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A common query most women ask
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D&C is a minor surgical procedure but women generally are apprehensive about undergoing it. Here is the what, why and how of it
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Preethi has just seen her gynaecologist for abnormal bleeding from the uterus. She has been advised a D&C. She has heard the term before and she knows that it is a common procedure. Her gynaecologist has told her that it is a minor surgical procedure but she is still a little apprehensive.
What is a D&C?
Dilatation and curettage (D&C) is a procedure used to diagnose or treat abnormal bleeding from the uterus. In younger women, a D&C is usually done to detect hormone imbalances by examining the lining of the uterus. In older women, it can be used to help detect cancer of the uterus.
Dilating the mouth of the uterus makes it easier to access the cavity of the uterus. Curettage involves removing a sample of the lining of the uterus to be examined.
Why is a D&C done?
Diagnostic D&C
A D&C may be done to diagnose conditions that could cause abnormal bleeding. It provides a sample of the tissue in the uterus. This sample can be viewed under a microscope to tell whether the cells are normal or abnormal. This kind of D&C is called a diagnostic D&C. It is usually done for menstrual abnormalities.
Menstrual problems
Menstrual periods can be irregular at certain times of life. From the age of 35 to 45, most women will have an occasional irregular period. Some women may have heavy periods. As women approach the age of 50, their periods may become irregular as they near menopause. There may also be bleeding between periods. A hormone imbalance can cause the lining of the uterus (endometrium) to thicken more than usual. This could explain heavier or longer bleeding.
If your gynaecologist has given you medications and still there is no change in the periods, then a D&C may be recommended. Usually an ultrasound will be done before a D&C to rule out an abnormality in the uterus like a polyp or a fibroid, which may be causing the bleeding.
To rule out cancer
In older women, especially the ones who are post-menopausal, cancer has
to be ruled out when there is abnormal bleeding. Again, an ultrasound may be done before performing the D&C. The thickness of the lining of the uterus is measured on the ultrasound and may help decide whether a D&C is required or not.
Therapeutic D&C
Sometimes a D&C is done to stop profuse bleeding when medication has not worked. A therapeutic D&C is also done when there has been a miscarriage. If a woman has a miscarriage, tissue from the pregnancy may remain in her uterus. Often a D&C is done to remove this tissue. This is important because the tissue may cause heavy bleeding or occasionally, an infection.
How is a D&C done?
A D&C usually requires admission to a hospital. A few simple blood tests will be done before it. The D&C is usually done under general or spinal anaesthesia. With general anaesthesia, the medication is given either through an intravenous (IV) line or a mask. There is no awareness of the procedure with general anaesthesia. With spinal or epidural anaesthesia, medication is given into the spinal column and though you are awake, the procedure cannot be felt.
The mouth of the uterus is first gently dilated using special instruments. Then using an instrument called a curette, the lining of the uterus is sampled. Usually during a D&C, the sampling is done from three areas. The first sample is from the lining of the inside of the cervix (endocervix). The second sample is from the lining of the uterus (endometrium). The third sample is from the outside of the cervix (ectocervix). These samples are done to pinpoint exactly where the problem lies.
All tissue obtained during a D&C must be sent for a pathological exam. This will identify the changes in the tissue and will help in deciding the treatment.
Hysteroscopy
In certain situations, the gynaecologist may want to have a look inside the uterus before performing a sampling of the lining of the uterus. Hysteroscopy is a procedure in which a small, lighted telescope is used to view the inside of the uterus. This procedure is done when a growth is suspected inside the uterus. The growth could be a polyp, a fibroid or a malignant change.
(The author is a Chennai based obstetrician and gynaecologist with a special interest in women's health issues)
GITA ARJUN
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Metro Plus
Bangalore
Chennai
Coimbatore
Delhi
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Kochi
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