What is Dilation and Curettage (D&C)? Purpose, Procedure & Recovery

Dilation and curettage, commonly called D&C, is a minor surgical procedure where your doctor gently opens (dilates) your cervix and removes tissue from inside your uterus using a special instrument called a curette. Think of it as a careful cleaning of the uterine lining, similar to how you might gently scrape frost from a window. This outpatient procedure is one of the most common gynecological treatments, helping doctors both diagnose problems and provide therapeutic relief for various conditions.

What is Dilation and Curettage (D&C)?

A D&C involves two main steps that work together to access and treat your uterus. During dilation, your doctor gradually opens your cervix (the opening to your uterus) using special tools or medications. This creates a pathway for the second step, curettage, where tissue is gently scraped or suctioned from your uterine lining.

The entire procedure typically takes 15 to 30 minutes and is performed in a hospital or outpatient surgical center. You'll receive anesthesia to ensure you're comfortable throughout the process. Most women go home the same day, making it a relatively straightforward treatment option.

Your doctor might use different techniques depending on your specific situation. Some procedures combine D&C with suction (called suction curettage), while others may use only the scraping method. Both approaches are safe and effective when performed by experienced gynecologists.

Why is Dilation and Curettage (D&C) done?

D&C serves two main purposes: diagnosis and treatment of various uterine conditions. Your doctor might recommend this procedure when other tests haven't provided clear answers about what's happening inside your uterus. It's like having a skilled detective carefully examine evidence that can't be seen from the outside.

For diagnostic purposes, D&C helps investigate several concerning symptoms. These include heavy or irregular menstrual bleeding, bleeding between periods, or bleeding after menopause. Your doctor can also use this procedure to check for infections, hormonal imbalances, or growths like polyps or fibroids.

The therapeutic benefits of D&C address various medical situations that need immediate attention:

• Removing tissue after a miscarriage to prevent infection and heavy bleeding
• Treating an incomplete abortion where some pregnancy tissue remains
• Removing polyps or small fibroids that cause heavy bleeding
• Clearing out thickened uterine lining (endometrial hyperplasia)
• Removing tissue for biopsy to rule out cancer
• Treating certain types of abnormal bleeding

Sometimes D&C becomes necessary in emergency situations, such as severe bleeding that won't stop with other treatments. In these cases, the procedure can be life-saving by quickly removing the source of bleeding and preventing complications.

What is the procedure for D&C?

The D&C procedure follows a careful, step-by-step process designed to keep you safe and comfortable. Before anything begins, you'll meet with your anesthesiologist to discuss the type of anesthesia that's best for you. Most women receive general anesthesia, which means you'll be completely asleep during the procedure.

Once you're comfortable, your doctor will position you similarly to a routine pelvic exam. They'll clean the area thoroughly and may insert a speculum to get a clear view of your cervix. This preparation ensures everything stays sterile and safe throughout the procedure.

The dilation phase comes next, where your doctor gradually opens your cervix. They might use special dilating rods of increasing sizes, or they may have given you medication beforehand to soften your cervix naturally. This step requires patience and precision, as rushing could cause injury to delicate tissues.

During the curettage phase, your doctor inserts a curette (a spoon-shaped instrument) or suction device through the dilated cervix. They'll gently scrape or suction away the uterine lining, collecting tissue samples if needed for testing. The entire process feels methodical and controlled, with your doctor carefully monitoring your response.

After removing the necessary tissue, your doctor will check to ensure all bleeding has stopped and that your cervix is returning to its normal position. You'll then be moved to a recovery area where nurses will monitor your vital signs and comfort level as the anesthesia wears off.

How to prepare for your D&C?

Preparing for your D&C involves several important steps that help ensure the procedure goes smoothly and safely. Your doctor will provide specific instructions based on your individual situation, but most preparations are straightforward and easy to follow.

