Article, february 3rd, 2010[1]

Dear Dr. Mona, I am having troubles with my period and was told I need a D&C. One doctor said I need to have this done at the hospital and another one said it can be done in the office. Could you help with this? Angela Dear Angela, This is a great question that has several answers. But my gut response is to advise you to go with the doctor you like most, because this may have something to do with other aspects of your medical care of which I am not aware. Before I delve into the answer, let’s make sure that everyone knows what we are talking about. A D& C (dilation and curettage) is a procedure done to either explore the inside of the uterus or to remove something from the uterus using a small instrument known as curette, hence the word “curettage”. In order for the curette to get inside the uterus, the cervix (the lower segment of the uterus) has to be open. Hence the term “dilation”, because it may be necessary to dilate the cervix either mechanically with a “dilator” or chemically with some medications before performing the procedure The uterus is a pear-shaped structure present in the pelvis of women. Its cavity is lined with glandular cells that are shed every month as the menstrual flow in response to hormonal changes arising from the ovaries. A D&C is done for numerous reasons--to evaluate bleeding in women 35 years of age and older, in cases of severe menstrual cramping, in cases of premenopausal or menopausal bleeding, for women with abnormal cells on pap smears, and in women who are unable to get pregnant. Samples of the endometrial lining are collected and sent to a pathology lab to be evaluated for precancerous cells, uterine cancer, uterine lining overgrowth (hyperplasia), and uterine polyps. With the advent of the hysteroscope (a small scope used to look inside the uterus) we are able to combine the two procedures--look inside the uterus with the scope, collect biopsy samples of suspicious or representative areas, or to gain a better understanding of specific anatomy to determine possible causes of problems in the uterus. A D& C can also be a therapy or a treatment in some cases where there are some things present in the uterus of the cervix. Cervical or endometrial polyps (overgrowth of tissues) are removed during a D&C and fibroid tumors. In addition, a D&C is used to remove contents from the uterus either after a delivery where there might be retained placenta or tissues, tumors (molar pregnancy), abnormal pregnancy (blighted ovum), retained tissues after a spontaneous miscarriage. Adhesions from prior D&C’s or infections may be removed to clear and clean up the uterine cavity in hopes of increasing chances of getting pregnant. The D&C is a safe procedure but has risks like anything else we do in life. The major risks include bleeding, infection, injury to the uterus (perforation which usually heals on its own), injury to cervix, injury to adjacent organs that might require other intervention, scarring of the uterine wall. Additionally there may be need for further intervention based on what is found in the biopsy. Now, we get to your question: where to have your D&C. It is well-established by studies it is safe to do a D&C both in the office setting or the hospital, and under local, regional, or general anesthesia. If a D&C is done in the office, a local injection of anesthetic solution similar to the dental block is given to the patient; this will cause numbness in the area and facilitate the procedure without the need for major anesthesia. In some cases a physician may prefer to have the D&C done in the hospital operating room or an outpatient surgery center for medical considerations, such as stability of the patient, the patient’s ability to tolerate the procedure, cardiac status, anxiety levels, the extent of the procedure, the ability to access the cervical opening and dilate the canal to enter the cavity. But recent studies have concluded that doing a D&C in an office setting is a safe and effective method of treatment and should be considered. If cervical dilation is an issue, several therapies are available to soften the cervix. A pill known as Cytotec can be taken, or laminaria (sea weed sticks) can be placed in the cervix the night before the procedure to help soften and dilate the cervix. So, Angela, talk to the doctor with whom you feel most comfortable, and ask about your options and then decide. Good luck.



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