Everything You Need to Know About Dilation and Curettage (D&C) (2024)

Used for both treatment and diagnosis, dilation and curettage surgery, commonly referred to as D&C, is a procedure that involves removing portions of endometrium, which is the tissue that lines the uterus (or womb).

This technique involves dilating the cervix—the lower portion of the uterus—and using a specialized tool to scrape away necessary portions of this tissue. This procedure is conducted by specialists called gynecologists or obstetricians.

D&C is primarily used in cases of miscarriage, unexplained bleeding between menstrual periods, or when there’s leftover tissue following childbirth or an abortion.

This surgery may also be employed as a diagnostic procedure assessing uterine health and fertility, as part of a procedure called hysteroscopy, or as a means of treating excessive bleeding.

Generally speaking, it’s an outpatient procedure, meaning patients are usually able to go home the same day. General anesthesia or spinal epidural in which you’re put to sleep aren’t usually necessary—most are fine with localized numbing—though these may be an option for some patients.

What Is Dilation and Curettage?

Part of the reason D&C surgery is outpatient is that it only involves minimal damage to actual tissues, and the uterus is accessed with no incisions made. In most cases, localized anesthetic drugs are used and general anesthesia isn’t needed, so the patient remains awake while the procedure is performed.

Essentially, a speculum is used to open the folds of the vagin*, allowing access to the cervix. The cervix is then dilated—gradually pushed open with a series of rods of increasing size—which allows healthcare providers access to the inside of the uterus.

Once the lining of the uterus can be accessed, a curette, a specialized tool, is used to scrape the tissue. This tool, shaped like a stylus with a spoon-like scraper at its end, is able to take small portions of the endometrium.

In some cases, suction is used as a tube sucks up tissue for removal or evaluation (something sometimes called “dilation and evacuation,” or D&E). D&C surgery is generally a scheduled procedure.

Contraindications

As with any surgery, a number of existing conditions contraindicate its being employed. These include:

• Pregnancy: The primary contraindication for D&C surgery is a viable pregnancy. If you are pregnant or suspect you may be, let your healthcare provider know.
• Allergy: Those with a known allergy to anesthetic drugs may also be placed at risk during the procedure.
• Excessive bleeding problems: If you have problems with excessive bleeding, this procedure may also not be safe. Make sure to let your healthcare provider know if this is the case.

Potential Risks

Though it’s considered a minor surgery, D&C surgery is not without its risks:

• Heavy bleeding can occur as a result of the procedure; this occurs due to unintended perforation of the uterine lining.
• Infection can occur at the site of the surgery or if the uterine lining has been perforated.
• Asherman’s syndrome is a rarer complication, in which scar tissue forms on the uterine lining when D&C is performed after a miscarriage. Though treatable, this can affect fertility and menstrual blood flow.

Purpose of Dilation and Curettage

There are several health conditions that D&C takes on, and as noted, it has both diagnostic and therapeutic applications. When used for the former, it’s often part of hysteroscopy, which involves using a video camera to inspect the uterine lining. Specifically, the procedure is called for in the following cases:

• Uterine bleeding: Bleeding between periods, especially when excessive, calls for D&C for assessment and treatment. This occurs due to the formation of growths in the uterus, such as uterine polyps and fibroids, hormonal imbalances, menopause, or certain cancers, among other reasons.
• Infertility testing: D&C is sometimes used alongside blood tests and other assessments as part of diagnosis in cases of suspected infertility.
• Cancer screening: Samples of the uterine lining may be harvested using D&C for screening in cases of uterine cancer, including both endometrial cancer (that of the lining) and that of the uterus itself.
• Following miscarriage or abortion: Small portions of the placenta or other gestational material may become lodged in the uterus following miscarriage or abortion. D&C can be employed to remove this material.
• Following vagin*l birth: As with miscarriage and abortion, D&C may be used as a means of removing excess placenta tissue from the uterine lining to prevent infection.
• Ending a pregnancy: D&C may also be employed as part of the procedure called vacuum aspiration to perform an abortion.

Notably, there are other cases that call for D&C; if believed to be beneficial, your gynecologist or obstetrician will make sure to explain why.

How to Prepare

Location

D&C is a relatively minor surgery, and patients typically don’t require an overnight stay for recovery. This procedure can take place in a hospital, healthcare provider’s office, or outpatient clinic.

