Getting Ready for Endometriosis Surgery: A Week‑by‑Week Guide

You’ve got a surgery date on the calendar. Now the questions get very practical: What do I do this week? What needs to be scheduled? Which meds do I stop—and when? What should I buy, pack, and set up at home?

This guide stays strictly in the logistics lane—the operational “how-to” of how to prepare for endometriosis surgery and other minimally invasive gynecologic procedures (including some adenomyosis surgeries). It pulls together what multiple recent studies show about perioperative best practices—especially Enhanced Recovery After Surgery (ERAS) pathways—and adds the real-world steps patients most often need at the 1‑month and 1‑week marks.

If you’re a patient here at Lotus, and are looking for the full clinical picture (what happens during surgery, recovery timelines, and symptom expectations), login to your patient portal and browse the Surgery Prep module.

First, one rule that overrides everything

Your surgeon/anesthesia team’s written instructions win. ERAS pathways and medication guidance can vary by hospital, your health history, and what’s planned in the OR. Use this article as a checklist generator—then confirm specifics with your team.

A quick note on ERAS: across minimally invasive gynecologic surgeries, ERAS-style care is consistently linked with less pain, lower opioid needs, earlier eating/walking, and shorter hospital stay in many settings. Research also suggests outcomes are best when more ERAS elements are actually followed (higher “compliance” correlates with fewer complications and higher satisfaction). So: this isn’t just about what you do—the system matters too, and it’s worth asking if your hospital uses an ERAS pathway.

4–6 weeks out: Set the foundation (paperwork, health optimization, travel)

This is the “make time work for you” window—when you can fix problems before they become last-minute cancellations.

Medical clearance and pre-op testing

Depending on your age, symptoms, and medical history, your team may order labs (often CBC/iron studies), pregnancy testing (if applicable), and sometimes an EKG or other testing.

If you’ve had heavy bleeding (common with adenomyosis and sometimes endometriosis), ask early about anemia screening and correction. Even if your surgery is minimally invasive, going in with low iron can make recovery harder.

Imaging and records (especially if you’re traveling or changing surgeons)

If you’re still in the “final mapping” stage—especially for deep endometriosis—ask whether you need a specialist endometriosis ultrasound or MRI (and whether it must be done at a specific center). International survey data suggest ultrasound is widely used before surgery, but access and expertise can be concentrated in certain centers, and many clinicians report patients may not reliably get “specialist” imaging everywhere. Translation: if your prior ultrasound was “normal,” that may not be the same as a targeted endometriosis scan—worth clarifying now, not a week before surgery.

Travel and lodging (if you’re flying in)

If you’re traveling for care, book with recovery in mind:

• Lodging close to the hospital for the first 1–3 nights if same-day discharge is possible
• Flexible change/cancel options
• A plan for prescriptions (some hospitals send e-prescriptions to local pharmacies only)

Dental work timing (yes, really)

If you need dental work, try to complete it well before surgery when possible. The goal is to avoid last-minute infections, antibiotics, or inflammation close to your operation date. (Your surgeon can give a preferred window.)

Start the “ERAS conversation” early

Ask: “Do you use an ERAS pathway for laparoscopic surgery?”

Why this matters: in multiple gynecologic surgery studies, ERAS is associated with earlier return of bowel function, shorter catheter time, shorter length of stay, and sometimes lower costs—but benefits track with how consistently the pathway is followed. If your hospital uses ERAS, request a written patient handout so you can plan meals, rides, and supplies accordingly.

1–2 weeks out: Medication and supplement plan (the part that trips people up)

This is the most important window for endometriosis surgery preparation mistakes—because stopping (or continuing) the wrong thing can increase bleeding risk, interact with anesthesia, or cause day-of-surgery delays.

Build your personal “stop/continue” list

Send your team a complete list (photo is fine) of:

• Prescriptions
• OTC meds (including ibuprofen/naproxen/aspirin)
• Supplements (especially herbals)
• Hormones/birth control
• Weight-loss/diabetes injections and pills (including GLP‑1 drugs)

Then ask for explicit dates: “My surgery is on ___; what is my last dose of each medication?”

NSAIDs, aspirin, and blood thinners

Many surgeons ask patients to stop NSAIDs (like ibuprofen/naproxen) and aspirin ahead of time because they can affect bleeding—but timing varies based on your situation and why you take them.

If you take a prescribed blood thinner (or even a daily aspirin for a medical reason), do not self-stop. You need a coordinated plan (sometimes called a “bridge” plan).

Hormones and birth control

Whether to stop hormonal contraception or other hormones depends on your clot risk, the type of surgery, and your goals (symptom control, contraception, cycle timing). Some people are told to continue; others are told to stop. This is a “surgeon + anesthesia + your prescriber” decision—get it in writing.

Herbal supplements (common culprits)

Many herbals can affect bleeding, blood pressure, or sedation. If you take any, assume they need review. When in doubt: list everything and ask your surgeon for a stop date.

GLP‑1 medications (semaglutide, tirzepatide, etc.): the anesthesia issue patients aren’t being told clearly

If you take a GLP‑1 receptor agonist (or GLP‑1/GIP medication) for diabetes or weight management, bring it up early—even if your surgery isn’t GI-related.

Plain-language why this matters: these medications can slow stomach emptying, meaning your stomach may still contain food/liquid despite standard fasting. That raises concern for regurgitation/aspiration around anesthesia.

