Hysterectomy Prep: What to Expect and How to Prepare

When you decide to have a hysterectomy, it’s not usually a decision that is made lightly. Often, it comes after months or years of miserable symptoms that have taken over your life. For example, heavy bleeding that keeps you home, pelvic pain that makes work or sex feel impossible, or endometriosis that turns everyday tasks into endurance events.

The choice to have a hysterectomy can feel scary and overwhelming, but it can also bring a lot of relief for your symptoms, and hope for a better sex life, calmer work life, and days that aren’t betrayed by your uterus.

So, as you go into surgery, it can really help to prepare yourself beforehand. Research shows that higher pre-surgery anxiety is linked to more post-operative pain. Prehabilitation, which includes small steps to support your body and mind, can make recovery smoother, less overwhelming, and more empowering.

Why do people get hysterectomies?

People get hysterectomies to help treat various different health issues that could impact their uterus. Common reasons include:

• Fibroids causing pain, pressure, or bladder issues
• Heavy and abnormal bleeding that disrupts daily life
• Endometriosis or adenomyosis
• Prolapse
• Chronic pelvic pain

A hysterectomy can also be recommended to help treat or prevent cancer in your cervix or reproductive organs.

Why should you prepare for your hysterectomy?

A hysterectomy is one of the most common surgeries for people born with a uterus in the U.S., second only to cesarean sections. There are around 600,000 performed each year and by the age of 65, nearly 40% of women will have had one.

For surgeons, the procedure is routine. But for you, this is the first and only hysterectomy you’ll ever have. Preparing yourself beforehand can really help you to feel physically ready, reduce your anxiety, and improve how you feel in the weeks after surgery.

How does prehabilitation help you get ready for hysterectomy?

Prehabilitation (or “prehab” ) is a way to prepare your body, diet, and mindset before surgery. It’s gaining attention because it can improve recovery outcomes. For major surgeries like heart, abdominal, or colon procedures, research shows that prehab may reduce complications, shorten hospital stays, and improve recovery, especially when it includes things like exercise, nutrition, and breathing training.

Research specifically on prehab before hysterectomy is limited. Reviews of other pelvic and major abdominal surgeries show mixed results. But in theory, going into surgery stronger, healthier, and more informed can make your recovery smoother and less stressful.

Where does pelvic physical therapy fit into prehab?

Pelvic physical therapy (PT) is an important part of your prehab team before a hysterectomy. Pelvic PTs understand how a hysterectomy could impact your:

• Pelvic floor function
• Bladder and bowel habits
• Sexual comfort and arousal
• Abdominal support and mobility
• Scar healing
• Core strength and breathing mechanics
  
  

Before surgery, a pelvic PT can work with you to build pelvic floor coordination, practice pressure management strategies, prepare for changes in bladder or bowel habits, and learn how to move in the early days to protect healing. And it’s important that this support continues after surgery. Pelvic PT after a hysterectomy can help your recovery feel more comfortable and give you tools for long-term pelvic health.

When should you start prehab before a hysterectomy?

When you start prehab before a hysterectomy can depend on your goals, but in general: 

• 6-8 weeks before: If you want to build strength, pelvic floor coordination, and endurance before your hysterectomy
• 2-4 weeks before: If your main focus is on education, body mechanics, bowel prep, and nervous system regulation
• 1-2 weeks before: If you’re looking to refine your mobility, practice diaphragmatic breathing, and prepare your home environment

How should you prepare your mind for your hysterectomy?

Preparing your body for surgery matters. But it’s also important to make sure you also feel emotionally ready. Luckily, a lot of the things that help you feel physically ready for a hysterectomy are the same things that will help you feel mentally ready. 

For example, taking the time to get all of your questions answered, learning as much as you can about your surgery, and getting your home and support system in place will help you to feel more calm and prepared for surgery and your recovery.

It can also help to practice some central nervous system regulation techniques, such as grounding exercises, vagus nerve stimulation, slow diaphragmatic breathing, or meditation. These tools can help you calm your nerves, reduce pre-surgery stress, and give you new skills that you can use during recovery, too!

What should I eat before and after my hysterectomy?

You may or may not have dietary restrictions in the weeks and days leading up to your surgery. If your surgeon hasn’t given any other specific instructions, focus on staying hydrated and eating a well-balanced and nutritious diet. It’s common to be told not to eat or drink for a certain amount of time before your surgery, so make sure to follow your pre-op instructions carefully!

After surgery, you may be told to stick to a clear liquid diet at first, and then transition to a diet of bland starchy foods (white bread, crackers, mashed potatoes) until any nausea goes away. But as soon as you can, it’s important to switch to foods that support your healing. For example:  

• Lean proteins, like poultry, fish, lentils, or beans
• Fiber-rich whole grains, like brown rice or quinoa
• Vitamin-packed whole fruits and vegetables, like raspberry, avocados, spinach, or broccoli
• Hydration, since water is best!

