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 (womb). The uterus is the organ at the top of the vagina. Babies develop in the uterus, and menstrual blood (the period) comes from the uterus.

Dilation is performed to open and widen the cervix (entrance to the uterus). Curettage (scraping) 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.
• Remove polyps from the uterus.
• Remove an IUD.
• Remove pieces of placenta after childbirth.
• Remove the tissue remaining after a miscarriage (spontaneous abortion).
• Perform a termination of pregnancy (also called a TOP or abortion).
• Remove incomplete, missed, or induced TOPs.

Examples of other treatments are:

• having a hysteroscopy (dilating the cervix and placing a scope through the vagina and cervix into the uterus to look at the inside of the uterus)
• endometrial biopsy (a sample of the inner layer of the uterine wall is removed using a thin, straw-like tube inserted through the vagina and cervix into the uterus)
• treating the problem with medicines, such as hormones

Another alternative is to choose not to have any procedure. Be aware of the possible risks of your condition if you choose to not have a procedure. 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 scoop-like 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?

You usually go home a few hours after the procedure if there are no complications. 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 on schedule after the D&C.

Follow your provider's instructions about when you can have sexual intercourse. 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.

Your provider will tell you what other steps you should take and when you should return for a follow-up visit.

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 discomfort. In rare cases, you may have an allergic reaction to the drug used in regional 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 per hour or the bleeding is heavier than your menstrual flow).
• You develop a temperature over 100°F (37.7°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.