Objective: Hysterectomy is the common procedure in gynaecology. With the increasing rate of hysterectomies and that too at young age there is need for assessment of patient preferences regarding their treatment choices.This study aimed to investigate the factors influencing the preference for medical or surgical management among women with various uterine pathologies, exploring the reasons behind their treatment choices and the implications for healthcare decision-making. Methods: This is a cross-sectional survey using a validated questionnaireconducted among a diverse sample of 514 women diagnosed with various uterine pathologies. Participants were asked to indicate their treatment preference between medical management and surgical intervention. Results: A total of 514 participants were included in the study, and 41.4% of participants (292) preferred medical management. A total of 234 participants (45.5%) reported experiencing menstrual problems. A total of 51.56% (265 participants) reported being previously advised to undergo a hysterectomy, and 47.08% (242 participants) believed that hysterectomy affects sexual function. The social and biological characteristics of the women preferring surgical management over conservative management included older women, having a lower educational level, and belonging to a lower socioeconomic status (p<0.05). Conclusion: The study highlights the complex decision-making process involved in choosing medical or surgical management for uterine pathology. Factors such as fear of surgery, desire to preserve reproductive capabilities, and financial considerations play crucial roles in treatment preference. Hysterectomy rate can be reduced by proper counselling regarding their disease and enhancing their understanding about risks and benefits of different treatment modalities for their disease.