Questions to Ask Before a Hysterectomy (and What to Get in Writing)

The list is in your notes app. Fourteen questions, some of them repeats, one of them about suture material because someone online said to ask. You've rehearsed it in the shower. The appointment is Tuesday, it's half an hour, and you are going to nail it.

Then you're in the room, and your brain turns to mush. You don't remember them again until the appointment is over and you're back at home.

The question you'll regret not asking isn't the clever one. It's the dull one. "When you say don't lift, what does that mean for me, in pounds, for how many weeks?" That number is your surgeon's judgement, not a fixed rule, and it won't be written down unless you ask.

So here's the list, the reason behind each group, and the one thing to leave with: the answers, on paper.

THE QUICK LIST

Click here for a printable version you can take with you to your appointments.

What should I ask about my ovaries, my tubes and my cervix?

Your ovaries, your tubes and your cervix are three separate decisions, and keeping or losing one doesn't decide the others. The countdown to your surgery walks through each; here, it's the questions you take to the appointment.

Removing the ovaries at a hysterectomy for a non-cancer reason isn't routine anywhere I looked. The NHS, citing NICE, says ovaries should only be removed if there's a significant risk of associated disease, and adds a line every woman should take literally: if you'd prefer to keep them, make sure you've made that clear to your surgeon before the operation.

The UK guideline for heavy bleeding is even more firm: only remove ovaries with the express wish and informed consent of the woman. So ask both: are you planning to remove them, and if not, what's the plan if they look abnormal once you're inside? The what-if is the part women wish they'd asked about.

"Ask about leaving ovaries," one wrote. "One of mine was taken for a reason I don't believe was necessary." Another wanted to know "how he/she decides to keep ovaries, cervix, etc. once inside." The surgeon has a rule for that moment. You're allowed to hear it before you're asleep.

Taking the fallopian tubes while leaving the ovaries, offered in Canada since 2010 and British Columbia first, is done to lower the risk of ovarian cancer, and the American college says the surgeon and patient should discuss the potential benefits. It also says planning to take the tubes shouldn't change your route. Ask yours: will you take the tubes, and does that change my operation?

NICE says the surgeon should discuss taking the cervix (a total hysterectomy) or keeping it (subtotal) with you. Keeping it can change the route, too, because the American route guideline says a supracervical operation is done laparoscopically or open, so ask before the route is fixed. Removing the cervix may have an effect on sex after a hysterectomy.

Keeping your ovaries doesn't guarantee they'll keep working, so ask what to watch for.

NICE tells clinicians to inform women about the risk of possible loss of ovarian function even if their ovaries are retained, and a 2011 study that followed women aged 30 to 47 for four years found those who'd kept their ovaries through a hysterectomy were nearly twice as likely to reach ovarian failure as women who hadn't had the surgery: about 15 percent against 8.

"I kept both ovaries and still ended up in early perimenopause," one woman wrote, "because they lost a blood supply." You'll find the signs in what happens to your hormones after a hysterectomy, and if you haven't yet settled whether to keep your ovaries, there's a full breakdown to help you decide.

What's on the consent form, and what happens if they find something?

Your consent sets the boundary of what the surgeon is allowed to do, and it holds even once you're under.

In Canada, the doctors' medical-protection association says a surgeon may exceed the mandate you gave only when stopping would leave the operation ineffective or put your health or life at serious risk. The UK regulator says the same: no exceeding the scope of your consent, except in an emergency.

And England's national consent form for a keyhole hysterectomy has you sign it in the first person: any procedure in addition to those described on this form will only be carried out if it is necessary to save my life or to prevent serious harm to my health.

Because that exception exists, nobody can promise nothing else will be done. So anything you want or don't want has to be decided and written down beforehand, because once you're asleep it's out of your hands.

One woman found that out by proxy. Her surgeon found endometriosis on her appendix mid-operation and phoned her partner for consent to take it out. "She was not expecting that," she wrote, "and I wish we'd dealt with that q before surgery." Another woke up with a hernia repaired she hadn't known she had.

