What is Dilation and Curettage (D&C)?
Dilation and curettage (D&C) is a common, safe procedure used to remove tissue from the lining of the uterus gently. The name describes the two main steps: dilation, which means opening the cervix, and curettage, which means gently scraping or suctioning tissue from the uterine cavity.
This procedure is often recommended after a miscarriage (also called a D and C procedure for miscarriage), to treat heavy or irregular bleeding, or to diagnose conditions like endometrial cancer.
It may also be used to remove retained placenta after childbirth or to follow up on abnormal test results, such as a thickened endometrium seen on an ultrasound.
Other names for this procedure include dilatation and curettage, uterine curettage, suction curettage, sharp curettage, or evacuation of retained products of conception (ERPC), especially in the UK.
While sometimes confused with abortion care, a D&C is a medical procedure that can be used for many reasons not just pregnancy-related ones.
How Does the Dilation and Curettage Procedure Work?
The D&C procedure involves two key steps: dilation of the cervix and removal of uterine contents.
First, your cervix is gradually opened (dilated). This may be done on the day of the procedure using medication like misoprostol or small rods called laminaria, or during surgery using specialized dilatation instruments.
Next, the uterine tissue is removed. This can be done in two ways:
- Suction curettage: A thin tube is inserted into the uterus and uses gentle suction to remove tissue.
- Sharp curettage: A small, spoon-shaped instrument called a curette is used to lightly scrape the uterine lining.
In some cases, your provider may use ultrasound guidance or perform a hysteroscopy (inserting a tiny camera into the uterus) to make sure the procedure is complete and precise.
Therapeutic D&C Use Cases
- Miscarriage management
- First-trimester abortion
- Treatment of molar pregnancy
- Retained pregnancy tissue
- Excessive or irregular vaginal bleeding
15-30 minutes
Surgery Duration
General, local, or Sedation
Anesthesia Used
Outpatient (same-day)
Hospital Stay
1-2 weeks
Full Recovery Timeline
What Are the Indications of the Dilation and Curettage Procedure?
Dilation and Curettage (D&C) is performed for both diagnostic and therapeutic purposes in gynecology. Common indications include:
Diagnostic Indications
- Abnormal Uterine Bleeding: Helps determine the cause of heavy, prolonged, or irregular menstrual bleeding.
- Postmenopausal Bleeding: Assists in investigating unexplained bleeding after menopause.
- Endometrial Polyps: Diagnose abnormal tissue growths in the uterine lining.
- Endometrial Hyperplasia: Evaluates a thickened uterine lining that may lead to cancer.
- Infertility Investigations: Examines the uterine cavity for abnormalities that may cause infertility.
Therapeutic Indications
- Post-Miscarriage Tissue Removal: Clears retained tissue to prevent infection.
- Excessive Menstrual Bleeding: Treats unmanageable heavy bleeding.
- Polyp Removal: Removes uterine polyps causing symptoms or fertility issues.
- Endometrial Hyperplasia Treatment: Manages non-cancerous uterine lining overgrowth.
- Incomplete Abortion: Removes remaining pregnancy tissue after an incomplete abortion.
- Unexplained Pelvic Pain: Part of broader diagnostic procedures.
Why Is a D&C Done?
A D&C is performed for two main reasons: to diagnose a condition or to treat one.
- Diagnostic purpose: To collect a sample of the endometrium (uterine lining) for testing. This helps identify issues such as hormone imbalances, polyps, endometrial hyperplasia, or cancer.
- Therapeutic purpose: To remove unwanted or abnormal tissue, such as after a miscarriage, abortion, or childbirth, or to control heavy bleeding.
The decision to perform a D&C is based on your symptoms, medical history, and diagnostic test results.
Who Needs a D&C Procedure?
You may need a dilation and curettage procedure if you have any of the following:
- A miscarriage with incomplete passage of tissue
- Persistent vaginal bleeding after pregnancy
- Abnormal uterine bleeding that doesn't respond to medication
- Postmenopausal bleeding
- A thickened endometrium seen on ultrasound
- Suspected endometrial polyps or hyperplasia
- An incomplete abortion (after using the abortion pill)
Your provider will evaluate your condition and determine if a D&C is the most appropriate option for your care.
When Would a Doctor Recommend a D&C?