Recent evidence in an elective endoscopy trial found that continuing GLP‑1/GLP‑1+GIP therapy (vs holding one dose) led to a much higher rate of unexpected residual stomach contents significant enough to prevent completing the procedure—even though patients followed usual instructions. Notably, people with clinically significant residual contents often did not have warning symptoms that day, so “I feel fine” isn’t a reliable safety check. A broader anesthesia-focused narrative review also describes evolving guidance and supports an individualized, risk-adapted plan based on symptoms, dose escalation phase, comorbidities, and procedure type—sometimes including diet modification, strict fasting, and selective gastric ultrasound.

What you should do (logistics):

• Tell anesthesia exactly which GLP‑1 drug you take, the dose, and when your last dose is scheduled.
• Ask: “Should I hold a dose? For how long?” and “Do you want a clear-liquid plan the day before?”
• Do not stop it on your own—your diabetes/weight prescriber may need to coordinate alternatives.

The week of surgery: Home setup, prescriptions, and “day-after” planning

This is when ERAS details (early walking, earlier eating, discharge timing) intersect with real life—transportation, food, and who’s helping you.

Confirm your ride and your first 24 hours of help

Many centers require:

• A responsible adult (18+) to drive you home
• A 24-hour companion after anesthesia (sometimes mandatory for outpatient surgery)

Lock this down early. If you don’t have someone local, tell the clinic now—social work or patient services may have options.

Arrange leave, childcare, and pet care

Even with minimally invasive approaches and ERAS, you may have lifting restrictions and fatigue. Plan for:

• Child pickup/dropoff
• Pet feeding/walking
• Backup coverage if you need an extra recovery day

Fill prescriptions before surgery (not on the way home)

ERAS pathways often reduce opioid use and emphasize multimodal pain control, but you still may be prescribed several meds (pain, nausea, bowel regimen). Multiple studies show ERAS is linked with less pain and fewer opioids overall, yet some experts caution that pain can be undertreated if plans are too rigid—especially for people with chronic pelvic pain.

Logistics move: ask your team to send discharge meds in advance when possible, and pick them up 1–3 days pre-op.

Stock your kitchen for “easy GI recovery”

ERAS research in benign gynecologic laparoscopy associates these pathways with faster bowel recovery (earlier gas/bowel movement), especially when early feeding and mobilization are used. Your job is to make that feasible:

Choose a small list of low-effort foods you tolerate well (your team may specify low-fiber/low-residue early on). Also buy:

• A stool softener/laxative if your discharge plan includes it
• Electrolyte drinks if allowed
• Simple protein options

Set up where you’ll actually sleep

Prepare a “recovery nest”:

• Phone charger within reach
• A small pillow for the car ride/abdominal bracing
• Nightstand meds/water
• A clear walking path (because early walking is often part of ERAS)

The last 48 hours: Follow the protocol (diet, skin prep, packing)

This is where you stop improvising and start executing the written plan.

Diet instructions: clear liquids, bowel prep, nutrition drinks

Your instructions may include any combination of:

• Clear-liquid window
• Bowel prep (varies widely; not everyone needs it)
• Carbohydrate/nutrition drinks (common in ERAS pathways)
• Specific fasting cutoffs for solids vs clear liquids

One gynecologic ERAS study specifically included practical measures like shorter fasting and earlier feeding and found better short-term recovery markers compared with conventional care. That said, your exact surgery (and whether bowel work might be involved) can change the plan—follow your surgeon’s version.

Skin prep (CHG showers) if provided

If you’re given chlorhexidine (CHG) soap/wipes, use them exactly as directed. Don’t add extra products that can irritate skin.

What to pack—and what to leave at home

Pack light, but purposefully:

• ID/insurance, device charger
• A list of meds/allergies
• Loose high-waist clothing
• Pads (spotting happens; tampons usually avoided initially)
• Glasses case (avoid contact hassle)

Leave valuables at home.

Practical takeaways: Questions to ask your PA (or surgeon/anesthesia team)

• “Do you use an ERAS pathway for my procedure—and can I have the patient checklist?”
• “Is my planned surgery outpatient/same-day, and what would make me stay overnight?”
• “Exactly when do I stop: NSAIDs, aspirin, blood thinners, herbals, and hormones?”
• “I take a GLP‑1 medication (name/dose). Should I hold it? Do you want a clear-liquid day before?”
• “What time can I drink clear liquids? What time do I stop everything by mouth?”
• “Will I have a catheter, and when does it come out?”
• “Can my discharge prescriptions be sent now so I can pick them up before surgery?”
• “Who do I call after hours if I’m worried?” (This matters—some ERAS programs shorten stays safely, but patients may need clearer post-discharge support to avoid unnecessary urgent visits.)

What we still don’t know (and why your plan may differ)

Even though ERAS is consistently linked with better short-term recovery markers in minimally invasive gynecologic surgery, real-world pathways vary: hospitals don’t all use the same protocol, adherence differs, and long-term outcomes are less consistently measured. Medication guidance—especially for GLP‑1 drugs—is also evolving as newer trials and consensus statements refine what’s safest for different procedures and patient risk profiles.

That’s why the best “pre-op checklist” is the one customized to your surgery, your medications, and your facility—and why getting your instructions early (then following them precisely) is one of the most powerful things you can do to protect your surgery date and your recovery.