharge, the thing I couldn't manage alone wasn't lifting or stairs. It was getting up out of a chair. Rising from sitting put a lot of pressure internally and on the cuff (my cervix was removed), and I needed more help than I was prepared for.
The last day, and the morning
By the final 24 hours the big decisions are behind you, and it's mostly logistics.
The fasting rules are looser than they used to be. "Nothing after midnight" is still what a lot of people expect, but many hospitals now allow clear fluids up to two hours before, a light meal up to six, and some run a carbohydrate drink beforehand. The one rule that counts: the sheet your hospital hands you wins over anything you read here or hear from a friend. Follow it exactly.
The night-before and morning-of list is the same across every hospital sheet, and it's dull, which is the point:
- Shower, and skip lotion, perfume, deodorant and nail polish.
- Leave jewellery and piercings at home.
- Pack your photo ID, your medicine list and any bottles, and your puffer or CPAP if you use one.
- Have loose, comfortable clothes to come home in.
By the morning, there's almost nothing left to do but show up.
Common questions
Start with three: are my ovaries staying and why, where is that written down, and what happens if you find something unexpected during surgery. If you're keeping your ovaries, add a fourth: what are the odds they stop working early, and how would I know. The fuller checklist is on the way.
Enough for at least the first few days, though no source pins the number down by surgery type. Plan for someone around early on, arrange a ride home as a hard requirement after a general anaesthetic, and if you live alone, set your home up in advance and ask the hospital directly what it needs to discharge you safely.
UK guidance suggests considering it about four weeks before, because oestrogen-containing pills and HRT raise clot risk around surgery. It's a trade-off your surgeon or GP decides with you, and stopping brings its own pregnancy risk, so don't stop anything on your own.
There's no clean national number. Waits are tracked by province, often mix hysterectomies in with other uterine operations, and range from weeks to over a year. Check your own province's wait-time tool, and read its figure knowing it's rarely measuring only your surgery.