Both fine. Both a surprise nobody saw coming.

So get the answers down in writing before the day. Can I see the consent form before the day? Where is my preference about my ovaries written down? If you find something unexpected, what have I agreed to, and what haven't I? And if keyhole has to become open surgery, what does that look like, and where is that on the form?

The shift to open surgery is written down in only one place. The English consent form says it outright: during keyhole surgery, the team may decide to complete the operation with an open approach.

The American route guideline agrees, adding that the surgeon may check with the camera first and switch to open if keyhole won't work. The UK college's recovery leaflets and the NHS hysterectomy pages don't mention it at all.

The one document that tells you the operation can change shape is the one you sign, often on the morning of surgery. I couldn't find a Canadian form that says it at all, which doesn't mean yours won't. It means you ask to see the line.

One woman called it her "back up plan" and asked exactly this. She learned that any emergency abdominal cut would be a bikini-line incision, and went in knowing it. That's the whole point of the question.

The line runs the other way too. What's on the form can also not happen. A woman at 30 who'd agreed with her surgeon to take everything, "papers marked correct, communication perfect," found out from her pathology report that her ovaries were still in. The surgeon "didn't see a need to remove them during surgery because they looked fine."

The top reply in her thread: "there is probably something you signed stating that a surgeon can pivot during the surgery based on findings." Probably. So the fifth question is the mirror of the third: if something we agreed to take out looks healthy once you're in, do you still take it, and where does it say so?

And one more, because it happened: a surgeon crossed a procedure off a woman's consent form with a black marker at her pre-op appointment, said "OK, your choice," and did it anyway.

She's pursuing it. You can't undo that from a hospital bed, but you can do this. Ask for a copy of the form as signed, and read the list of procedures on it out loud with your surgeon before you leave the room.

What should I ask about the operation itself?

How the operation is done shapes the first weeks of recovery, and most of it is decided before you're asked.

Why this route for me? The American college's route guideline, written in 2017 and reaffirmed in 2021, lists what goes into the decision: the size and shape of the vagina and uterus, how easy the uterus is to reach (it names adhesions), how far any disease has spread, whether anything else needs doing at the same time, the surgeon's training and experience, their average case volume, what equipment the hospital has, whether the case is emergent or scheduled, and the preference of the informed patient.

NICE says the same in one sentence: an individual assessment, taking her preferences into account. Canada's guideline says it too. Nine factors, and you're one of them.

The question is simply "which of those decided it, for me?" Your surgeon's answer is the only one that's about your uterus.

Given my history, how likely is it that mine becomes an open operation? Published rates exist, and they're the wrong number, because the biggest risk factor reported for switching to open surgery is a history of adhesions, and you either have that or you don't. Ask the personal version. It's the only version with an answer.

How many of these do you do a year? It feels rude. It isn't. Canada's own guideline for hysterectomy says, with its highest grade of evidence, that higher-volume hospitals and surgeons are more likely to have lower complication rates, and the American college puts the surgeon's case volume on its list of what should decide your route. Nobody's telling you to shop around, but the information is good to have.

You're asking about your own operation, and the same American document says that in some circumstances the best course of action could be referral to another surgeon who does the approach you want.

Will you be using a morcellator, and will it be contained? This one is for a keyhole or robotic operation for fibroids only. A morcellator cuts tissue into pieces so it can come out through a small incision, and cutting tissue that way carries a small risk of spreading undetected cancer cells. Since 2020 the FDA has told surgeons to use a containment system, and its advice to patients is to ask whether one will be used.

How do you close the top of the vagina, and do those stitches come out? The top of the vagina gets sewn shut, and the scar is called the vaginal cuff, or the vault (the glossary has both). The UK college's leaflets say any stitches in your vagina will not need to be removed, as they are dissolvable. How long they take to dissolve isn't in any leaflet I read, and one woman's took 120 days, with spotting the whole way.

