A D&C, short for dilation and curettage, is a minor surgical procedure that opens the cervix and removes tissue from the lining of the uterus. It’s one of the most common gynecological procedures, used both to diagnose conditions like abnormal bleeding and to treat problems like miscarriage. The procedure typically takes under 15 minutes and is usually done on an outpatient basis.
Why a D&C Is Performed
D&C serves two broad purposes: gathering tissue for diagnosis or removing tissue as treatment. On the diagnostic side, a doctor may recommend a D&C when abnormal uterine bleeding needs investigation, particularly if a simpler office biopsy wasn’t possible, didn’t collect enough tissue, or came back with inconclusive results. The tissue collected can be checked for uterine polyps, a precancerous thickening of the uterine lining, or uterine cancer.
Persistent bleeding after menopause is one of the more common triggers. If an initial biopsy comes back benign but bleeding continues, a D&C provides a more thorough tissue sample. It’s also used when the cervix is too narrow for a standard office biopsy or when a patient can’t tolerate one.
On the treatment side, D&C is frequently used to manage early pregnancy loss. After a miscarriage, tissue sometimes remains in the uterus, and a D&C removes it to prevent infection and heavy bleeding. It can also be used to treat a molar pregnancy, a rare condition where abnormal tissue grows in the uterus instead of a normal pregnancy.
What Happens During the Procedure
The procedure has two steps, which its name describes. First comes dilation: a series of thin rods, each slightly wider than the last, are inserted into the cervix to gradually widen the opening. In some cases, a medication called misoprostol is given a few hours beforehand to soften the cervix and make dilation easier. This cervical preparation is more common for patients later in the first trimester, adolescents, or anyone whose cervix is expected to be difficult to dilate.
Once the cervix is open, the second step begins. A curette, a thin instrument with a spoon-shaped edge, is passed through the cervix and into the uterus. The doctor uses it to gently scrape the uterine lining and collect or remove tissue. In many modern settings, suction (vacuum aspiration) is used instead of or alongside the curette, which can be faster and gentler on the tissue.
D&C is performed under general anesthesia, sedation, or a local nerve block depending on the setting and the reason for the procedure. Most people are asleep or deeply sedated and feel nothing during it. The actual procedure typically takes 10 to 15 minutes, though you’ll spend additional time in pre-op and recovery.
Sharp Curettage vs. Vacuum Aspiration
Traditional D&C uses a sharp metal curette to scrape the uterine lining. A newer alternative, manual vacuum aspiration (MVA), uses gentle suction through a flexible plastic tube instead. Both approaches are effective, but they aren’t identical in terms of safety.
In a randomized controlled trial comparing the two methods for miscarriage treatment, MVA had a lower rate of incomplete tissue removal (0.6% vs. 2.4% for sharp curettage) and less bleeding, though neither difference reached statistical significance. More notably, a study of over 1,500 patients found that 1.2% of those treated with sharp curettage developed scar tissue in the uterus (called Asherman’s syndrome), while zero cases occurred in patients treated with vacuum aspiration or medication. The flexible plastic cannula used in MVA is less likely to damage the deeper layers of the uterine lining compared to a sharp metal instrument.
Both the World Health Organization and the International Federation of Gynecology and Obstetrics now recommend vacuum aspiration or medication over sharp curettage for pregnancy-related procedures. If you’re having a D&C for miscarriage management, it’s worth asking your doctor which technique they plan to use.
Risks and Complications
D&C is considered safe, and serious complications are uncommon. The most common immediate risk is uterine perforation, where the instrument passes through the uterine wall. This sounds alarming but typically heals on its own without further treatment. Infection occurs in about 1% to 2% of cases.
The longer-term concern is Asherman’s syndrome, where scar tissue forms inside the uterus after the procedure. This is rare but can affect future fertility and menstrual cycles. The risk is higher with sharp curettage than with suction methods, and it’s more likely when D&C is performed for pregnancy-related reasons (when the uterine lining is thicker and more vulnerable to damage) than for diagnostic purposes.
Alternatives to D&C
D&C isn’t always the only option. For early pregnancy loss, medication management with misoprostol can help the body pass remaining tissue without surgery. A 2021 analysis found that vacuum aspiration, D&C, and medication were similarly effective for managing early pregnancy loss. Some people prefer medication because it avoids surgery entirely, while others prefer a procedure for the certainty of a defined timeline.
For diagnostic purposes, an office-based endometrial biopsy can often collect enough tissue to check for cancer or precancerous changes, with similar detection rates to D&C. A D&C becomes necessary when the biopsy doesn’t yield enough tissue, the cervix is too narrow, or results are inconclusive.
Recovery After a D&C
Most people go home the same day. Mild cramping, similar to period cramps, is common for a day or two afterward. Light spotting or bleeding can last for several days to two weeks. You’ll typically be advised to avoid putting anything in the vagina, including tampons, for a period of time afterward, and to hold off on sexual intercourse until your doctor clears you. Most people return to normal activities within a day or two, though strenuous exercise is usually postponed for about a week.
Your next period may come earlier or later than expected. The uterine lining needs time to rebuild after being removed, so some irregularity is normal for the first cycle or two.
What Happens With the Tissue
When D&C is done for diagnostic reasons, the collected tissue goes to a pathology lab for examination under a microscope. Pathology results typically take up to 10 days. The pathologist’s report will indicate whether the tissue is normal, shows precancerous changes, contains polyps, or reveals signs of cancer. Your doctor will review the findings with you and discuss any next steps based on what the lab finds.