Dilation and curettage (D&C) at Cheltenham Hospital

What is dilation and curettage?

Dilation and curettage (D&C) is a procedure that opens (dilates) your cervix, the entrance to your womb, so that tissue can be removed from inside it. It can be used to find out what's causing a problem, or to treat one directly.

What conditions does it treat?

D&C can help find the cause of abnormal vaginal bleeding, such as heavy periods, bleeding between periods, or bleeding after the menopause, by checking a sample of the womb lining for polyps, abnormal cells or cancer.

It's also used to remove tissue that's been left behind after a miscarriage or childbirth, known as retained products of conception, and can be used to end a pregnancy in the first trimester, or to check tissue from a molar pregnancy.

What are the benefits of having a D&C?

A tissue sample taken during a D&C is examined in a laboratory, which can give you a clear answer about what's causing your symptoms. After a miscarriage or childbirth, it can also lower your risk of infection and heavy bleeding by making sure your womb is completely empty.

Are there different surgical approaches?

• With a curette: a spoon-shaped instrument that's used to gently scrape the lining of the womb.
• With a suction or vacuum device: sometimes called vacuum aspiration or suction curettage, this draws the tissue out.

A D&C for retained tissue after a miscarriage or birth is sometimes called an evacuation of retained products of conception (ERPC). A D&C may also be combined with a hysteroscopy, where a thin, lit telescope is used to look inside your womb at the same time.

What happens before the operation?

Your care team will take a full medical history, so tell them about any medications or allergies you have, and let them know if there's any chance you could be pregnant.

In the run-up to your procedure:

• you'll usually need to stop eating for around 6 hours beforehand, though small sips of water are normally allowed up to 2 hours before
• you can usually take your regular medication, but tell the clinic if you take blood thinners or diabetes medication
• your surgeon may soften and widen your cervix beforehand using a medicine called misoprostol, or a small rod called a laminaria stick
• arrange for someone to take you home afterwards, since you won't be able to drive for 24 hours if you have a general anaesthetic.

What happens during the procedure?

1. You're given your chosen anaesthetic, which might be general (you're asleep), regional (such as an epidural, so you have no feeling from the waist down but stay awake), or local (only your cervix is numbed).
2. You lie on your back with your feet supported, similar to during a smear test, and a speculum holds your vagina open so your cervix is visible.
3. Your surgeon gently widens your cervix using a series of rods called dilators, each slightly bigger than the last, until it's wide enough for the instruments needed.
4. A curette or a suction device is used to remove the lining or contents of your womb.
5. If needed, a sample of the tissue is sent to a laboratory for testing.

The procedure itself usually takes around 5 to 10 minutes, though the whole appointment, including your anaesthetic and recovery time, takes longer.

What does recovery look like?

You'll usually go home the same day. If you've had a general anaesthetic, you'll need someone to drive you home, and you shouldn't drive yourself for 24 hours.

Mild cramping and light bleeding or spotting are normal for a few days afterwards, and occasionally this can continue for up to a month. Use pads rather than tampons or menstrual cups until your surgeon says it's safe to use them again, and avoid sex until your cervix has fully closed, usually around a week, to reduce your risk of infection. Most people are back to their usual activities within about 5 days.

Your next period may come earlier or later than usual, since it depends on how quickly your womb lining rebuilds. If you had a D&C after a miscarriage, ask your surgeon how long to wait before trying to conceive again, since some recommend waiting for 2 to 3 menstrual cycles. If a tissue sample was taken, results are usually available within a week, and you'll normally have a follow-up appointment within 2 weeks.

What are the risks and complications?

Serious complications are rare. Possible risks include:

• infection, including a urinary tract infection
• bleeding
• a small tear or perforation in the wall of your womb; this is the most common complication, though it's still uncommon overall
• injury to your cervix
• a reaction to the anaesthetic or other medicines used.

In rare cases, especially after a D&C for miscarriage, bands of scar tissue called adhesions can form inside the womb, known as Asherman's syndrome. This can affect your periods or fertility, but it can be treated with a minor operation to remove the adhesions.

Your individual risk of a perforation is higher if you've previously had heavy bleeding after birth, if you're past the menopause, if you've never given birth before, or if your womb is tilted backwards (retroverted); your surgeon can tell you if any of these apply to you.