Dilatation and curettage (D&C)

Page last reviewed: 13/07/2011

Dilatation and curettage (D&C) is a minor surgical procedure where tissue is removed from the lining of the womb (uterus). The lining is called the endometrium.

What is dilatation and curettage used for?

Dilatation and curettage is a procedure that is carried out by a gynaecologist (a specialist in treating conditions of the female reproductive system).

Dilatation and curettage is sometimes used to help diagnose a condition, and it can also be used for treatment purposes. For example, the procedure can be used to help diagnose cancer of the womb or to remove fibroids (non-cancerous tumours that can develop inside the womb).

There are two parts to the dilatation and curettage procedure. They are:

  • dilatation - where the cervix (the neck of the womb) is dilated (widened)
  • curettage - where the endometrium is removed using a sharp instrument

Dilatation and curettage is often used in combination with a hysteroscopy. A hysteroscopy is a procedure that uses a narrow telescopic device (a hysteroscope) to look inside the womb. The hysteroscope is inserted into the womb, allowing the gynaecologist to check for any abnormalities, such as fibroids or polyps (growths of cells).

Outlook

Dilatation and curettage is usually a safe and simple procedure, and associated complications are rare, occurring in less than five per cent of cases. However, possible complications could include:

  • infection of the womb
  • heavy bleeding
  • Asherman's syndrome, where the womb is damaged, resulting in scarring

See Dilatation and curettage - complications for more information about these.

Uterus

The uterus (also known as the womb) is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.

Cervix

The cervix is at the lower end of the womb. It connects the womb with the vagina.

Anaesthetic

Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.

Page last reviewed: 13/07/2011

Dilatation and curettage (D&C) can be used to diagnose and treat a number of different conditions.

Diagnosis

When dilatation and curettage is used to help diagnose condition, a tissue sample (biopsy) may be taken for testing in a laboratory. This diagnostic approach may used if you have:

  • abnormal bleeding  
  • irregular periods
  • spotting (a slight loss of blood through the vagina that does not relate to menstruation)
  • bleeding after sex (post-coital bleeding)
  • bleeding after menopause (the end of menstruation, occurring in women who are around 50)
  • fertility problems
  • adenomyosis (where the inner lining of the womb grows inside the middle layer, causing pain, cramps and bleeding)

The sample that is taken from the womb will be sent to a laboratory to check for:

Treatment

Conditions that dilatation and curettage is sometimes used to  treat include:

  • excessive bleeding following birth by clearing out any placenta that is left in the womb (the placenta is the organ that attaches the mother to her unborn baby and provides the baby food and oxygen)
  • removing a molar pregnancy (where the fertilisation of the egg goes wrong and leads to an abnormal growth of cells inside the womb)
  • removing unwanted tissue, polyps or benign tumours from the womb
  • removing an intrauterine device (IUD) (a small, T-shaped contraceptive device made from plastic and copper) that has become embedded in the wall of the womb
  • removing any tissue that remains after a miscarriage or abortion, in order to prevent infection

Glossary

Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.  
Womb
The uterus (also known as the womb) is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.
Biopsy
A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.
Benign
Benign refers to a condition that should not become life-threatening. In relation to tumours, benign means not cancerous.
Abortion
An abortion or termination is a medical procedure that ends pregnancy. The method used depends on the stage of pregnancy.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.

Page last reviewed: 13/07/2011

In most cases, dilatation and curettage (D&C) is performed on an outpatient basis, which means that you should not have to stay in hospital overnight.

Dilatation and curettage

Dilatation and curettage is usually carried out under general anaesthetic, which means that you will be asleep and will not feel any pain or discomfort. However, if preferred, the procedure can also be performed using a local anaesthetic. In this case, the area will be completely numb so you will not feel any pain or discomfort, but you will be awake.

Before having dilatation and curettage, you will not be able to eat or drink anything for several hours. This will reduce your risk of vomiting or regurgitating food while you are under anaesthetic.

Dilatation and curettage usually takes about 10 minutes. The operation is performed through the vagina (the female sex organ) and it will not leave a scar. The cervix (neck of the womb) is dilated (widened) using rods, and a small scraping instrument called a curette is passed into the womb to gently scrape off the womb lining (endometrium).

If the dilatation and curettage procedure is being carried out for diagnostic purposes, the removed tissue sample (biopsy) will be sent to a laboratory to be tested.

Endometrial ablation

Dilatation and curettage is being used less frequently to treat conditions such as heavy menstrual bleeding because newer, less invasive techniques are now available.

One such procedure is known as endometrial ablation and involves a small probe being inserted through the cervix (neck of the womb) into the womb, after which lasers or microwaves are used to remove the womb lining (endometrium).
 
However, endometrial ablation is not suitable for all women, such as those who have an irregularly shaped womb and those who have had previous uterine (womb) surgery. In such cases, dilatation and curettage may be recommended.

