A D&C, short for dilation and curettage, is a procedure where a doctor opens (dilates) the cervix and then removes tissue from the lining of the uterus. It’s one of the most common invasive procedures performed in the United States, used both to diagnose uterine conditions and to treat them. If your doctor has recommended a D&C, or you’re trying to understand your options after a miscarriage, here’s what the procedure involves and what to expect.
Why a D&C Is Performed
The reasons for a D&C fall into two broad categories: pregnancy-related and non-pregnancy-related. The context changes what the procedure looks like and how it’s done.
In pregnancy, a D&C is most often performed after an early miscarriage to remove tissue that the body hasn’t passed on its own. It’s also used for elective termination, to evacuate a molar pregnancy (a rare complication where abnormal tissue grows instead of a fetus), or when a doctor suspects that tissue has been retained after a delivery. For pregnancy-related D&Cs, vacuum aspiration is typically used alongside or instead of manual scraping.
Outside of pregnancy, a D&C serves as either a diagnostic tool or a treatment. On the diagnostic side, it’s used when a simpler office biopsy of the uterine lining fails to get enough tissue or produces unclear results. This comes up frequently in cases of postmenopausal bleeding, persistent abnormal bleeding, or when precancerous changes have been found and the doctor needs a larger tissue sample to rule out endometrial cancer. As a treatment, a D&C can stop excessive uterine bleeding that hasn’t responded to medication, particularly when the bleeding is heavy enough to become dangerous.
What Happens During the Procedure
The procedure has two distinct steps, which is where the name comes from. First, the doctor gradually widens the cervix using small, tapered rods called dilators. Sometimes a medication is placed in or near the cervix beforehand to soften it, which makes dilation easier. Second, the doctor uses a spoon-shaped instrument called a curette to gently scrape tissue from the uterine lining, or uses suction to remove it. The whole procedure typically takes 15 to 30 minutes.
Anesthesia options vary. You may be fully asleep under general anesthesia, numb from the waist down with a spinal or epidural, or awake with local anesthesia injected into the cervix. The choice depends on why the D&C is being done, your medical history, and what you and your doctor prefer. For pregnancy-related D&Cs, general anesthesia or deep sedation is common. If general or regional anesthesia is used, you’ll need to fast for about eight hours beforehand, typically nothing after midnight the night before.
D&C After a Miscarriage: How It Compares to Waiting
After an early pregnancy loss, you generally have options: wait for the body to pass the tissue naturally (expectant management), take medication to help the process along, or have a D&C. Each approach has trade-offs, and understanding the numbers can help you make that decision.
A large Cochrane review comparing expectant management to surgical treatment found that about 28% of women who chose to wait ultimately needed an unplanned surgical procedure anyway, compared to just 4% of women who had a D&C needing additional surgery. The waiting group also experienced more days of bleeding and a slightly higher chance of needing a blood transfusion (1.4% vs. none in the surgical group). Infection rates, however, were similar between the two approaches, and so were psychological outcomes. Expectant management did cost less overall.
None of these options is clearly “best” for everyone. Some people prefer to avoid surgery and are comfortable with the possibility of a longer, less predictable process. Others want the certainty and speed of a D&C. Medication management is a middle path that has its own success rates and side effects, covered in separate research.
Risks and Complications
A D&C is considered a safe, routine procedure, but it does carry some risks. The most common complication is heavy bleeding. Uterine perforation, where the instrument passes through the uterine wall, is rare. In premenopausal women, it happens in about 0.3% of non-pregnancy-related D&Cs. That rate rises to about 2.6% in postmenopausal women, whose uterine walls tend to be thinner. For pregnancy-related procedures, roughly 0.5% of first- and second-trimester D&Cs result in perforation, and the rate can reach up to 5% when the procedure is used to control postpartum hemorrhage.
A longer-term concern is Asherman syndrome, a condition where scar tissue (adhesions) forms inside the uterus after the procedure. This can affect future periods and fertility. Research on women who had a D&C after a pregnancy loss found the incidence of Asherman syndrome was about 1.6%. The biggest risk factor was having three or more prior procedures, which increased the risk by 4.6 times. A single D&C carries a low risk, but repeated uterine instrumentation adds up.
The Limits of a “Blind” Procedure
One important thing to know: a standard D&C is done without the doctor being able to see inside the uterus. The curette scrapes the lining based on feel, not sight. This means it can miss small or localized abnormalities, particularly when the goal is diagnosing something like endometrial cancer. Research has shown that blind sampling has a notable rate of false negatives for cancer detection.
For this reason, many doctors now pair a D&C with a hysteroscopy, a procedure where a thin camera is inserted through the cervix first, allowing the doctor to visually examine the uterine cavity and take targeted biopsies of suspicious areas. If you’re having a D&C for diagnostic purposes, it’s worth asking whether hysteroscopy will be included.
Recovery and What to Expect After
Most people go home the same day. Cramping similar to menstrual cramps is normal for a day or two, and light bleeding or spotting can continue for up to two weeks. Over-the-counter pain relievers are usually enough to manage discomfort. If you had general anesthesia, you’ll need someone to drive you home and may feel groggy for the rest of the day.
You’ll typically be told to avoid putting anything in the vagina for a period of time afterward, usually about two weeks. That means no tampons, no intercourse, and no douching while the cervix closes and the uterine lining heals. Most people return to normal activities, including work, within a day or two, though this depends on how you feel and what type of anesthesia was used. Your next period may arrive a little earlier or later than expected as your cycle resets.
Watch for signs that something isn’t right: heavy bleeding that soaks through more than one pad per hour, fever, worsening pain rather than improving pain, or foul-smelling discharge. These can signal infection or retained tissue and need prompt medical attention.