What can you expect in the operating theater when you come in for D&C? Here’s a quick breakdown:

• Surgical lights are important to ensure the surgery team is able to see everything.
• The operating table will be where you’ll be asked to lay down once you’re ready for surgery.
• Tables of instruments will be arranged to promote quick, efficient workflow. Notable among these are the curette, speculum, and forceps.
• Monitoring devices will track your heart rate, blood pressure, breathing, and blood oxygen levels. You’ll be connected to monitors displaying this information.
• An intravenous (IV) line may be connected to your arm to deliver medications, including an anesthetic.

What to Wear

Since D&C is an outpatient procedure, you won’t need to bring along any extra clothing. You should, however, plan to stay about four to five hours at the hospital, clinic, or office, and keep in mind that you’ll be wearing a gown while the surgery is performed. In terms of what to wear, here are some tips:

• Wear loose-fitting clothing.
• Choose comfortable, easy-to-slip-on shoes.
• Don’t wear acrylic nails or any kind of nail polish.
• Leave your jewelry at home.

Food and Drink

There are few limitations in terms of what you can eat or drink before the procedure. That said, if you opt for general anesthesia or spinal epidural, you’ll be asked to skip foods and beverages for at least eight hours before your appointment.

You can have a limited amount of water. In addition, most healthcare providers advise you to abstain from alcohol for at least 24 hours prior to D&C.

Medications

As with any surgery, taking some medications can increase the chances of complications. You may need to adjust your dosage or temporarily stop taking:

• Anticoagulants (blood thinners) like Coumadin (warfarin), heparin, Pradaxa (dabigatran), Plavix (clopidogrel), and others
• Aspirin
• Ibuprofen (Motrin, Advil, Nuprin, etc.) and other nonsteroidal anti-inflammatory drugs (NSAIDs)
• Some herbal supplements including feverfew, high dosages of omega-3 fatty acids and vitamin E, gingko, ginseng, garlic, and others
• Insulin or other drugs for diabetes (may need to be adjusted on the day of the procedure)

What to Bring

Since an overnight stay is rarely needed after D&C, there isn’t too much you’ll need to bring. Still, you should have along:

• Insurance information
• List of medications and supplements you’re taking
• An extra sanitary pad for after the procedure
• A driver or transportation for the ride home

Pre-Op Lifestyle Changes

Few preoperative lifestyle changes are necessary prior to this surgery. That said, there are several things you can do on your own to help prevent complications. These include:

• Quitting tobacco
• Moderating or abstaining from alcohol use
• Getting regular or even daily exercise
• Eating a healthy diet
• Managing excess weight

What to Expect on the Day of Surgery

While D&C is a relatively quick procedure—it typically only takes about 15 minutes—a great deal happens on the day of the surgery, and you should plan for a four- to five-hour stay. Whether it occurs in a hospital, clinic, or specialist’s office, careful preparation on your part and that of the medical team is needed.

Before the Surgery

Your overall health status will be assessed before surgery. Along with having your vital signs checked, you’ll answer questions about medications you’re taking and any health conditions you’re facing.

At this initial consultation, you’ll also have an opportunity to ask your gynecologist or obstetrician any final questions and chat with the anesthesiologist about your pain management preferences.

During the Surgery

Once your healthcare providers have determined it’s safe to go ahead, you’ll be taken to the operating theater; as noted, while this work can be performed in the surgical ward of a hospital, it can also be done in clinical and office settings.

What happens? Here’s a quick rundown:

• Staging and positioning: You will first be asked to urinate one last time and change into a hospital gown. Once ready, you’ll be asked to lay back on the operating table; your legs and feet will be in footrests to allow for easier access to the pelvic area.
• Medication and monitoring: Once positioned, you’ll be connected to monitoring devices and an IV that will deliver medications and any necessary fluids. You may be given drugs to reduce anxiety.
• Catheterization and cleaning: You’ll have a urinary catheter—a kind of tube—connected to your urethra. The healthcare provider will place a speculum inside the vagin* to visualize the cervix so it can be cleaned.
• Anesthesia: If you’re getting general anesthesia or regional anesthesia (in which only the lower half of your body is numb), this will be administered with a facemask. If you’ve opted for local anesthesia, you’ll get a numbing shot near the cervix.
• Measuring the uterus: Before the uterus is accessed, its length needs to be measured. This involves inserting a thin, tube-shaped device called a uterine sound, which may cause cramping if you have localized anesthesia. This is then removed.
• Assessing and expanding the cervix: In cases that call for it, portions of cervical tissue may be scraped with a small curette. The opening of the cervix is then opened up by inserting a series of gradually larger tubes.
• Scraping and/or suction: Once the cervix is open, the healthcare provider uses a curette to access the uterus and scrape away tissue from the lining. If suction is employed, the tube is positioned and used at this point.
• Testing: Once enough tissue is gathered and the area looks stable, the tools are removed, and the samples are collected and taken to the laboratory for clinical testing.