Things to buy before hysterectomy

It can help to get everything you need beforehand to make the first days and weeks way easier. Here is a pelvic PT-approved list of things to have prepared beforehand. These will help protect your pelvic health and surgical healing:

• Stool softeners
• Heating pad and heating pads
• Abdominal binder (follow your surgeon’s recommendations)
• High-waisted loose clothing (the easier to slip on, the better)
• “Squatty potty”-style footstool
• Wash bottle or bidet
• Pillow for coughing/sneezing support
• Easy foods for early recovery (soups, smoothies, protein snacks)
• Support network: friends, family, or caregivers for driving, errands, and chores

Are there questions to ask before hysterectomy?

The pre-op conversations with your care team will likely focus on things like your incision sites or hospital stay. This information is important, but so are your less technical questions. Here are some really common questions to add to your list. Feel free to pick and choose the ones that best fit your needs:

• What type of hysterectomy will I have, and why?
• Will my cervix or ovaries be removed?
• How long before I can return to work, exercise, or sex?
• Will sex feel different or will my orgasms change?
• What treatments do you recommend if sex is different?
• Will I have natural lubrication? 
• What personal lubricants do you recommend if I feel dry?
• Will I gain weight?
• Will my bladder or bowels act up?
• How tired will I really be? 
• What treatments do you offer to help me get my energy back up?
• What should I set up at home before surgery?

Hysterectomy FAQs (your most common questions, answered)

Can I have sex before a hysterectomy?

There doesn’t seem to be a universal rule when it comes to sex before a hysterectomy. Some people have reported that they’ve been told to hold off on sex in the days leading up to surgery to reduce infection risk, while others weren’t given any restrictions. It’s best to ask your surgeon directly what’s safe for your specific situation.

How long does recovery take?

The timeline of your recovery can depend on many different things, including the type of surgery you had, your health history, and things like your activity levels before surgery.

Many people feel better within 4 to 6 weeks of their surgery, but some symptoms can last longer than others. For example, fatigue can last longer. Many patients say fatigue surprises them more than pain, which is another reason that prehab and planning matters.

What are the short- and long-term risks of a hysterectomy?

Risks depend on the surgical method, whether your ovaries are removed, and your overall health. Possible issues include infection, bleeding, constipation, pelvic floor dysfunction, vaginal cuff complications (if the cervix is removed), scar adhesions, and hormonal changes. Your surgeon should explain which of these apply specifically to you.

Are there alternatives to a hysterectomy?

Yes. For non-cancer reasons, a hysterectomy usually isn’t the first treatment option. Depending on your diagnosis, alternatives may include hormonal therapies, IUDs, uterine artery embolization, myomectomy, endometrial ablation, pelvic floor therapy, or specific pain relief strategies.

Will orgasms be different after hysterectomy?

Your orgasms may feel different after a hysterectomy, but there isn’t one single, predictable outcome you should expect. Some people feel more pleasure once pelvic pain or bleeding is gone, while others notice differences in sensation, especially if their cervix or ovaries were removed. The cervix and uterus can play a role in orgasm for some, so removing them may change how your body builds or experiences pleasure. 

And orgasms after a hysterectomy may depend on whether your ovaries were also removed. If your ovaries are removed, lower estrogen can affect your lubrication and comfort. 

Pelvic floor physical therapy before and after surgery can help, and it’s important to talk openly with your care team about any changes you notice because there is a lot of help available.

Will I gain weight?

There isn’t strong evidence that a hysterectomy causes weight gain. Some research didn’t find that a hysterectomy led to long-term weight changes. But your recovery does mean that you’ll have to be temporarily inactive, and changes in estrogen during natural or surgical menopause can affect your body composition. 

So, while some people notice weight changes after a hysterectomy, others don’t. Things like your nutrition, activity levels, sleep habits, and stress may play a much bigger role than the surgery.

Will I go into menopause after hysterectomy?

Not necessarily. If your ovaries are also removed during your hysterectomy (oophorectomy), you will enter what’s known as surgical menopause after your surgery. But if your ovaries are left in place, the research is less clear. 

After a hysterectomy, your ovaries should continue to work as they should. But some research suggests that a hysterectomy may impact your ovarian aging. And because most hysterectomies happen around the time menopause naturally occurs, it can be hard to know what is caused by surgery and what is just your body’s normal timeline.

Final thoughts on hysterectomy prep

A hysterectomy can bring much-welcomed relief from years of life altering symptoms. And it also raises questions about hormones, sex, energy, and your daily life afterward. 

Preparing physically, emotionally, and logistically can make recovery smoother and less stressful. Even with limited research on hysterectomy prehab, gentle exercise, pelvic floor work, good nutrition, hydration, education, and planning can give you the confidence you deserve going into surgery. 

Working with a pelvic physical therapist, like the experts at Origin Physical Therapy, as part of your pre-hysterectomy care team can help you optimize strength, manage your pelvic floor, and set yourself up for a smoother recovery. 

With the right preparation, guidance, and support, you can approach your hysterectomy informed, empowered, and ready to reclaim your health and quality of life. Reach out now to get started!

