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Dilation and Curettage (D&C)

Dilation and Curettage (D&C) Introduction

The dilation and curettage procedure is called a D&C. The D stands for dilation, which means enlarging. Curettage (the C) means scraping. Together, this procedure involves expanding or enlarging the entrance of a woman's uterus so that a thin, sharp instrument can scrape or suction away the lining of the uterus and take tissue samples.

Today, the procedure is routine and considered safe. It is minor surgery performed in a hospital or ambulatory surgery center or clinic. D&C is usually a diagnostic procedure and seldom is therapeutic. It may stop bleeding for a little while (2-6 months), then the prior abnormal bleeding tends to return.

A generation ago, many women were not given this option for so-called female problems. Instead, they were left with the option of hysterectomy (complete removal of the uterus/womb) or other major surgery.

A D&C is seldom done as a lone procedure anymore. It is most frequently done as an adjunct procedure to a hysteroscopy and/or polypectomy. A D&C is often used for the following conditions:
- Irregular bleeding: You may experience irregular bleeding from time to time, including spotting between periods. If the spotting develops into continuous midcycle bleeding, your health care provider may perform a D&C to investigate the cause of bleeding.
- Too much bleeding: Bleeding with long, heavy periods, or bleeding after menopause, can signal a number of problems. These symptoms may not need immediate investigation. You may observe and record them. At some point, though, your doctor may look for a cause that is best detected with a hysteroscopy.
  - Fibroids and polyps: These conditions are very common. In fact, they are thought to occur in about 20% of all women. Fibroid tumors are noncancerous growths appearing in and on the uterus. Some even grow out from the uterine wall on a stalk. Fibroids can cause chronic pain and heavy bleeding. Polyps, like fibroids, are noncancerous growths and are a common cause of irregular bleeding. Polyps and fibroids can have symptoms that resemble other more serious causes of bleeding. Your doctor may still want to perform a hysteroscopy.
  - Endometrial cancer: Cancer is a scary word, especially when it is said about you. A D&C and hysteroscopy are often performed to make certain your symptoms are not caused by uterine cancer. It is, of course, important to detect cancer in its earliest, most curable stages.
  - Therapeutic D&C: A D&C is often planned as treatment when the source of the problem is already known. One situation is an incomplete miscarriage or even full-term delivery when, for some reason, the uterus has not pushed out all the fetal or placental tissue inside of it. If tissue is left behind, excess bleeding can result, perhaps even life-threatening bleeding. This is an important reason why your doctor will want to remove any remaining tissue with a D&C.
Your health care provider will avoid D&C in the following situations, except when absolutely necessary:
- Pelvic infection: If you have an infection involving your reproductive tract, there is a chance the surgical instruments that will enter the vagina and cervix can carry the bacteria from your vagina or cervix into your uterus. There is also an increased risk of injury to infected tissue. For these reasons, your doctor may prefer to wait until after the infection is cleared up with antibiotics before performing the D&C.
- Blood clotting disorders: Doctors depend on the body's natural ability to clot to stop bleeding after curettage. Women with certain blood disorders are usually not given this surgery.
- Serious medical problems: Heart and lung disease, for example, can make general, and sometimes local, anesthesia risky.

In fact, D&C is no longer performed as commonly as it was even a decade ago, thanks to advances in diagnosis (e.g., ultrasound and hysteroscopy) and nonsurgical hormonal (e.g., oral contraceptives) and antihormonal (e.g., Lupron) therapies.