After the Surgery

Since D&C is usually performed on an outpatient basis, most patients are able to go home within two to three hours of surgery. However, your stay will be longer and may even need to stretch overnight if there are complications.

If you’ve had general anesthesia, you’ll need to be taken to a post-anesthesia care unit (PACU) for recovery. Here your vital signs will be monitored as you wake up.

Once you’re fully awake, you may be moved to a general recovery area and be able to drink or eat snacks. You’ll also be encouraged to get up and walk around, as this helps prevent blood clots from forming.

Once the medical team is sure that your condition is stable and the procedure was successful, you can go home. When you change back into your clothes, you may need to use a pad as there may be some additional bleeding. If you’ve had general anesthesia or medications to help with anxiety, make sure to have a loved one or friend drive.

Recovery

While it’s considered a more minor procedure, there’s still quite a bit that goes into recovery from D&C. All told, complete recovery takes two to four weeks, though it can take longer.

Here’s what you need to keep in mind during this time:

• Have extra help for the first 24 hours if you’ve had general anesthesia.
• There may be bleeding for the first two to three days after surgery, so be prepared to wear a pad.
• Return to work and normal, non-strenuous activity can occur after 24 hours.
• Do not use tampons for two weeks or until you’re cleared by your healthcare provider.
• Abstain from vagin*l sex for two weeks following surgery.
• Stay on birth control to prevent pregnancy until your healthcare provider says it’s OK.
• Follow-up depends on the specific case; your healthcare provider will let you know when it’s needed.

Healing

So long as you are careful about the affected area, there isn’t too much needed in terms of care for the cervix and uterus. It’s safe to shower following D&C, though make sure to get your healthcare provider’s OK before you take a bath.

What’s most important when it comes to healing is knowing when to call your healthcare provider because something is going wrong. These signs are:

• High fever of 101 F (38.3 C)
• Chills
• Heavier bleeding during menstruation
• Pain persists or worsens despite medications
• Abdominal swelling
• Foul-smelling vagin*l discharge

Coping With Recovery

There may be an emotional fallout as you recover. What this emotional recovery looks like depends on your condition. Especially since this surgery may be applied following birth, miscarriage, or abortion—or may bring on a cancer diagnosis—it’s important to attend to your mental health as you go through rehabilitation.

What can you do if you’re faced with these challenges? Here are some quick tips:

• Seek support from your family, loved ones, spouse, or friends.
• Be patient with yourself and allow yourself time to process your emotions.
• Educate yourself about your condition.
• Find online communities of others going through what you are.
• Consider seeking out counseling with a therapist or grief counselor.

Possible Future Surgeries

When D&C is used for diagnosis, additional surgeries or procedures may be needed to address any conditions that are discovered. Notably too, surgeries may be needed to treat complications. These include:

• Uterus repair: Perforation of the uterine lining, the most common complication of D&C, can lead to excessive bleeding. In some cases, rips or tears of the uterus need to be sutured together and repaired surgically.
• Hysterectomy: In very difficult cases of uterine damage, if fibroids or polyps continue to develop, or if cancer has been detected, surgery may be needed to remove the uterus. Though effective, hysterectomy leads to infertility.

A Word From Verywell

There’s no doubt that the prospect of surgery—even a relatively minor one like D&C—can be scary. Such anxiety can certainly arise when you have problems associated with pregnancy, cancer, uterine fibroids, polyps, or other reproductive system issues. In the face of these procedures, it’s not uncommon to feel stressed and out of sorts.

However, it’s important to realize that D&C has a well-established history, and it’s continuing to advance and progress. As healthcare providers learn more, as surgical techniques and tools develop, and as treatments get better, patient outcomes will only get better.

Know that you have not only dedicated experts and the latest technologies on your side, you also have your family, friends, and loved ones. Working together, you’ll be ready to face your surgery and take on any medical conditions you face. D&C may well prove to be the first step on the road to healthier, happier days.