What is a D&C?

D&C stands for dilation (or dilatation) and curettage, which is the technical name for the procedure doctors use to clean out the inside of the uterus. In connection with pregnancy, a D&C is used to make sure a miscarriage is complete.

A D&C has traditionally been used

To make sure all of the tissue has been removed after a miscarriage
To stop bleeding after a normal delivery when excessive bleeding occurs
To stop heavy bleeding due to hormones that are out of balance
To stop heavy bleeding around the time of menopause
For diagnosis of certain conditions (like endometrial hyperplasia)

There are newer procedures that can be used with or instead of a traditional D&C which will be described below.

The uterus is a muscular organ shaped like a pear but much smaller, especially in women who have never been pregnant. The muscles can stretch wide enough for the uterus to enclose a baby and are strong enough to push a baby out at the right time.

The lining of the uterus is called the endometrium. During the second half of the menstrual cycle, this lining grows thick in response to hormones. It is where an embryo attaches, which is called implantation. An embryo cannot attach to the uterine lining unless it is in the right condition. Early on, the placenta (also called the afterbirth) forms, connecting the baby to the mother.

If pregnancy does not occur, the lining comes off and out of the body. This is what makes a menstrual period. Then the cycle begins again.

If a woman’s hormones are not in the correct balance, the lining can build up and not shed monthly as it should. This can happen when there is too much estrogen and not enough progesterone. This can cause excessive bleeding when the lining does eventually come off. It can also cause a condition called endometrial hyperplasia. This may be a precancerous condition, so it needs to be diagnosed and treated.

In the past, during a D&C, a doctor sometimes removed things growing in the uterus like polyps or fibroid tumors which can also cause bleeding. These can be seen beforehand on an ultrasound. However, there is now a way for a doctor to see into the uterus and remove fibroids directly. This is called hysteroscopy.

Excessive bleeding from the uterus can cause enough blood loss to make a woman anemic, even dangerously so. A D&C can be used to remove the lining of the uterus and stop the bleeding. Extra hormones are also usually given in the right combination to allow the lining to grow back normally and prevent further excess bleeding.

Hormonal imbalance that can lead to excessive bleeding can happen in some younger women, in women with certain medical conditions, and around the time of menopause. While women expect their periods to stop during menopause, many have episodes of excessive bleeding before their periods stop completely. Women who take hormones after menopause cannot just take estrogen. Estrogen without progesterone will cause endometrial hyperplasia. This can cause bleeding, but can also be pre-cancerous as noted above. A D&C can be done both to stop bleeding in this case but also to get samples of tissue to look at.

A woman who has suffered a miscarriage, but who still has parts of the tissues of pregnancy inside the uterus may need a D&C to remove all of what are called “products of conception.” This will then allow the uterus to heal and normal cycles to start up again. Sometimes hysteroscopy can be used instead to see and remove these tissues.

Dilation of the cervix may or may not be needed depending on the specific situation. The cervix is the mouth of the womb, and the inner part of it is usually closed except during labor. If dilation is needed, there are medications in suppository form that can be placed in the outer part of the cervix to help open it.

If a woman has just delivered a baby and is bleeding heavily, this can be a medical emergency. In addition to using medication, a D&C may be necessary to stop a woman from bleeding to death.

Traditional curettage is done with a small sharp instrument that goes into the uterus and scrapes off the lining. Now there is often suction attached to a blunt instrument and tissue is removed more by suction than scraping. This by itself is not painful, but most of the time a D&C is done under sedation or general anesthesia.

There are also medicines that can do a “chemical D&C,” most commonly misoprostol (Cytotec).

With the new procedures available, less dilation and sharp curettages are being performed. Often tissue removal is done via hysteroscopy so that the doctor can see exactly what he or she is removing. If curettage of the lining is needed, suction is often used. Suction curettage is less likely to cause scars in the uterus. Uterine scarring is a known complication of a traditional D&C. Ultrasound can be used before and after a D&C to help determine where the problem is and to see if it has been resolved afterwards.

If you need a D&C but you are trying to get pregnant now, or plan to try in the future, you should discuss this with your doctor. The best procedure that causes the least scarring should be done. On the other hand, if you are done having children or near menopause, scarring is less of an issue. Each doctor has his or her own approach, and different procedures are best for different patients.

Many, if not most, women consider having or have had a D&C at some time.

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What is a D&C?

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