D&C Procedure: Dilation and Curettage Complete Guide

What Is a D&C Procedure?

A D&C (Dilation and Curettage) is a minor gynecological surgical procedure where the cervix (the opening of the uterus) is dilated and the uterine lining (endometrium) is scraped or suctioned to remove tissue. It is one of the most commonly performed gynecological procedures worldwide.

The name "dilation and curettage" describes the two main steps of the procedure. Dilation refers to the widening of the cervix using instruments called dilators, which gradually stretch the cervical opening. Curettage refers to the scraping or suctioning of tissue from the inner lining of the uterus using a spoon-shaped instrument called a curette or a suction device.

The procedure has been performed since the late 19th century and remains an important tool in gynecological medicine. Modern D&C techniques are highly refined, with improved instruments and anesthesia making the procedure safer and more comfortable than ever before. Today, many healthcare providers use suction curettage (also called vacuum aspiration) instead of or in combination with traditional sharp curettage, as it may be gentler on the uterine tissue.

D&C is typically performed in a hospital or outpatient surgical center. The procedure itself takes only about 10-15 minutes, though you should expect to spend several hours at the facility for preparation and recovery. Most women are able to go home the same day, making it a true outpatient procedure in most cases.

Types of D&C Procedures

There are several variations of the D&C procedure, each suited to different clinical situations:

• Sharp curettage: The traditional method using a metal curette to scrape the uterine lining. This provides tissue samples that can be examined under a microscope.
• Suction curettage (vacuum aspiration): Uses gentle suction to remove tissue. Often preferred for early pregnancy loss as it may be gentler on uterine tissue.
• Hysteroscopy with D&C: A thin camera (hysteroscope) is inserted first to visualize the uterine cavity before curettage. This allows targeted removal of polyps, fibroids, or other abnormalities.

Why Is a D&C Performed?

A D&C is performed for both diagnostic and therapeutic reasons, including investigating abnormal uterine bleeding, managing miscarriage, detecting uterine cancer, removing uterine polyps or fibroids, and obtaining tissue samples when other tests are inconclusive.

Healthcare providers recommend D&C for a variety of medical reasons. Understanding why your doctor has recommended this procedure can help you feel more prepared and less anxious. The indications for D&C can be broadly divided into diagnostic purposes (finding out what's wrong) and therapeutic purposes (treating a condition).

Diagnostic Indications

When doctors need to understand what's causing certain symptoms or abnormalities, D&C provides tissue samples that can be examined in the laboratory. This is particularly valuable for:

• Abnormal uterine bleeding: Heavy, prolonged, or irregular menstrual bleeding that doesn't respond to medication may require D&C to determine the cause
• Postmenopausal bleeding: Any bleeding after menopause must be investigated, as it can sometimes indicate uterine cancer
• Abnormal endometrial cells: If a Pap smear or other test shows abnormal cells, D&C can help determine if cancer or precancerous changes are present
• Suspected uterine polyps or fibroids: While imaging can show these growths, D&C allows for tissue examination
• Infertility evaluation: In some cases, examining the uterine lining can help explain difficulty conceiving

Therapeutic Indications

D&C is also performed to treat certain conditions:

• Incomplete miscarriage: When pregnancy tissue remains in the uterus after a miscarriage, D&C removes it to prevent infection and heavy bleeding
• Missed miscarriage: When the fetus has stopped developing but the body hasn't expelled the tissue naturally
• Molar pregnancy: An abnormal pregnancy where a non-viable fertilized egg implants in the uterus
• Retained placenta: When placental tissue remains in the uterus after childbirth
• Removal of polyps: Small growths on the uterine lining that can cause bleeding
• Treatment of excessive uterine bleeding: As an emergency measure to stop severe hemorrhage

How Do You Prepare for a D&C?

Preparation for a D&C includes discussing the procedure with your doctor, reviewing your medications (especially blood thinners), undergoing pre-operative tests, fasting for 6-12 hours if general anesthesia is planned, and arranging for someone to drive you home afterward.

Proper preparation for a D&C helps ensure the procedure goes smoothly and reduces your risk of complications. Your healthcare provider will give you specific instructions based on your individual situation, but there are general guidelines that apply to most patients.

Before the Procedure

In the days and weeks leading up to your D&C, you'll need to take several preparatory steps:

Consultation with your doctor: Your healthcare provider will explain why the D&C is recommended, what will happen during the procedure, and what to expect during recovery. This is your opportunity to ask questions and express any concerns. Don't hesitate to ask about alternatives to D&C if you want to understand all your options.

Medical history review: Your doctor will review your complete medical history, including previous surgeries, current medications, allergies, and any bleeding disorders. Be sure to mention all medications you take, including over-the-counter drugs, vitamins, and herbal supplements.