The night before your procedure, you'll need to avoid eating or drinking anything after midnight. This fasting period, called NPO (nothing by mouth), prevents complications with anesthesia. If you take regular medications, ask your doctor which ones you should continue and which ones to skip.

Your preparation checklist should include these essential steps:

• Arrange for someone to drive you home after the procedure
• Take any prescribed medications exactly as directed
• Avoid aspirin or blood-thinning medications for the time period specified
• Remove nail polish, jewelry, and contact lenses before arriving
• Wear comfortable, loose-fitting clothing
• Bring a list of all medications and supplements you take

Your doctor might also prescribe medication to help soften your cervix before the procedure. Take these medications exactly as directed, even if they cause mild cramping or spotting. This preparation makes the dilation process easier and more comfortable for you.

Having said that, don't hesitate to contact your doctor if you develop a fever, severe pain, or heavy bleeding in the days leading up to your procedure. These symptoms might indicate an infection or other issue that needs attention before moving forward.

How to read your D&C results?

Understanding your D&C results starts with knowing that tissue samples collected during the procedure are sent to a pathology lab for detailed examination. A pathologist, a doctor who specializes in analyzing tissues, will study your samples under a microscope and prepare a comprehensive report for your gynecologist.

The pathology report typically arrives within 5 to 10 business days after your procedure. Your doctor will review these findings carefully and schedule a follow-up appointment to discuss what they mean for your specific situation. This waiting period, while sometimes anxiety-provoking, allows for thorough analysis and accurate interpretation.

Normal results generally show healthy endometrial tissue appropriate for your age and menstrual cycle phase. The pathologist will note the tissue's appearance, thickness, and cellular structure. If you're premenopausal, normal results might show changes consistent with your hormonal cycle, while postmenopausal women typically have thinner, less active tissue.

Abnormal results require careful interpretation and might indicate several different conditions. These could include hormonal imbalances, infections, polyps, fibroids, or in rare cases, precancerous or cancerous changes. Your doctor will explain exactly what any abnormal findings mean and discuss appropriate next steps based on your individual circumstances.

Remember that abnormal results don't automatically mean something serious is wrong. Many conditions found through D&C are easily treatable, and early detection often leads to better outcomes. Your doctor will work with you to develop a treatment plan that addresses your specific needs and concerns.

How to manage your recovery after D&C?

Recovery from D&C is typically straightforward, with most women feeling back to normal within a few days to a week. Your body needs time to heal from the procedure, and following your doctor's recovery instructions helps ensure smooth healing without complications.

Immediately after the procedure, you'll likely experience mild cramping similar to menstrual cramps. This discomfort is completely normal and shows that your uterus is returning to its regular size and position. Over-the-counter pain relievers like ibuprofen or acetaminophen usually provide adequate relief.

You'll also notice some vaginal bleeding or spotting for several days after the procedure. This bleeding is typically lighter than a normal period and gradually decreases over time. Use pads rather than tampons during this time, as tampons could introduce bacteria and increase your risk of infection.

Your recovery guidelines will include several important restrictions designed to protect your healing tissues:

• Avoid heavy lifting (more than 10 pounds) for at least a week
• No sexual intercourse for 1-2 weeks or until cleared by your doctor
• Skip baths, swimming, and hot tubs until bleeding stops completely
• Take time off work if needed, especially if your job involves physical activity
• Avoid strenuous exercise for about a week
• Don't use tampons or douches until your doctor says it's safe

Most women can return to normal activities within 2-3 days, though you should listen to your body and rest when needed. If you experience severe pain, heavy bleeding, fever, or signs of infection, contact your doctor immediately as these symptoms need prompt attention.

What are the risk factors for D&C complications?

While D&C is generally very safe, certain factors can increase your risk of complications. Understanding these risk factors helps you and your doctor make informed decisions about your treatment and take appropriate precautions during and after the procedure.

Age-related factors play a role in your overall risk profile. Older women, particularly those who are postmenopausal, may have more fragile tissues that are prone to injury during the procedure. However, experienced gynecologists adjust their techniques accordingly, and age alone doesn't prevent you from having a safe D&C.

