The endometrium is the inside layer of the uterus, the lining that builds up between menstrual cycles and then sheds during menstruation. The cervix is the lower part of the uterus that extends through the top of the vagina and partly into the vaginal canal. Dilation and curettage, D&C, is a surgery to dilate (open) the cervical canal and scrape the endometrium with a sharp instrument called a curette.
D&Cs can be diagnostic, to test or identify possible uterine conditions, and it can be treatment as well.
Before a D&C, a doctor applies a local anesthetic or light sedation, and then inserts a curette through the dilated cervix into the uterus to scrape and remove endometrial tissue. The tissue is sent to a pathologist for analysis and diagnosis.
A D&C is often recommended to determine the cause of heavy or irregular bleeding, such as endometrial hyperplasia, polyps, and menopausal bleeding.
If you have heavy or irregular bleeding, see the Excessive Bleeding link here.
The appropriate way to diagnose endometrial hyperplasia is to have a pelvic and transvaginal ultrasound to determine if the endometrium is abnormally thickened. The ultrasound should be performed in the Radiology Department of a hospital or a in a free-standing imaging center, not in a gynecologist’s office. For more information regarding endometrial hyperplasia, click here.
If you have polyps, polypectomy is an effective, less invasive treatment than a D&C. In a polypectomy a wire loop is used to remove polyps at their base. For more information, click here.
A D&C is contraindicated if you have a submucosal uterine fibroid. The location of uterine fibroids that cause heavy menstrual bleeding with large blood clots is submucosal. “Submucosal” fibroids are located in the endometrium, the inside layer of the uterus. A D&C performed when there is a submucosal fibroid scrapes the fibroid, without removing it, which makes the bleeding significantly heavier. For more information regarding fibroids, click here.
Multiple D&Cs can cause Asherman’s Syndrome. Asherman’s Syndrome is a painful condition where scar tissue develops in the uterus as a result of frequent scraping of the endometrium, which can result in infertility and chronic pelvic pain.
Perforation of the uterus is another risk of D&C. Perforation of the uterus may result in hematoma (a collection of blood), hemorrhage, and, in rare instances, death.
A D&C should not be performed if you have a vaginal infection. There is an increased risk that the surgical instruments may carry bacteria from your vagina or cervix into your uterus.
Most conditions diagnosed with a D&C can be treated conservatively, without major surgery.
The uterus and ovaries have many important lifelong functions. The most consistent problems women report after hysterectomy, whether the ovaries and cervix are retained or not, include a 25–pound average weight gain in the first year following the surgery, a loss of sexual feeling, a loss of vitality, joint pain, back pain, profound fatigue, and personality change.
For more information, watch the short video “Female Anatomy: the Functions of the Female Organs.”