Medication adjustments: You may need to stop taking certain medications before the procedure. Blood thinners like warfarin, aspirin, or newer anticoagulants may need to be stopped several days before surgery. Anti-inflammatory drugs like ibuprofen may also need to be avoided. Your doctor will give you specific instructions about which medications to stop and when.

Pre-operative testing: Depending on your age and health status, you may need blood tests, a pregnancy test, or other examinations before the procedure. These tests help ensure you're healthy enough for surgery and help your healthcare team plan your care.

The Day Before and Day of the Procedure

As your procedure date approaches, follow these important guidelines:

• Fasting: If you'll receive general anesthesia or sedation, you'll typically need to stop eating and drinking 6-12 hours before your procedure. This is crucial for your safety during anesthesia.
• Arrange transportation: You will not be able to drive yourself home after the procedure due to the effects of anesthesia. Arrange for a responsible adult to take you home and stay with you for the first few hours.
• Wear comfortable clothing: Choose loose, comfortable clothes that are easy to change into after the procedure.
• Leave valuables at home: Don't bring jewelry or large amounts of cash to the hospital or surgical center.
• Follow hygiene instructions: Your doctor may ask you not to use vaginal douches, tampons, or have sexual intercourse for a day or two before the procedure.

What Happens During a D&C?

During a D&C, you receive anesthesia, then the doctor gently dilates your cervix using gradually larger instruments, inserts a curette or suction device to remove tissue from your uterine lining, and the tissue is sent for laboratory analysis if needed. The procedure typically takes 10-15 minutes.

Understanding what happens during the procedure can help reduce anxiety and make you feel more prepared. The D&C follows a well-established sequence of steps that healthcare providers have refined over decades of practice.

Anesthesia Options

Before the procedure begins, you'll receive anesthesia to ensure you're comfortable. The type of anesthesia depends on several factors, including the reason for the D&C, your health status, and the setting where it's performed:

• Local anesthesia: Numbing medication is injected around the cervix. You'll be awake but shouldn't feel pain. This is sometimes used for diagnostic D&Cs in office settings.
• Sedation (twilight anesthesia): You receive medication through an IV that makes you very drowsy and relaxed. You may not remember the procedure afterward.
• General anesthesia: You're completely asleep during the procedure. This is commonly used for D&Cs performed in hospitals or surgical centers.
• Regional anesthesia (spinal or epidural): Numbs you from the waist down. Less commonly used for D&C but may be an option in certain situations.

The Procedure Steps

Once anesthesia takes effect, the procedure follows these steps:

Step 1: Positioning - You'll lie on your back on an examination table with your feet in stirrups, similar to the position used during a pelvic exam. The area around your vagina will be cleaned with an antiseptic solution to reduce infection risk.

Step 2: Speculum insertion - A speculum (the same instrument used during Pap smears) is inserted into your vagina to hold the vaginal walls apart and allow the doctor to see your cervix clearly.

Step 3: Cervical dilation - The doctor grasps the cervix with a special instrument to hold it steady. Then, using a series of progressively larger dilators, the cervical opening is gradually widened. This is the "dilation" part of D&C. Sometimes a medication called misoprostol is given before the procedure to help soften the cervix and make dilation easier.

Step 4: Curettage - Once the cervix is dilated enough, the doctor inserts a curette (a long, thin instrument with a loop or scoop at the end) or a suction device through the cervix into the uterus. The uterine lining is then gently scraped or suctioned to remove tissue. If a hysteroscope is used, the doctor can see inside the uterus on a video monitor and target specific areas for tissue removal.

Step 5: Completion - The instruments are removed, and the doctor checks for any excessive bleeding. No stitches are needed. The removed tissue is placed in a container and sent to the laboratory for examination if needed.

After the Procedure

After the D&C is complete, you'll be moved to a recovery area where nurses will monitor you as the anesthesia wears off. You may experience:

• Grogginess and drowsiness from the anesthesia
• Mild cramping similar to menstrual cramps
• Light bleeding or spotting
• Slight nausea from the anesthesia

Most women stay in the recovery area for 1-2 hours before being discharged home. Before you leave, your healthcare team will give you instructions for care at home and explain what symptoms to watch for.

How Long Does Recovery From a D&C Take?

Most women recover quickly after a D&C, returning to normal activities within 1-2 days. Light bleeding or spotting may continue for up to 2 weeks. You should avoid sexual intercourse, tampons, and douching for 1-2 weeks. Your next menstrual period typically returns within 4-6 weeks.

Recovery from a D&C is generally straightforward, but it's important to follow your doctor's instructions carefully to ensure proper healing and reduce the risk of complications. Understanding what's normal during recovery helps you know when to contact your healthcare provider.

