Dilation and Curettage

Dilation and curettage has two main steps: widening of the cervix and removal of tissue from the uterus or evacuation of its contents. In some people, the procedure is performed to investigate the cause of abnormal uterine bleeding. In other cases, it is used therapeutically, such as to remove tissue remaining after a miscarriage or to help control heavy bleeding. Mayo Clinic and ACOG emphasize that the purpose of the procedure varies according to the clinical situation and that D&C should not be thought of as a single uniform intervention. ^[1][2][3]

In which situations may it be performed?

D&C is commonly considered when evaluating abnormal uterine bleeding, when an intrauterine tissue sample is needed, when tissue remains in the uterus after miscarriage, or in some pregnancy termination pathways. However, not every irregular bleeding problem requires D&C. Age, menopausal status, ultrasound findings, the possibility of office-based endometrial biopsy, and the patient’s hemodynamic condition all affect decision-making. In some cases, a more limited office procedure may be sufficient; in others, D&C may be more appropriate. The need for the procedure is therefore assessed not only from the symptom itself, but from the suspected underlying cause. ^[1][2][4]

Recommendation of D&C after miscarriage also does not mean the same thing for every patient. Some people may have the option of expectant management or medication treatment, while in others the procedure is more appropriate because of heavy bleeding, suspected infection, or retained tissue. Instead of absolute statements such as “it must always be done” or “it should never be done,” the correct approach is to make the decision according to the clinical picture. Personal history, gestational age, and ultrasound evaluation are central to that decision. ^[1][2]

How is the procedure performed?

Before D&C, clinicians assess pregnancy status, the amount of bleeding, medications being used, signs of infection, and suitability for anesthesia. During the procedure, the cervix is dilated appropriately and the uterine tissue is removed using a curette or suction method. If the purpose is diagnostic, the material may be sent for pathology examination. Technical details vary depending on why the procedure is being done and whether it is related to pregnancy. In some patients, additional evaluation such as hysteroscopy may also be planned at the same time. ^[1][2][3]

After the procedure, mild cramping, light bleeding, and discomfort lasting a few days may occur. Even so, recovery should not be assumed to be automatically uncomplicated. Patients are usually advised to monitor for signs of infection, heavier-than-expected bleeding, and increasing pain. Recommendations about tampon use, sexual activity, and strenuous exercise may also vary after the procedure. For that reason, personalized discharge instructions are more reliable than generic advice found online. ^[1][2]

What are the possible risks?

Although D&C is a common procedure, it is not risk-free. Possible complications include bleeding, infection, cervical injury, perforation of the uterine wall, and, more rarely, formation of intrauterine adhesions. The risk profile may change in pregnancy-related cases or in patients with unusual uterine anatomy. Most complications are uncommon, but it remains important to discuss them openly during informed consent. The fact that the procedure may be short does not make it automatically minor or inconsequential. ^[1][2][3]

Intrauterine adhesions are sometimes discussed in relation to Asherman syndrome and, although uncommon, can matter later in relation to menstruation or fertility. The risk is not the same in every patient, and most people do not experience this complication after D&C. Still, careful follow-up is particularly important in those with repeated intrauterine procedures, infection, or a history of technically difficult procedures. Severe pain, foul-smelling discharge, fever, or very heavy bleeding should prompt prompt medical assessment. ^[1][3]

When should a doctor be contacted?

Bleeding that soaks pads quickly over a matter of hours, severe abdominal pain, faintness, fever, foul-smelling vaginal discharge, or increasing weakness should be evaluated. If the procedure was performed after miscarriage, both physical and emotional recovery deserve attention. Some patients may need not only medical follow-up but also psychological support. Open communication with the healthcare team can make the process safer and more manageable. ^[1][2]

When used for the right indication, dilation and curettage can have both diagnostic and therapeutic value. However, the need for it, the way it is performed, and the follow-up plan all differ from one person to another. If you have abnormal bleeding, ongoing symptoms after miscarriage, or a possible need for intrauterine sampling, the safest approach is to seek personalized gynecologic assessment. ^[1][2][4]

Pre-procedure counseling is an important part of D&C. Patients should be told clearly why the procedure is being recommended, whether alternatives exist, what a pregnancy-related context means if present, and whether the tissue will be sent for pathology. Especially when D&C is performed because of abnormal bleeding, the goal may be not only to reduce bleeding but also to investigate an underlying polyp, hyperplasia, or other pathology. When the objective of the procedure is clear, informed decision-making becomes easier. ^[1][2][4]

The result of diagnostic uterine tissue sampling may shape the next stage of treatment. In that sense, D&C is sometimes not the final step, but the start of the next clinical step. Pathology may be normal, may show hormonally related changes, or may point to a condition that requires further evaluation. Patients should therefore pay attention not only to physical recovery, but also to the follow-up discussion of results, because the main clinical decision often becomes clear at that point. ^[1][2][3]

The time it takes for menstrual patterns to normalize after D&C may also vary depending on why the procedure was performed. Follow-up after a pregnancy-related D&C may not be the same as follow-up after a D&C performed for investigation of abnormal bleeding. Personalized instructions from the treating team are therefore more reliable than generic online timelines. ^[1][2][3]