Evacuation of retained products of conception (ERPOC)

Evacuation of retained products of conception (ERPOC) is a similar procedure to dilatation and curettage. It is used to prevent infection by removing foetal tissue after a miscarriage (the loss of the baby carried in the womb).

Glossary

Womb
The uterus (also known as the womb) is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.
Anaesthetic
Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.
Local anaesthetic
A local anaesthetic is a drug that is injected by needle or applied as a cream, which causes a loss of feeling in a specific area of the body.
Painkillers
Analgesics are medicines that relieve pain. For example paracetamol, aspirin and ibuprofen.

Page last reviewed: 13/07/2011

After the procedure

After the dilatation and curettage (D&C) procedure, arrange for a friend, partner or relative to take you home and stay with you for 24 hours because you may still be feeling disorientated due to the effects of the general anaesthetic.

Do not drive or operate heavy machinery for 24 hours after having the procedure. You should be able to return to work and normal activities within two to three days.

There are a number of important issues that you need to be aware of when recovering from a dilatation and curettage procedure. These are discussed below.

Cramps

Immediately after having dilatation and curettage, most women will experience cramps that are similar to menstrual cramps. However, the cramps should stop around 24 hours after having the procedure.

Mild analgesics (painkillers) that are available over-the-counter (OTC) can help to relieve any discomfort that you are experiencing. Painkillers such as paracetamol or ibuprofen can be taken to relieve any pain. Aspirin should not be given to children who are under 16.

Nausea

You may experience some feelings of nausea (feel sick) after having a dilatation and curettage procedure. However, this should only last for a few hours.

Bleeding

After the procedure, it is likely that you will experience some vaginal bleeding, which appears bright red at first, before fading to a brown stain.

Use sanitary towels, rather than tampons, to stem the bleeding, and avoid using tampons until your next period because this reduces the risk of developing an infection.

The bleeding should pass within 5-10 days of having the procedure. During this time, to avoid developing an infection, do not use any scented bath products or go swimming.

Sexual intercourse

After you have had dilatation and curettage, you should not have sex for several weeks. Exactly how long you will need to avoid having sex will depend on your individual circumstances, as well as the reason why the procedure was carried out. Your doctor will be able to give you more advice about this, although on average it is around 10-14 days.

Results

If you had dilatation and curettage for diagnostic purposes (to help diagnose a condition), the laboratory test results should be available within 14 days. Written confirmation of the results will be sent to you, or you will be given an appointment so that you can discuss the results with your gynaecologist.

When to seek medical advice

You should seek immediate medical advice if, after having dilatation and curettage, you experience:

  • excessive bleeding - when you have prolonged heavy bleeding that lasts for over seven days, which is bright red, has large clots, and does not reduce and stop
  • excessive pain - see your GP if you experience anything more than mild discomfort, such as severe pain
  • signs of infection - if you have an unpleasant smell in your discharge, or a high temperature (fever) of 38C (100.4F) or above, it may be a sign that you have an infection

Glossary

Discharge
Discharge is when a liquid such as pus oozes from a part of your body.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Fever
A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37°C (98.6°F).
Anaesthetic
Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.
Painkillers
Analgesics are medicines that relieve pain. For example paracetamol, aspirin and ibuprofen.

Page last reviewed: 13/07/2011

Infection

Despite the best efforts of medical staff, infection is always a risk after a surgical procedure. However, the risk of an infection developing following dilatation and curettage (D&C) is low (less than 5 in 100).

Symptoms of a post-operative infection may include:

  • a high temperature (fever) of 38C (100.4F) or above
  • abdominal (tummy) pain
  • a foul-smelling vaginal discharge

Seek medical attention if you experience any of these symptoms. Most infections can be cured with antibiotics.

Heavy bleeding

Heavy bleeding is a rare complication of dilatation and curettage. It can occur if a surgical instrument injures the wall of the womb, or if an undetected fibroid (a non-cancerous growth) is cut during the procedure.

As with infection, the risk of an instrument injuring the wall of the womb is less than 5 in 100. Contact hospital staff if bleeding after the operation remains heavy and does not reduce over the course of the first week.

Asherman's syndrome

Asherman's syndrome occurs when dilatation and curettage causes damage to the womb, resulting in scarring. If the scarring is particularly bad, it may then fill the womb and disrupt your periods. In some cases it may cause infertility.It is estimated that Asherman's syndrome occurs in less than 2% of dilatation and curettage cases.

Asherman's syndrome can usually be successfully treated by surgically removing the scarring.

Sometimes, Asherman's syndrome can be missed as a cause of infertility. Therefore, if you are experiencing fertility problems, and you have previously had dilatation and curettage, you may want to discuss the possibility that you may have the condition with your GP or gynaecologist.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

Browse Health A-Z