What is dilation and curettage?
Curettage of the uterus (womb), commonly known as dilation and curettage or D & C, is the scraping of the lining of the uterus (the endometrium).

When is D & C carried out?
There are two main reasons for performing a D&C:

an evacuation D&C is performed in a recently pregnant woman in order to remove tissue remaining in the womb.

a gynaecological D&C is part of the investigation of a woman who is experiencing heavy or irregular periods or vaginal bleeding after the menopause.

When is an evacuation performed in a recently pregnant woman?
After, or sometimes during, a miscarriage the gynaecologist will examine the woman to see if there is any tissue from the pregnancy remaining in the womb. An ultrasound scan is the most reliable way to determine this. An evacuation is usually advised in order to avoid heavy bleeding and prevent a possible infection of the uterus.

An alternative to surgery is a medical evacuation which uses tablets to cause the womb to contract and empty itself. The success rate of a medical evacuation in emptying the uterus completely is slightly less than the surgical approach, but is an option for some women.

If the woman has had a miscarriage at an early stage in her pregnancy, or if the amount of remaining tissue is small, a D& C may not be necessary since the remaining tissue will be passed as part of the next period.

What happens during a D&C?
After a miscarriage, the woman is first given a general anaesthetic by an anaesthetist. The gynaecologist opens (dilates) the cervix with instruments called dilators then inserts a hollow tube through the cervix. Suction is applied to remove the retained tissue. The procedure usually takes less than five minutes. This procedure is very similar to that which is performed during a termination of pregnancy.

How soon can a woman return to work after an D & C?
Most women will take the following day off work, but, physically, one recovers quickly. Some women experience psychological effects after a miscarriage, as the pregnancy might have been anticipated with much joy. It is helpful to talk through thoughts and feelings with friends and relatives or with your midwife or doctor.

It is normal to experience irregular bleeding in the days following the D&C. Contact your doctor if there is heavy bleeding with large clots, severe lower abdominal pain, bleeding, a smelly vaginal discharge or if you have a high temperature.

Why are gynaecological curettages performed?
Sometimes, there is a change in the character and/or the amount of a woman's period or there may be breakthrough bleeding or spotting in between periods or during sexual intercourse. This can be caused by hormonal disturbances or may be due to a malignant or benign disease of the cervix or uterus.

Older women, especially those who experience post-menopausal bleeding, receive a gynaecological D&C. In order to make a diagnosis, and find out which treatment is best, the gynaecologist will scrape (curette) the lining of the womb for closer examination.

Few women under the age of 40 require this procedure as disease in the uterus is rarely seen in young women.

How is a gynaecological curettage performed?
Gynaecological curettage is often an outpatient investigation that is performed at the hospital by a gynaecologist. The gynaecologist will perform a pelvic examination. After this, a small tube, the width of a very thin straw, is inserted in the uterus. A biopsy of the lining of the womb can be obtained. A woman usually experiences discomfort similar to a painful period but this passes within seconds. The sample is sent to a pathologist for examination and results are ready within a week. This kind of D&C provides a limited amount of information and most gynaecologists recommend a hysteroscopy (telescopic examination of the inside of the womb) as well as the biopsy procedure. Most hysteroscopy examinations can be performed without general anaesthesia.

Sometimes a D&C (with or without a hysteroscopy) is performed under general anaesthesia. This is usually done if the gynaecologist anticipates that the neck of the womb will be difficult to dilate or if the woman is either very anxious or requests a general anaesthetic.

Rarely, a woman may need an emergency D&C that is performed if she has heavy bleeding which cannot be stopped with tablet treatment. In such cases, the D&C is used to treat the problem. However a D&C is usually used to make a diagnosis, and is not used as part of treating the bleeding problem.

How soon can a woman return to work after a gynaecological curettage?
After a curettage, it is a good idea to relax for the rest of the day, but the recovery is quick. It is normal to have a small amount of vaginal bleeding for a few days afterwards. If heavy bleeding occurs, similar to a heavy period, or if there is severe lower abdominal pain or a high temperature, a doctor should be contacted.

Are there any risks with a D&C?
No, the medical or surgical procedure is completely risk free but complications following a D&C are very uncommon.

Possible complications include:

in recently pregnant women there is the small risk of making a hole in the uterus (uterine perforation) because the wall of the recently pregnant womb is very soft.

sometimes tissue may be left behind (incomplete evacuation). This tissue may be passed without complication but increased bleeding or infection may require a repeat procedure.

the risks of a D&C in non-pregnant women is much lower, although there is still the small risk of the uterus being perforated.

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