"I asked what a vaginal cuff was because I had no idea," another wrote. "Turns out, it's not a surgical device that they put inside of you!"

Glue, stitches or staples on the skin, and does anything need taking out? The keyhole leaflet says the cuts on your abdomen are closed by stitches or glue, and some stitches may need to be removed about five to seven days after. One woman's staples "kept me in pain until they were taken out at 2 weeks." You'll want to know before the day whether you're going back to have something removed.

Will I have a catheter, how long for, and will I be awake when it goes in? All three of the UK college's leaflets say the same thing: you may have a catheter, a tube draining your bladder, usually for up to 24 hours. The enhanced-recovery guideline for gynaecological cancer surgery says out the same day for keyhole.

Will I have a vaginal pack? The UK college's keyhole leaflet says you may have a pack, a length of gauze like a large tampon, in your vagina, even for keyhole surgery, and a nurse removes it before you go home. "I wish I had asked if I would have vaginal packing or not," one woman wrote. It's "may," not always, so ask.

One question women ask: what holds the top of the vagina up once the uterus is gone? The cardinal and uterosacral ligaments do, and about 1 in 20 women will have some degree of vault prolapse within fifteen years of a hysterectomy. Ask how your surgeon supports the vault at the time of the operation, and what to watch for afterwards.

Who will be in the operating room?

More people than you think, and in a teaching hospital, some of them are learning.

Being told is your right in Canada, the UK and the US. The Canadian medical-protection association says patients must be informed about the involvement of trainees in their care, and have a right to know who will be involved when any part of the treatment is delegated.

The English consent form has you acknowledge that the operating person may not be the one you met, and that students and trainee nurses may be present.

The UK regulator says you're owed the names and roles of the key people.

Whether you can refuse is a different question. In the US, the AMA's Code of Medical Ethics (Opinion 9.2.1) says physicians must give patients the opportunity to decline student participation. That's a professional standard, not a statute.

The federal rule is separate and newer: since April 2024, US hospitals have had to get written consent for pelvic and other sensitive examinations done under anaesthesia for teaching, and disclose whether trainees will be doing important parts of the surgery.

In Canada, the Society of Obstetricians and Gynaecologists has said since 2010 that student participation in pelvic exams under anaesthesia must be explicit in the consent process. A 2024 survey in its own journal asked 134 Canadian medical students what they'd actually seen.

Of those who'd done a pelvic exam on an anaesthetised patient, one in five said specific consent had been obtained. About a quarter said none.

The rest weren't sure or had seen it both ways. Students reported this, not patients, and the sample was self-selected with nobody from Manitoba or Saskatchewan. The authors called the practice "highly variable."

Ontario's regulator has a consent policy updated in March 2025 that says nothing about trainees, students, or examinations under anaesthesia. In Canada, you ask because the paperwork may not.

Three questions: who will be in the room, and who does what? Will trainees be doing any part of the surgery? Will any examination be done under anaesthesia for teaching, and do you need my written consent? In the US that last one has a legal answer. In Canada, your surgeon's answer is the answer.

One woman asked it this way: "Will there be medical students practicing gyn exams on me while I'm unconscious? (I am ok with that because I care about medical education, but I want to know about it if they do.)" Wanting to know isn't an accusation.

The women who've been through it are less worried than the woman asking. A 151-comment thread about a resident doing surgery got reassurance as its top replies: your surgeon is present, the others are assisting. Somebody counted at least eight people in her operating room. They were all doing something.

You can ask for an all-female team. No policy says a hospital has to grant it, so it's a request. If trainees are what keeps you up, the operative-report guide explains how to find out afterwards who did what.

Which of my medicines do I stop, and when, and who tells me?

The most consequential questions on the list, and the easiest to skip because everyone assumes someone else has it covered.

One woman had been taking ibuprofen two or three times a day for months. Two pre-op appointments, nobody mentioned it. The morning before surgery she read her own paperwork: no anti-inflammatories for at least three days before. She called the on-call nurse and was told they might have to reschedule. That's the failure mode, and it isn't a wrong answer. It's no answer, because the question was never specific.