The First 24-48 Hours

The first day or two after your D&C are the most important for rest and recovery:

Rest at home: Plan to rest at home for the remainder of the day after your procedure. Having someone with you during this time is important, especially as the anesthesia wears off. You may feel tired, groggy, or slightly nauseated.

Cramping: Mild to moderate cramping is normal and typically feels similar to menstrual cramps. Over-the-counter pain medication like acetaminophen or ibuprofen usually provides adequate relief. If your doctor prescribed pain medication, use it as directed.

Bleeding: Light bleeding or spotting is expected and normal. Use sanitary pads (not tampons) to absorb any bleeding. The bleeding is usually light and may be pink, red, or brown in color.

Activity: Take it easy on the first day. You can walk around the house and perform light activities, but avoid strenuous exercise, heavy lifting, or any activity that causes significant cramping or increased bleeding.

The First Two Weeks

During the first two weeks after your D&C, your body is healing. Follow these guidelines:

• Avoid sexual intercourse: Wait at least 1-2 weeks or until your doctor clears you. This allows the cervix to close and reduces infection risk.
• No tampons: Use only sanitary pads until your follow-up appointment or as your doctor instructs.
• No douching: Avoid douching entirely, as it can introduce bacteria into the healing uterus.
• Avoid swimming: Stay out of pools, hot tubs, and baths (showers are fine) to reduce infection risk.
• Return to work: Most women can return to work within 1-2 days, depending on the type of work and how they feel.
• Exercise: Light exercise like walking is fine after the first day or two. Avoid strenuous exercise for about a week.

Returning to Normal

Your body will gradually return to its normal state over the following weeks:

Menstrual period: Your next period will usually arrive within 4-6 weeks after the D&C. The first period may be lighter or heavier than normal, and the timing may be slightly different than your usual cycle. This is normal and should regulate over the next few cycles.

Follow-up appointment: Your doctor will typically schedule a follow-up appointment 2-4 weeks after the procedure to ensure you're healing properly and discuss any tissue analysis results. Keep this appointment even if you feel fine.

Trying to conceive: If you want to become pregnant, your doctor may recommend waiting at least one menstrual cycle before trying to conceive. This allows the uterine lining to rebuild fully. However, ovulation can occur as soon as 2 weeks after a D&C, so use contraception if you're not ready for pregnancy.

What Are the Risks and Complications of D&C?

D&C is generally a safe procedure with overall complication rates under 2%. Rare risks include infection (1-2%), uterine perforation (less than 1%), heavy bleeding, Asherman's syndrome (intrauterine adhesions), cervical damage, and incomplete removal of tissue. Most complications are treatable when detected early.

While D&C is considered a safe procedure with a long track record, like any surgical procedure, it carries some risks. Understanding these risks helps you make an informed decision and know what to watch for during recovery. The good news is that serious complications are rare, especially when the procedure is performed by experienced healthcare providers.

Common Side Effects (Not Complications)

It's important to distinguish between normal side effects that most women experience and actual complications. The following are expected after a D&C and are not cause for concern:

• Mild to moderate cramping for 1-2 days
• Light bleeding or spotting for up to 2 weeks
• Fatigue on the day of the procedure from anesthesia
• Emotional feelings (especially after pregnancy loss)

Potential Complications

True complications from D&C are uncommon but can occur:

Infection (1-2% risk): Bacteria can enter the uterus during or after the procedure, causing an infection called endometritis. Symptoms include fever, chills, foul-smelling discharge, and worsening pelvic pain. Infections are usually treated successfully with antibiotics.

Uterine perforation (less than 1% risk): In rare cases, the surgical instruments can accidentally create a hole in the uterine wall. This risk is slightly higher in women who have had multiple pregnancies, are postmenopausal, or have a retroverted (tilted) uterus. Small perforations often heal on their own, but larger ones may require additional surgery to repair.

Heavy bleeding (hemorrhage): While some bleeding is normal, occasionally the bleeding can be excessive and require treatment with medication or, rarely, additional procedures to stop it.

Asherman's syndrome (intrauterine adhesions): Scar tissue can form inside the uterus after a D&C, especially if multiple D&Cs are performed or if the procedure is done shortly after pregnancy. This can cause light or absent periods and may affect fertility. Treatment involves surgical removal of the adhesions.

Cervical damage: The cervix can occasionally be injured during dilation. Minor lacerations usually heal without treatment. Rarely, the cervix can be weakened, which may affect future pregnancies (cervical incompetence).

Incomplete removal of tissue: Sometimes not all the targeted tissue is removed, which may require a repeat procedure.

Anesthesia complications: As with any procedure involving anesthesia, there are small risks associated with the anesthesia itself, including allergic reactions, breathing problems, or heart rhythm changes. These are monitored carefully by the anesthesia team.

