What is a D&C, and how do you know whether you really need it? Is there an alternative?

-Michele

D&C stands for dilation (or "dilatation") and curettage -- that is, opening the cervix (dilation) and scraping the inside of the uterus (curettage). It can be done in a doctor's office without anesthesia or in an outpatient surgery center or hospital with epidural, spinal or general anesthesia. When it is done without anesthesia, most women report cramps as the cervix is opened.

D&C is a common gynecologic procedure that has many uses. For instance, it may be done to diagnose and treat abnormal bleeding, to remove polyps inside the uterus, to complete a miscarriage, or to perform an elective abortion. Depending on the reason it is being done, there may be alternatives. In some cases a D&C is the very best option.

In the case of abnormal bleeding or bleeding after menopause, the doctor can send a sample of the scraped-away uterine lining to the lab for evaluation; at the same time, the procedure can be very effective at stopping the bleeding. Alternative ways to evaluate the uterine lining are ultrasound (especially saline infusion sonography), endometrial biopsy (kind of like a "mini" D&C), or hysteroscopy (looking inside the uterus with a telescope-like instrument).

A hysteroscopy can also be done to remove polyps, and that alternative is often much better than a plain D&C because the doctor can look at what he or she is doing. In the case of miscarriage, sometimes a doctor will recommend watchful waiting and allowing the body to pass the tissue on its own; in the case of very heavy bleeding with a miscarriage, often a D&C is the best choice to minimize blood loss.

Like all procedures, a D&C does have some risks; these include causing bleeding, introducing an infection, and perforating (poking a hole through) the uterus. These complications are not common, but they do happen occasionally. If your doctor recommends a D&C, then you should ask your doctor why, what information it will give, what effects it will be expected to have, what complications it might cause, and what the alternatives are -- along with their good and bad points. Informed consent is required for any and all medical and surgical procedures.

D&Cs have been performed for eons, and in general they are very safe, with little risk of long-term consequences. Still, each individual and her doctor need to discuss all potential risks and benefits.