Dilation and Curettage (D&C)

What is a dilation and curettage?

Dilation and curettage (D&C) is a minor surgical procedure used to remove tissue from the uterus. The uterus is the organ at the top of the vagina. Babies develop in the uterus, and menstrual blood comes from the uterus.

Dilatation is performed to open and widen the cervix (entrance to the uterus). Curettage is used to remove tissue from inside the uterus.

When is it used?

A D&C may be done to:

• Treat abnormal bleeding from the uterus.
• Look for the cause of recurrent pelvic pain or unusual enlargement of the uterus.
• Remove polyps from the uterus.
• Remove an IUD.
• Remove pieces of placenta after childbirth.
• Remove a miscarriage (spontaneous abortion).
• Perform an abortion.
• Remove incomplete, missed, or induced abortions.
• Check an abnormally shaped uterus.

Examples of alternative treatments are:

• having a hysteroscopy (dilating the cervix and using a scope to look at the inside of the uterus and remove parts of the uterine lining)
• endometrial biopsy (a sample of the inner layer of the uterine wall is removed using a tiny strawlike tube inserted through the vagina)
• treating the problem with medicines, such as hormones.

Another alternative is to choose not to have any procedure, recognizing the possible risks of your condition. You should ask your healthcare provider about these choices.

How do I prepare for a D&C?

Plan for your care and recovery after the procedure, especially if you are to have general anesthesia. Arrange to have someone take you home and stay with you for a while after the procedure. Allow for time to rest. Try to find people to help you with your daily duties for 24 hours after the procedure.

Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery.

Follow any other instructions provided by your healthcare provider. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You are given a sedative or a regional or general anesthetic. A sedative helps you relax. A regional anesthetic numbs part of your body, preventing you from feeling pain while you remain awake. A general anesthetic relaxes your muscles and causes a deep sleep. It will prevent you from feeling pain during the procedure.

Your healthcare provider stretches open (dilates) your cervix and guides a scooplike instrument (a curette) into the uterus. Your provider uses the curette to scrape all around the lining of the uterus and remove tissue from your uterus. This tissue will be sent to the lab for tests.

What happens after the procedure?

If there are no complications, you may go home a few hours after the procedure. Expect some bleeding and menstrual-type cramps for the first day or so. Your healthcare provider may suggest a pain medicine to relieve the discomfort. Women who are still having periods usually have their next period 2 to 6 weeks after the D&C.

Do not place anything inside the vagina until your provider says it is safe. Do not use tampons for a few weeks after the D&C. Follow your provider's instructions about when you can have sexual intercourse.

Ask your provider what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

Removing the uterine contents and lining may help diagnose and treat your problem. Testing this tissue may help your healthcare provider understand your condition and suggest further care.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• A regional anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. In most cases regional anesthesia is considered safer than general anesthesia.
• The uterus may be hurt or punctured (perforated) by the curette and require more surgery.
• The walls of the uterus may bleed more after the procedure than before the procedure.
• There is a small chance the uterus will become infected as a result of this procedure.
• Scar tissue (adhesions) may form inside the uterus, requiring more surgery and treatment.
• If you have cancer, you will need further treatment.

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You have heavy bleeding from your uterus (you need more than 1 pad or tampon per hour or the bleeding is heavier than your menstrual flow).
• You develop a fever over 100°F (37.8°C).
• You have severe abdominal pain or abdominal pain that continues even after you take acetaminophen or aspirin.
• You have a foul-smelling discharge from the vagina.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.