Previous uterine procedures or surgeries can create scar tissue that makes the procedure more challenging. If you've had multiple D&Cs, cesarean sections, or other uterine surgeries, your doctor will take extra care during the procedure. This history doesn't make D&C impossible, but it does require additional expertise and precautions.

Several medical conditions can increase your risk of complications during D&C:

• Blood clotting disorders that affect your ability to stop bleeding
• Heart disease or other conditions that make anesthesia riskier
• Active pelvic infections that could spread during the procedure
• Severe anemia that makes blood loss more dangerous
• Medications that affect blood clotting, like warfarin or aspirin
• Obesity, which can make the procedure technically more difficult

Your doctor will carefully review your medical history and current health status before recommending D&C. They may order additional tests or consultations with other specialists if you have significant risk factors. This thorough preparation helps ensure the safest possible outcome for your procedure.

What are the possible complications of D&C?

Complications from D&C are relatively rare, occurring in less than 1% of procedures when performed by experienced gynecologists. However, it's important to understand potential risks so you can make informed decisions about your care and recognize warning signs that need immediate attention.

The most common complications are generally mild and resolve with proper treatment. Excessive bleeding occurs in about 1 in 1000 procedures and usually responds well to medications or minor additional procedures. Infection is another possibility, affecting roughly 1 in 100 women, but antibiotics typically clear it up quickly when caught early.

More serious complications, while very rare, require immediate medical attention. These include perforation of the uterus, which happens in less than 1 in 500 procedures. This means the curette accidentally creates a small hole in the uterine wall. Most small perforations heal on their own, but larger ones might require surgical repair.

Rare complications that require specialized care include:

• Cervical laceration (tear in the cervix) during dilation
• Asherman's syndrome (scar tissue formation inside the uterus)
• Anesthesia-related complications
• Blood clots, particularly in women with clotting disorders
• Incomplete removal of tissue requiring repeat procedure
• Damage to surrounding organs (bladder or bowel)

Your risk of complications depends on many factors, including your overall health, the reason for the procedure, and your surgeon's experience. Discussing these risks with your doctor helps you understand what to expect and when to seek help if problems arise.

Most women recover completely from D&C without any lasting effects. The procedure's benefits typically far outweigh its risks, especially when it's needed to diagnose or treat a serious condition. Your doctor will monitor you carefully and provide detailed instructions for recognizing and managing any complications that might occur.

When should I see a doctor after D&C?

Knowing when to contact your doctor after D&C helps ensure you get prompt treatment if complications arise. While most women recover smoothly, certain symptoms require immediate medical attention and shouldn't be ignored or delayed.

Contact your doctor immediately if you experience heavy bleeding that soaks through more than two pads per hour for two consecutive hours. This level of bleeding is significantly more than normal post-procedure spotting and could indicate a serious complication that needs urgent treatment.

Fever of 100.4°F (38°C) or higher, especially when accompanied by chills or flu-like symptoms, may signal an infection. Pelvic infections after D&C can be serious if left untreated, but they respond well to antibiotics when caught early. Don't wait to see if a fever goes away on its own.

Several other symptoms warrant immediate medical attention:

• Severe pelvic or abdominal pain that doesn't improve with prescribed pain medication
• Foul-smelling vaginal discharge that may indicate infection
• Nausea and vomiting that prevents you from keeping fluids down
• Dizziness or fainting, which could suggest blood loss
• Difficulty urinating or blood in your urine
• Chest pain or difficulty breathing

You should also call your doctor for less urgent but concerning symptoms like bleeding that continues for more than two weeks, persistent cramping that seems to be getting worse rather than better, or any symptom that worries you, even if it seems minor.

Remember that your doctor's office is there to help you through your recovery. Don't hesitate to call with questions or concerns, as they'd rather address minor worries early than have you suffer unnecessarily or develop complications that could have been prevented with timely intervention.