So make it specific. Not "do I need to stop anything?" but "here is every prescription, over-the-counter drug and supplement I take, including the herbal stuff; which of these stop, and when?"

Four get a different answer from the rest:

• Blood thinners, aspirin and anti-inflammatories. They change how you bleed and clot, so when to stop them is your surgeon's call.
• The combined pill and oral HRT. UK guidance asks women to consider stopping oestrogen-containing contraception or HRT four weeks before elective surgery for clot risk.
• The weight-loss injections. Held before an operation by the gynaecological cancer surgery guideline, and on the Royal College of Anaesthetists' list of what to tell your anaesthetist.
• Your inhaler, your insulin, your eye drops. Usually you keep these. Ask which to take on the morning before surgery, and whether to bring the bottles or a list.

Most of these answers live at a second appointment: the pre-op assessment clinic, or pre-admission clinic. The NHS describes it as an appointment with a nurse who checks your health, history and home circumstances, then covers fasting, which medicines to stop, what to bring and how long you'll stay.

When do I meet the anaesthetist, and what do they need to know?

Your anaesthetist may come to you at the preassessment clinic, or not until you're at the hospital on the day of, and their own college says which one depends on your surgery and your health.

One woman had the IV about to go in when she asked her anaesthesiologist about something on her EKG that "no one had addressed." The anaesthesiologist consulted the surgeon, and the operation was postponed until a cardiologist had cleared her. She went home with a packed bag to a clean house, grateful later that somebody had listened.

So write the anaesthetic questions down and take them with you, which is the college's own advice: what type of anaesthetic is best for me, do I have any specific risks, and what do you need to know about me? The rest of the timeline, from the pre-op appointments to the night before, is in the countdown to your surgery.

Will I go home the same day, and what if I don't?

Canada's guideline wants you home the same day. Same-day discharge after a keyhole hysterectomy is cost-effective, doesn't increase complications or readmissions, and comes with high patient satisfaction, in its words, at a moderate grade. The guideline was due for review in 2024 and hasn't had one, but it's still the standing position.

So ask whether you're planned as a day case, what would keep you in, and what happens to your regular medicines if you stay.

That last one comes from a woman admitted overnight when nobody had planned for it: "Surgeon never put in any orders for my usual meds." Hospitals supply medicines from their own stock. Nova Scotia's policy names eye drops, inhalers and insulin pens as the exceptions you keep; the rest gets locked away. If you take something every day that you can't skip, find out beforehand what happens to it.

Your ride is not optional. Toronto General puts it in capitals: if you do not have someone to take you home, your surgery will be cancelled. The Canadian anaesthesia standard requires a responsible adult to take you home after day surgery, but doesn't say how long they have to stay. Your hospital sets that.

Whether the hospital runs an enhanced-recovery pathway changes the whole day: fasting, a drink beforehand, when you eat, when you walk, when the catheter comes out.

The pathway's own society describes it as preparation before admission, less physical stress from the operation, a structured plan for pain relief and early eating, and moving as soon as possible. The detailed guidelines behind it were written for gynaecological cancer surgery, so the fine print may not be yours.

A University of Toronto surgical programme's consensus says non-opioid pain relief should be first line and that you should leave with a prescription for it. One woman whose surgery landed just before a holiday spent the wait worrying whether her pharmacy would be open. Don't leave without the list, or without knowing where you're filling it.

What exactly can't I do afterwards, and for how long?

A 2013 review found no randomised trial or prospective cohort study linking what a woman does after pelvic floor surgery to whether the surgery holds, and wide variation in what surgeons recommend. The restrictions you'll be given have never been tested in a trial.

The variation shows in one UK college's three leaflets from the same year. Driving: two to four weeks after keyhole or vaginal surgery, three to six after abdominal. Lifting no more than a litre of water: one to two weeks after a vaginal hysterectomy, three to four after the others. Back to work: two to three weeks after keyhole, six to eight after open surgery.