Your provider may recommend a dilation and curettage procedure if:
- Imaging shows retained tissue after pregnancy loss
- You have unexplained or persistent uterine bleeding
- There is concern about precancerous or cancerous changes in the endometrium
- Conservative treatments (like watchful waiting or medication) haven't worked
- You have symptoms of infection or hemorrhage from retained tissue
The procedure may be combined with hysteroscopy with D&C or performed under ultrasound-guided D&C for added precision.
Signs You Need a D&C
Common signs that may indicate the need for a D&C include:
- Heavy vaginal bleeding (soaking through a pad in less than an hour)
- Bleeding that lasts longer than two weeks
- Bleeding after menopause
- Passing tissue or clots after a pregnancy
- Continued positive pregnancy test after miscarriage
- Severe pelvic pain with minimal bleeding
- Fever, chills, or foul-smelling discharge (possible signs of infection)
If your experience any of these symptoms, contact your provider. They may recommend a D&C or an alternative approach based on your condition.
How to Prepare for a Dilation and Curettage (D&C)?
Preparation depends on your health, the reason for the procedure, and the type of anesthesia. Most people are asked to:
- Share their complete medical history, including past surgeries, bleeding problems, or uterine conditions
- Review all medications, supplements, and herbal products with their provider
- Bring a list of medications and allergies to the appointment
- Ask questions about the procedure, what to expect, and recovery time
- Arrange a ride home if receiving sedation or general anesthesia (you should not drive for at least 24 hours)
- Wear comfortable, loose-fitting clothing on the day of the procedure
- Plan for rest afterward. Many people take one to two days off work and avoid strenuous activity
If the D&C is related to miscarriage or pregnancy loss, your doctor may also recommend counseling or support groups.
Do I Need Tests Before a D&C?
Not everyone needs testing, but your provider may order:
- Pelvic ultrasound to check the uterine lining or confirm retained tissue
- Blood tests to look for anemia, blood type, or Rh factor (you may need a RhoGAM injection if Rh-negative)
- Pregnancy test if the D&C is being done for abnormal bleeding
- Infection screening if there's a concern about pelvic infection
- Pap smear or endometrial biopsy if abnormal cells are suspected
These tests help your provider plan the safest procedure and reduce risks.
Can I Eat or Drink Before a D&C?
Fasting guidelines
- If you will have sedation or general anesthesia, stop eating solid foods about 8 hours before the procedure
- Stop drinking clear liquids 2 to 4 hours before
- If you will have local anesthesia only, fasting may not be required follow your provider's exact instructions
Medications
- Continue most regular medicines, especially for blood pressure, heart conditions, or seizures, unless told otherwise
- Stop aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), or blood thinners a few days before, unless approved by your provider, since they may increase bleeding risk
- Ask your doctor about adjusting diabetes medicines such as insulin or oral drugs
- Birth control pills are usually continued
- Never stop a medication without your provider's guidance
What Else Should I Do to Get Ready?
On the day of your procedure:
- Use the bathroom before the D&C, since your bladder will be emptied
- Avoid tampons, douches, or vaginal creams the day before and the day of
- Shower the night before or the morning of, but avoid lotions, perfumes, or deodorants near the pelvic area
- Leave jewelry and valuables at home
- Bring sanitary pads, as light bleeding afterward is common
- If your D&C is for miscarriage or abortion, your doctor may prescribe misoprostol to soften the cervix take it exactly as directed
How Is the Dilation and Curettage (D&C) Procedure Performed?
A D&C can be done in a hospital, surgery center, or sometimes in a clinic. The procedure usually follows these steps:
- Pre-procedure checks: You'll have a physical exam, review your medical history, and sign a consent form. Your anesthesia plan will be confirmed.
- Anesthesia: Depending on your situation, you may receive local, general, or spinal anesthesia.
- Cervical dilation: Your cervix is gradually widened using small dilators or medication.
- Curettage:
- Sharp curettage uses a surgical instrument called a curette to gently scrape the uterine lining.
- Suction curettage (vacuum aspiration) uses suction to remove tissue.
- Hemostasis: Your doctor ensures bleeding is controlled.
- Recovery: You'll be monitored until the anesthesia wears off, then discharged with instructions for care at home.
What Type of Anesthesia Is Used?
The type of anesthesia depends on your health and the reason for the procedure. Options include:
- Local anesthesia to numb the cervix while you remain awake
- Conscious sedation (IV sedation) to help you relax and feel drowsy
- General anesthesia so you are completely asleep during the procedure
- Regional anesthesia (spinal or epidural) in some cases, though this is less common
How Long Does a D&C Take?
