Dilation and curettage (D&C)

Overview

Dilation and curettage (D&C) is a procedure to remove tissue from inside your uterus. Doctors perform dilation and curettage to diagnose and treat certain uterine conditions — such as heavy bleeding — or to clear the uterine lining after a miscarriage or abortion.

In a dilation and curettage — sometimes spelled "dilatation" and curettage — your doctor uses small instruments or a medication to open (dilate) your cervix — the lower, narrow part of your uterus. Your doctor then uses a surgical instrument called a curette to remove uterine tissue. Curettes used in a D&C can be sharp or use suction.

Why it's done

Dilation and curettage can diagnose or treat a uterine condition.

To diagnose a condition

Your doctor might recommend a type of D&C called endometrial sampling to diagnose a condition if:

• You have abnormal uterine bleeding
• You experience bleeding after menopause
• Your doctor discovers abnormal endometrial cells during a routine test for cervical cancer

To perform the test, your doctor collects a tissue sample from the lining of your uterus (endometrium) and sends the sample to a lab for testing. The test can check for:

• Endometrial hyperplasia — a precancerous condition in which the uterine lining becomes too thick
• Uterine polyps
• Uterine cancer

To treat a condition

When performing a therapeutic D&C, your doctor removes the contents from inside your uterus, not just a small tissue sample. Your doctor may do this to:

• Clear out tissues that remain in the uterus after a miscarriage or abortion to prevent infection or heavy bleeding
• Remove a molar pregnancy, in which a tumor forms instead of a normal pregnancy
• Treat excessive bleeding after delivery by clearing out any placenta that remains in the uterus
• Remove cervical or uterine polyps, which are usually noncancerous (benign)

Your doctor may perform the D&C along with another procedure called a hysteroscopy. During a hysteroscopy, your doctor inserts a slim instrument with a light and camera on the end into your vagina, through your cervix and up into your uterus.

Your doctor then views the lining of your uterus on a screen, noting any areas that look abnormal, making sure there aren't any polyps and taking tissue samples as needed. During a hysteroscopy, your doctor can also remove uterine polyps and fibroid tumors.

Risks

Dilation and curettage is usually very safe, and complications are rare. However, there are risks. These include:

• Perforation of the uterus. Perforation of the uterus occurs when a surgical instrument pokes a hole in the uterus. This happens more often in women who were recently pregnant and in women who have gone through menopause.

  Most perforations heal on their own. However, if a blood vessel or other organ is damaged, a second procedure may be necessary to repair it.

• Damage to the cervix. If the cervix is torn during the D&C, your doctor can apply pressure or medicine to stop the bleeding, or can close the wound with stitches (sutures).

• Scar tissue on the uterine wall. Rarely, a D&C results in development of scar tissue in the uterus, a condition known as Asherman's syndrome. Asherman's syndrome happens most often when the D&C is done after a miscarriage or delivery.

  This can lead to abnormal, absent or painful menstrual cycles, future miscarriages and infertility.

• Infection. Infection after a D&C is possible, but rare.

Contact your doctor if you experience any of the following after a D&C:

• Bleeding that's heavy enough that you need to change pads every hour
• Fever
• Cramps lasting more than 48 hours
• Pain that gets worse instead of better
• Foul-smelling discharge from the vagina

How you prepare

Dilation and curettage may be performed in a hospital, clinic or your doctor's office, and it's usually done as an outpatient procedure.

Before the procedure:

• Follow your doctor's instructions on limiting food and drink.
• Arrange for someone to help you get home because you may be drowsy after the anesthesia wears off.
• Clear your schedule to allow enough time for the procedure and recovery afterward. You'll likely spend a few hours in recovery after the procedure.

In some cases, your doctor may start the process of dilating your cervix a few hours or even a day before the procedure. This helps your cervix open gradually and is usually done when your cervix needs to be dilated more than in a standard D&C, such as during pregnancy terminations or with certain types of hysteroscopy.

To promote dilation, your doctor uses a medication called misoprostol (Cytotec) — given orally or vaginally — to soften the cervix or inserts a slender rod made of laminaria into your cervix. The laminaria gradually expands by absorbing the fluid in your cervix, causing your cervix to open.

What you can expect

During the procedure

For dilation and curettage, you'll receive anesthesia. The choice of anesthesia depends on the reason for the D&C and your medical history.

General anesthesia makes you unconscious and unable to feel pain. Other forms of anesthesia provide light sedation or use injections to numb only a small area (local anesthesia) or a larger region (regional anesthesia) of your body.

During the procedure:

• You lie on your back on an exam table while your heels rest in supports called stirrups.
• Your doctor inserts an instrument called a speculum into your vagina, as during a Pap test, in order to see your cervix.
• Your doctor inserts a series of thicker and thicker rods into your cervix to slowly dilate your cervix until it's adequately opened.
• Your doctor removes the dilation rods and inserts a spoon-shaped instrument with a sharp edge or a suction device and removes uterine tissue.

Because you're either unconscious or sedated during a D&C, you shouldn't feel any discomfort.

After the procedure

You may spend a few hours in a recovery room after the D&C so that your doctor can monitor you for heavy bleeding or other complications. This also gives you time to recover from the effects of anesthesia.

If you had general anesthesia, you may become nauseated or vomit, or you might have a sore throat if a tube was placed in your windpipe to help you breathe. With general anesthesia or light sedation, you may also feel drowsy for several hours.

Normal side effects of a D&C may last a few days and include:

• Mild cramping
• Spotting or light bleeding

For discomfort from cramping, your doctor may suggest taking ibuprofen (Advil, Motrin IB, others) or another medication.

You should be able to resume your normal activities within a day or two.

Wait to put anything in your vagina until your cervix returns to normal to prevent bacteria from entering your uterus, possibly causing an infection. Ask your doctor when you can use tampons and resume sexual activity.

Your uterus must build a new lining after a D&C, so your next period may not come on time. If you had a D&C because of a miscarriage, and you want to become pregnant, talk with your doctor about when it's safe to start trying again.

Results

Your doctor will discuss the results of the procedure after the D&C or at a follow-up appointment.