A Dilation and Curettage (D&C) is a common gynecological procedure performed to remove tissue from the uterus, often following a miscarriage, to diagnose uterine conditions, or to manage abnormal bleeding. The procedure involves dilating, or opening, the cervix and then using a surgical instrument to gently clear the uterine lining. It is normal and expected to experience some degree of bleeding and clotting during the recovery period as the body heals from this process.
Expected Bleeding and Clotting During Recovery
Following a D&C, patients should anticipate vaginal bleeding that often resembles a menstrual period, though the flow can vary significantly from person to person. Immediately after the procedure, the bleeding may be light or moderate, sometimes starting heavy and quickly tapering to spotting. This bleeding usually continues for one to two weeks, with some individuals experiencing light spotting for up to four weeks.
The color of the discharge may change over time, typically moving from bright red to brown or pink, similar to the end of a regular period. Clotting is a normal part of the process, particularly in the first few days. These clots are usually small, about the size of a dime or a quarter, and should be infrequent, not constant.
A temporary increase in bleeding or cramping may occur a few days post-procedure. It is important to use sanitary pads instead of tampons during this time. This allows monitoring of the volume of blood loss and reduces the risk of introducing bacteria into the healing uterus.
Defining Excessive Clotting
The primary concern is differentiating normal clotting from excessive blood loss that may indicate a complication, such as a uterine hemorrhage or retained tissue. The most widely accepted clinical metric for defining excessive bleeding is based on the rate of sanitary pad saturation. Soaking through two maximum absorbency sanitary pads in one hour, for two consecutive hours, is considered a medical emergency and requires immediate attention.
The size and frequency of clots act as a clear threshold for concern. Clots that are consistently larger than a plum or a golf ball are considered excessive and warrant immediate contact with a healthcare provider. This significant clotting may indicate that the uterus is not contracting effectively or that tissue remains inside the uterine cavity.
Use a common object, such as a golf ball, to standardize the frame of reference when communicating clot size to medical staff. Passing very large clots frequently or continuously is a sign of abnormal blood loss, even if the two-pad-per-hour threshold is not met. The flow should be decreasing over time, not increasing or remaining heavily saturated after the first few days.
Other Warning Signs
Other symptoms indicate a potential complication like infection or uterine injury. A fever is a significant warning sign, specifically a temperature of 100.4°F (38°C) or higher. The presence of a fever may suggest the development of a uterine infection, or endometritis.
Severe or worsening abdominal or pelvic pain that is not relieved by over-the-counter pain medication is another indicator that requires evaluation. While some cramping is expected as the uterus returns to its normal size, constant or intensifying pain can signal an issue like a uterine perforation or a severe infection. Any discharge from the vagina that develops a foul or unusual odor is also a serious sign of a potential infection.
Chills, increased pelvic tenderness, and feelings of lightheadedness or dizziness should not be ignored. Lightheadedness, in particular, can be related to significant blood loss that may not be immediately obvious or a systemic infection.
Immediate Steps and Follow Up Care
If the threshold for excessive clotting or bleeding is met (soaking through two maxi-pads per hour for two hours), seek emergency medical care immediately. For less severe but still concerning symptoms, such as consistently passing clots larger than a golf ball or a persistent fever, contact your healthcare provider’s on-call service. Track the frequency and size of clots and the temperature to provide clear information to medical personnel.
Avoid inserting anything into the vagina, including tampons, douches, or engaging in sexual intercourse, until cleared by a medical professional. This precaution prevents the introduction of bacteria into the healing uterus and reduces infection risk. Rest is important, and strenuous activity or heavy lifting should be avoided, as these can increase bleeding or cramping.
A follow-up appointment with the provider is a standard part of D&C aftercare to ensure the uterus is healing correctly and to discuss the return to normal activities. During this visit, the provider can address any lingering concerns about spotting, mild cramping, or emotional recovery. The first menstrual period typically returns four to eight weeks after the procedure, though it may be heavier or lighter than usual.