The procedure itself usually takes 10 to 20 minutes. However, you should plan to spend several hours at the hospital or clinic to allow time for preparation, anesthesia, and recovery.
Who Performs the Procedure?
A D&C is performed by:
- Obstetrician-gynecologists (OB-GYNs)
- Gynecologic surgeons trained in uterine procedures
What should I expect immediately after the Dilation and Curetture (D&C)?
Right after the D&C, you'll be moved to a recovery area.
- You may feel groggy, nauseous, or lightheaded if you had sedation or general anesthesia.
- Cramping is common, it feels similar to menstrual cramps and usually improves within a few hours.
- Light bleeding or spotting is normal and may last for a few days to a week.
- You'll be monitored until you're stable and able to drink fluids and use the bathroom.
- Most people go home the same day, once the effects of anesthesia wear off.
You'll receive written discharge instructions before leaving.
When can I return to normal activities?
You can gradually resume daily tasks as you feel ready.
- Rest for 24 to 48 hours, avoid work, exercise, or heavy lifting during this time.
- Return to work when you feel well, usually in 1-2 days for desk jobs.
- Driving is safe once you're off pain medication and no longer sedated, typically after 24 hours.
- Sexual intercourse should be avoided for at least 1-2 weeks, or until your provider says it's safe.
- Tampons and douching should be avoided for at least 1-2 weeks to reduce infection risk.
- Bathing and swimming, you can shower right away, but wait 1-2 weeks before using hot tubs, pools, or baths.
Always follow your provider's specific guidance.
Are Lifestyle Changes Required After Dilation and Curetture (D&C)?
Most people can return to their usual lifestyle quickly, but a few temporary adjustments can support healing:
- Physical recovery: Stay hydrated, eat balanced meals, and incorporate gentle movement once cleared
- Pain management: Use pain relievers only as directed by your provider
- Infection prevention: Avoid swimming, hot tubs, or intercourse until advised
- Emotional support: If the D&C followed miscarriage or pregnancy loss, consider counseling or support groups
- Future planning: Talk to your doctor about family planning, birth control, or timing for future pregnancies
- Stress care: Practice relaxation, journaling, or other activities that support emotional wellbeing
When Should I Call My Doctor?
Seek medical help right away if you experience:
- Heavy bleeding (soaking more than one pad per hour)
- Severe abdominal pain not relieved by medicine
- Fever or chills
- Foul-smelling vaginal discharge
What Are the Benefits of Dilation and Curettage (D&C)Procedure?
A D&C can help your provider diagnose or treat conditions safely and effectively. Benefits include:
- Removal of retained tissue after miscarriage, abortion, or childbirth
- Control of heavy or irregular bleeding
- Diagnosis of abnormal uterine bleeding through tissue sampling (biopsy)
- Treatment of conditions like molar pregnancy or uterine polyps
- Relief of symptoms such as prolonged bleeding or cramping
What Are the Risks and Complications of Dilation and Curettage (D&C)?
D&C is generally considered safe, but complications can occur. Possible risks include:
- Infection
- Heavy or prolonged bleeding
- Uterine perforation (rare)
- Uterine scarring (Asherman's syndrome)
- Adverse reaction to anesthesia
- Incomplete removal of tissue, which may require repeat treatment
Risk minimization strategies:
- Procedures are performed by trained specialists
- Sterile surgical technique is always used
- Careful monitoring during and after surgery
- Pain management and, if needed, antibiotics are provided
- Follow-up appointments ensure proper healing
Seek immediate medical care if you develop:
- Severe abdominal pain
- Heavy bleeding (soaking more than one pad per hour)
- Fever, chills, or foul-smelling vaginal discharge
What Are the Side Effects of Dilation and Curettage (D&C)?
Mild, short-term side effects are common and usually improve within a few days. These may include:
- Light vaginal bleeding or spotting
- Mild cramping, similar to menstrual cramps
- Temporary fatigue or grogginess from anesthesia
How much does D&C cost?
In India, the cost of a Dilation and Curettage (D&C) procedure typically falls between Rs. 20,000 and Rs. 55,000. The exact amount can vary based on factors such as the hospital chosen, the doctor's expertise, the underlying reason for the procedure (whether it's for miscarriage management, abortion, or diagnostic purposes), and the type of anesthesia administered.
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