Risk Factors for Complications

Certain factors may increase the risk of complications from D&C:

• Previous uterine surgery or multiple D&C procedures
• Uterine fibroids or other structural abnormalities
• Active pelvic infection at the time of the procedure
• Blood clotting disorders
• Postmenopausal status (thinner uterine walls)
• Multiple pregnancies (softer uterus)

Does D&C Affect Fertility?

A single D&C rarely affects future fertility. However, multiple D&Cs or complications like Asherman's syndrome (uterine scarring) can potentially impact the ability to conceive. Most women who undergo D&C go on to have successful pregnancies. Ovulation can return within 2 weeks after the procedure.

One of the most common concerns women have about D&C is whether it will affect their ability to have children in the future. This is an understandable worry, especially for women who experience D&C after miscarriage. The reassuring news is that, for most women, a single D&C has no negative impact on fertility.

Fertility After a Single D&C

Research consistently shows that women who undergo a single D&C have similar fertility rates to women who haven't had the procedure. The uterine lining (endometrium) has remarkable regenerative ability and typically returns to normal within one or two menstrual cycles after a D&C.

After a D&C for miscarriage, many studies show that women can conceive again within several months. In fact, some research suggests that fertility may even be slightly increased in the first few months after a D&C, though more research is needed to confirm this finding.

When Fertility Might Be Affected

There are situations where D&C could potentially impact fertility:

Multiple D&Cs: Women who undergo several D&Cs may have a higher risk of developing Asherman's syndrome, where scar tissue forms inside the uterus. This scarring can interfere with embryo implantation and lead to infertility or pregnancy complications. The risk increases with each subsequent procedure.

Asherman's syndrome: This condition causes adhesions (bands of scar tissue) to form inside the uterus, sometimes causing the walls to stick together. Symptoms include light or absent periods, pelvic pain, and difficulty conceiving. Fortunately, Asherman's syndrome can often be treated with hysteroscopic surgery to remove the adhesions, and many women go on to have successful pregnancies after treatment.

Aggressive curettage: If the procedure removes too much of the basal layer of the endometrium (the deeper layer from which the lining regenerates), it may be harder for the endometrium to rebuild properly. This is one reason why many healthcare providers now prefer suction curettage, which may be gentler on the tissues.

Getting Pregnant After D&C

If you want to conceive after a D&C, here's what you should know:

• Ovulation returns quickly: You can ovulate as soon as 2 weeks after a D&C, meaning pregnancy is physically possible very soon after the procedure.
• Wait for one cycle: Most doctors recommend waiting at least one menstrual period before trying to conceive. This allows the uterine lining to rebuild and makes it easier to date a pregnancy.
• After miscarriage: If your D&C was for pregnancy loss, your doctor may recommend waiting 1-3 months before trying again. This gives you time to heal both physically and emotionally.
• No rush: There's no medical evidence that waiting longer than one cycle is necessary for physical health reasons, but take the time you need emotionally before trying again.

Are There Alternatives to D&C?

Alternatives to D&C include expectant management (waiting for the body to pass tissue naturally), medication (misoprostol) to help expel tissue, hysteroscopy for targeted tissue removal, and endometrial biopsy for diagnostic purposes. The best option depends on the reason for the procedure and your individual circumstances.

D&C is not always the only option. Depending on why the procedure is being recommended, there may be alternatives worth discussing with your healthcare provider. Understanding your options allows you to make an informed decision about your care.

For Miscarriage Management

When D&C is recommended after miscarriage, there are typically three approaches:

Expectant management: This means waiting for your body to pass the pregnancy tissue naturally without medical intervention. About 50-80% of women with early pregnancy loss will complete the miscarriage naturally within 2-6 weeks. This option may be preferred if you want to avoid surgery and are prepared for the unpredictability of when the miscarriage will occur.

Medication (medical management): Misoprostol is a medication that causes the uterus to contract and expel its contents. It can be taken as a pill or placed vaginally. Success rates range from 70-90% depending on the type of pregnancy loss. This option provides more control over timing than expectant management while avoiding surgery.

Surgical management (D&C): This provides the most predictable and complete resolution. It may be preferred when there is heavy bleeding, signs of infection, or when you want the quickest resolution.

For Diagnostic Purposes

When D&C is recommended to diagnose abnormal bleeding or detect uterine abnormalities:

Endometrial biopsy: A thin, flexible tube is inserted through the cervix to collect a small sample of the uterine lining. This can be done in the office without anesthesia and provides tissue for examination. However, it samples only a small area and may miss focal abnormalities.

Hysteroscopy: A thin camera is inserted into the uterus to visualize the uterine cavity directly. This can identify polyps, fibroids, and other abnormalities and allows targeted biopsy. It's often combined with D&C for both diagnosis and treatment.

Transvaginal ultrasound: While this doesn't provide tissue samples, it can help identify many uterine abnormalities non-invasively and may determine whether further testing is needed.