‍

Sources

American College of Obstetricians and Gynecologists. “Choosing the Route of Hysterectomy for Benign Disease.” ACOG, June 2017, https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/06/choosing-the-route-of-hysterectomy-for-benign-disease.

Dagorno, C., et al. “Prehabilitation in Hepato-Pancreato-Biliary Surgery: A Systematic Review and Meta-Analysis. A Necessary Step Forward Evidence-Based Sample Size Calculation for Future Trials.” Journal of Visceral Surgery, vol. 159, no. 5, Oct. 2022, pp. 362–372. doi:10.1016/j.jviscsurg.2021.07.003.

DeCherney, A. H., G. Bachmann, K. Isaacson, and S. Gall. “Postoperative Fatigue Negatively Impacts the Daily Lives of Patients Recovering from Hysterectomy.” Obstetrics & Gynecology, vol. 99, no. 1, Jan. 2002, pp. 51–57. doi:10.1016/s0029-7844(01)01622-2.

Dedden, Suzanne J., et al. “Hysterectomy and Sexual Function: A Systematic Review and Meta-Analysis.” The Journal of Sexual Medicine, vol. 20, no. 4, Apr. 2023, pp. 447–466. doi:10.1093/jsxmed/qdac051.

Fitzgerald, D. M., J. Berecki-Gisolf, R. L. Hockey, and A. J. Dobson. “Hysterectomy and Weight Gain.” Menopause, vol. 16, no. 2, Mar.–Apr. 2009, pp. 279–285. doi:10.1097/gme.0b013e3181865373.

Gottlieb, A. S., et al. “Pre and Post-Operative Self-Care Management Among Women Undergoing Hysterectomy.” Bioinformation, vol. 19, no. 6, 30 June 2023, pp. 721–724. doi:10.6026/97320630019721.

Harvey, S. V., et al. “Trends and Predictors of Hysterectomy Prevalence Among Women in the United States.” American Journal of Obstetrics & Gynecology, vol. 227, no. 4, Oct. 2022, pp. 611.e1–611.e12. doi:10.1016/j.ajog.2022.06.028.

Better Health Channel. “Hysterectomy.” Better Health Victoria, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hysterectomy#reasons-for-having-a-hysterectomy.

Molenaar, C. J. L., et al. “Effect of Multimodal Prehabilitation on Reducing Postoperative Complications and Enhancing Functional Capacity Following Colorectal Cancer Surgery: The PREHAB Randomized Clinical Trial.” JAMA Surgery, vol. 158, no. 6, June 2023, pp. 572–581. doi:10.1001/jamasurg.2023.0198.

Moorman, P. G., et al. “Effect of Hysterectomy with Ovarian Preservation on Ovarian Function.” Obstetrics & Gynecology, vol. 118, no. 6, Dec. 2011, pp. 1271–1279. doi:10.1097/AOG.0b013e318236fd12.

Perry, R., et al. “Pre-Admission Interventions (Prehabilitation) to Improve Outcome after Major Elective Surgery: A Systematic Review and Meta-Analysis.” BMJ Open, vol. 11, no. 9, 30 Sept. 2021, e050806. doi:10.1136/bmjopen-2021-050806.

Ricci, C., et al. “Physical Prehabilitation in Patients Who Underwent Major Abdominal Surgery: A Comprehensive Systematic Review and Component Network Meta-Analysis Using GRADE and CINeMA Approach.” Annals of Surgical Oncology, vol. 31, no. 3, Mar. 2024, pp. 1725–1738. doi:10.1245/s10434-023-14632-8.

Szymański, J. K., M. Starzec-Proserpio, A. Słabuszewska-Jóźwiak, and G. Jakiel. “Is PREHAB in Pelvic Floor Surgery Needed? A Topical Review.” Medicina (Kaunas), vol. 56, no. 11, 6 Nov. 2020, p. 593. doi:10.3390/medicina56110593.

Trabuco, E. C., et al. “Association of Ovary-Sparing Hysterectomy with Ovarian Reserve.” Obstetrics & Gynecology, vol. 127, no. 5, May 2016, pp. 819–827. doi:10.1097/AOG.0000000000001398.

Cleveland Clinic. “Menopause After Hysterectomy.” Cleveland Clinic Health, https://health.clevelandclinic.org/menopause-after-hysterectomy.

GoodRx. “What to Eat After Hysterectomy.” GoodRx, https://www.goodrx.com/health-topic/gynecology/what-to-eat-after-hysterectomy?srsltid=AfmBOooPQhVNrQEuISQqkfUoNLBb-ydZ5sC9PsG2buPMgEyljy6MNbjs.

HysterSisters. “Hysterectomy Recovery and Support.” HysterSisters, https://www.hystersisters.com/vb2/article_604361.htm.

ScienceDirect. “Article on Hysterectomy.” ScienceDirect, https://www.sciencedirect.com/science/article/pii/S0022399900001896?via%3Dihub%27.

‍