Dilation and Curettage Procedure
Overview
A dilation and curettage (D&C) removes tissue from the inside of the uterus. Doctors may perform this procedure to address heavy menstrual bleeding, manage tissue after a miscarriage, or treat certain uterine conditions.
Steps in the procedure:
- The doctor gently widens the cervix using medicine or small tools.
- A specialized instrument called a curette removes tissue from the uterine lining.
The D&C can help with symptoms like irregular periods or excessive bleeding, and it may also help diagnose causes of abnormal menstrual issues.
Reasons for Performing the Procedure
Checking for a Medical Issue
Doctors often use a dilation and curettage procedure to look for the cause of certain symptoms or problems related to the uterus. Some main reasons include:
- Unusual vaginal or uterine bleeding (such as heavy periods, bleeding between periods, or bleeding after menopause)
- Finding abnormal cells during a routine exam, like a cancer screening
- Needing to check the lining of the uterus (endometrium) for growths or changes
Doctors collect a small sample of the tissue lining the uterus and send it to a lab for study. Lab tests can help find problems such as:
| Condition | Description |
|---|---|
| Thickened uterine lining | When the endometrium grows more than normal |
| Polyps | Small, often benign growths in the uterus |
| Uterine or endometrial cancer | Abnormal, possibly cancerous cells |
| Precancerous changes | Early signs that might lead to cancer |
Sometimes, doctors need more information than sampling alone can provide. In these cases, they perform a complete dilation and curettage, often with a hysteroscopy, to get a better view and take more tissue if required.
Managing a Medical Problem
Doctors also use dilation and curettage to treat various uterine issues. In these cases, the goal is not just to take a sample but to remove tissue or solve a problem. Examples include:
- Removing tissue left behind after a miscarriage or abortion to prevent infection or stop heavy bleeding.
- Treating heavy or unusual bleeding, such as after childbirth if parts of the placenta remain.
- Removing benign growths like polyps or fibroids inside the uterus or cervix.
- Clearing out a molar pregnancy, which is when abnormal tissue forms instead of a normal pregnancy.
Doctors might combine this procedure with a hysteroscopy. This involves putting a thin tube with a light and camera into the uterus to see and remove growths, polyps, or fibroids more accurately. Sometimes, doctors use endometrial sampling along with hysteroscopy to guide treatment choices.
Possible Issues
While dilation and curettage is usually safe, certain problems can still happen. The following list outlines some main complications patients may face:
- Heavy Bleeding: Sometimes, a person might need to change pads every hour due to blood loss. This can be a sign that something is wrong and medical help is needed.
- Infections: There is a small risk of infection after the procedure. Infections can occur if bacteria enter the uterus, causing symptoms like fever or unpleasant-smelling vaginal discharge.
- Cramping and Pain: It is common to have cramps for a day or two afterward, but pain that gets worse or does not go away should be checked by a doctor.
- Spotting: Light bleeding or spotting is expected. Heavy or ongoing bleeding is less common and may need treatment.
| Risk | Description |
|---|---|
| Uterine tear | Tools used during the procedure can sometimes poke a hole in the uterus. This is more likely in individuals recently pregnant or postmenopausal. Most of the time, small tears heal by themselves, but sometimes more surgery is needed. |
| Injury to Cervix | The cervix may be damaged or torn, possibly needing stitches or medication. Using medicine to soften the cervix before the procedure lowers this risk. |
| Scar Tissue | Scar tissue inside the uterus, called Asherman’s syndrome, can form. This mostly happens after a miscarriage or childbirth and can cause changes in periods, trouble getting pregnant, or future miscarriages. Surgery may help fix this issue. |
Having a fever, lightheadedness, or bad-smelling vaginal discharge may signal a problem. Anyone with these symptoms or increasing pain should speak to a healthcare provider right away. Some risks may also be higher if a person has an intrauterine device (IUD) in place.
Getting Ready for the Procedure
Before the dilation and curettage, follow your healthcare provider’s instructions. Most patients need to avoid eating or drinking for a certain period before the procedure.
The care team will tell you exactly when to stop, usually the night before. This helps reduce risks linked to anesthesia. Preparations may include:
- A pelvic exam to check the uterus and surrounding areas.
- Blood tests to look for any health problems.
- Starting antibiotics to lower the chance of infection.
- Arranging a ride home, as you may feel sleepy after the anesthesia.
Sometimes, the doctor needs to open, or dilate, the cervix ahead of the procedure. This can be done using a cervical ripening agent, which softens and prepares the cervix. Another option is placing a small, absorbent rod called laminaria into the cervix to gradually widen it.
As it absorbs moisture, it slowly opens the cervix. Most people can expect the process to take several hours, including the procedure and recovery. Wearing comfortable clothing and planning for a rest period after the procedure is helpful.
What You Can Expect
During the Procedure
People having this procedure usually receive anesthesia to help them feel relaxed or asleep. The type of anesthesia used, such as general or epidural, depends on the reason for the procedure and any medical concerns.
During the procedure, the individual lies on their back with feet in special supports called stirrups. A speculum is placed into the vagina so the doctor can see the cervix. Then, thin rods are used to gently widen (dilate) the cervix. Once the cervix is open enough, the doctor removes these rods.
The doctor uses either a suction tool or a spoon-like instrument to clear tissue from the uterus. The whole process usually takes a short time and is often done in a hospital or clinic.
After the Process
Once the procedure is done, the person goes to a recovery area. Nurses and doctors watch for heavy bleeding and check on side effects from anesthesia. Most people experience mild cramping and light bleeding or spotting for a few days.
Taking medicine like ibuprofen can help with cramps. Most can return to regular activities within a day or two. There are some important steps to follow after the procedure:
- Do not use tampons or put anything into the vagina until the care team says it is safe.
- Ask when sexual activity can be resumed to avoid infection.
- It may take time for the uterus to heal, and the menstrual cycle might be different for a little while.
Any unusual pain, heavy bleeding, or fever should be reported to a doctor right away. If the procedure was because of a miscarriage and pregnancy is wanted again, it is best to speak with a doctor or nurse about when to try.
Findings
After the D&C, the medical team will review the findings with the patient. This may happen shortly after the procedure or at a follow-up visit, depending on the reason for the D&C and whether tissue samples were sent to a lab.
If lab results are involved—such as testing for abnormal cells, infection, or pregnancy-related tissue—the provider will explain those results once available. The discussion also includes what was observed during the procedure and any next steps needed for care or diagnosis.
Key Points
- Medical staff explain results clearly.
- Follow-up appointments are scheduled if needed.
- Patients can ask questions about their care.