The recovery guide has the ranges with their sources. Your number is a judgement call, and judgement calls are the ones you get in writing.

Don't ask "how long is recovery." One woman was told two weeks, then found out her cruise three weeks later was off limits for six.

Ask about each of these specifically, and get a date. Driving. Lifting, in something you own, a bag of flour or a toddler. Stairs. Your job by name, with the return date on a letter, because your employer will want one. Housework, and which housework. Sex. Swimming and baths. Travel. Exercise.

Driving has a medical answer and an insurance answer. The UK college says no driving for 24 hours after a general anaesthetic, then the range for your route. A UK pelvic physiotherapy group's leaflet on driving adds that the test is whether you can do an emergency stop, and that some insurers won't cover you until a doctor says so in writing.

That's all UK; I found no Canadian guidance on driving after gynaecological surgery and no verified insurer's rule.

So: when is it medically safe, when can I brake hard, and does my insurer want anything in writing.

Pelvic floor care starts in hospital, at least on paper. In the UK college's description of an abdominal hysterectomy, a physiotherapist is part of the hospital stay, teaching pelvic floor exercises once the catheter is out.

No guideline I found makes a referral after discharge routine. One woman "didn't know what it was until I had a problem post op." Ask who you see, and what happens once you're home.

None of the three UK recovery leaflets says when you'll be seen again, so ask: when do I see you again, how do I reach you before then, and what do I call about? Read up on the six-week check and the signs that mean call now before you go.

And the paperwork: how do I get a copy of my operative report and my pathology report? Here's how, and it's easier to arrange before you leave than after.

How do I get all of this asked in one appointment?

You don't, and that's fine. There are three appointments: the surgeon, the pre-op clinic, and the anaesthetist. Split the list three ways and take it with you each time.

Written lists work. A Cochrane review of 33 trials covering 8,244 patients found that patients who brought a question list, or were coached beforehand, asked more questions. The reviewers found no other clear benefit, and more questions asked is the whole aim.

The anaesthetists' college also tells you to write your questions down.

Write the answers down as you get them.

Three countries hand patients the same four questions. Choosing Wisely Canada: do I really need this, what are the risks, are there safer or simpler options, what happens if I do nothing? The UK calls it BRAN: benefits, risks, alternatives, nothing. The American college lists the same four as what a surgeon owes you in the consent conversation.

Then edit. One woman's advice to another with a long list: "A lot of them as well could be statements instead of questions. 'I'd prefer my cervix is removed, I'd like laparoscopic surgery instead of open abdominal if possible, and I'd like to discuss post op care.'" Preferences become statements, questions stay questions. The list gets shorter and the surgeon hears what you want.

Bring someone whose job is the pen. "Send a notepad and pen so someone can write down the answers," one woman told another. "You won't remember when they tell you anyway."

End with the best last question I found, from a woman still preparing for her own: "at the end ask them if there are any questions most people ask that maybe you forgot to ask." Then say it back. Clinicians call this teach-back, where they ask the patient to state in their own words what they need to do.

Nothing stops you running it on yourself: "So what I'm hearing is, ovaries stay unless they look wrong, no lifting over the flour bag until the 14th, and I call you if the fever's over whatever you said. Is that right?"

The US patient-safety version is Ask Me 3: what is my main problem, what do I need to do, why is it important.

If something in the answers doesn't sit right, a second opinion is your right in Canada. The medical-protection association says patients may seek second opinions, and in the same breath that no doctor is obliged to provide treatment they don't think is indicated.

The women online put it bluntly: "if the doc is not the one, walk away."

The American college puts it more carefully: referral to another surgeon can be the right outcome of the route conversation. Nobody has to be fired for you to see someone else.

For the whole recovery on paper before you go in, dates and all, use the roadmap.

Click here for a printable version you can take with you to your appointments.

Common questions