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.
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.
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.