A D&C (dilation and curettage) is needed when tissue inside the uterus must be removed or sampled, either to treat a problem or diagnose one. The most common reasons are incomplete miscarriage, abnormal uterine bleeding that needs explanation, and molar pregnancy. In some cases it’s urgent; in others, it’s one option among several, and understanding when it’s truly necessary can help you make an informed choice.
After a Miscarriage
Miscarriage is the single most common reason for a D&C. When a pregnancy ends but tissue remains in the uterus, your body sometimes clears it on its own, but not always. A D&C becomes necessary when that tissue stays behind and causes heavy bleeding, signs of infection (fever, pelvic pain, foul-smelling discharge), or when ultrasound confirms the uterus hasn’t emptied after a reasonable waiting period.
Not every miscarriage requires a D&C. Expectant management, meaning waiting for the body to pass the tissue naturally, leads to complete miscarriage in about 70% of women within two weeks. The odds depend on the type of loss: incomplete miscarriages resolve on their own more often (about 84% within two weeks) than missed miscarriages, where the embryo stopped developing but hasn’t been expelled (roughly 52%). Medication to help the uterus contract succeeds in 69% to 80% of cases, though between 25% and 50% of women who start with waiting or medication still end up needing a surgical procedure.
A D&C is the right choice when you’re bleeding heavily enough to soak through a pad every hour, when you develop a fever or worsening pelvic pain suggesting infection, or when you simply prefer a faster, more definitive resolution rather than days or weeks of uncertainty. It’s also typically recommended when ultrasound shows a significant amount of retained tissue, particularly when the measurement inside the uterine cavity exceeds about 15 millimeters, which roughly doubles the likelihood of eventually needing the procedure anyway.
When Infection Makes It Urgent
A small number of situations call for an emergency D&C. The most serious is a septic abortion, where retained pregnancy tissue becomes infected. Warning signs include a combination of fever, severe pelvic or abdominal pain, uterine tenderness, and purulent or foul-smelling vaginal discharge. Left untreated, infection can progress to sepsis and a dangerous clotting disorder that causes bleeding from IV sites, gums, or other mucous membranes.
In these cases, a D&C is considered definitive treatment because it removes the source of infection. Antibiotics alone aren’t enough. If you develop these symptoms after a miscarriage, abortion, or delivery, the situation is time-sensitive and typically involves same-day surgery.
Diagnosing Abnormal Bleeding
Outside of pregnancy, the main reason for a D&C is to figure out why you’re bleeding abnormally. This is especially important for postmenopausal bleeding, which always warrants investigation because it can signal endometrial cancer. A D&C collects tissue from the uterine lining so it can be examined under a microscope, and its sensitivity for detecting endometrial cancer exceeds 90%.
Often, the first step is a simpler office-based biopsy using a thin plastic device inserted through the cervix without anesthesia. A full D&C is typically recommended when that office biopsy can’t be completed (a narrow cervix can make it difficult), when the sample is inconclusive, or when imaging suggests a specific abnormality like a polyp. When combined with hysteroscopy, a tiny camera placed inside the uterus, the D&C can both diagnose and treat in one procedure by removing polyps or other growths on the spot.
Other Conditions That Require a D&C
A molar pregnancy, where abnormal tissue grows in the uterus instead of a normal embryo, almost always requires a D&C. Waiting is not an option here because molar tissue can grow aggressively and, in rare cases, become cancerous if left in place.
Retained tissue after childbirth is another indication. If pieces of the placenta remain in the uterus after delivery and cause ongoing bleeding or infection, a D&C clears the uterus when other measures haven’t worked. Heavy, prolonged bleeding after an abortion that doesn’t respond to medication may also require a D&C to remove remaining tissue.
What the Procedure Involves
The “D” stands for dilation, opening the cervix, and the “C” stands for curettage, gently scraping or suctioning the uterine lining. When the goal is diagnosis, only a small tissue sample is taken. When the goal is treatment, the procedure removes all the tissue that needs to come out. It’s usually performed as outpatient surgery, meaning you go home the same day. Anesthesia options range from local numbing of the cervix to general anesthesia where you’re fully asleep, depending on the situation and your preference.
The procedure itself typically takes 10 to 15 minutes. Afterward, you can expect cramping similar to period pain and light bleeding that tapers off over a few days to two weeks.
Recovery Timeline
Recovery from a D&C is considerably faster than from major gynecologic surgery. Most people return to desk work and light daily activities within a day or two. Physical restrictions are minimal compared to procedures like hysterectomy, but most providers recommend avoiding sexual intercourse and not placing anything in the vagina (including tampons) for about two weeks to reduce infection risk.
Your period typically returns within four to six weeks. If you were having the procedure for a miscarriage, your provider will usually discuss how long to wait before trying to conceive again, which varies based on individual circumstances.
Risks Worth Knowing About
A D&C is generally safe, but it does carry a few risks. Uterine perforation, where an instrument passes through the uterine wall, is rare and usually heals without additional treatment. Infection is possible but uncommon. The risk that gets the most attention is Asherman’s syndrome, where scar tissue forms inside the uterus and can affect future periods and fertility. More than 90% of Asherman’s cases develop after pregnancy-related D&Cs, though the overall incidence is still low. The risk increases with repeated procedures and with D&Cs performed in the setting of infection.
This is one reason many providers now discuss medication management as a first option for uncomplicated miscarriage, reserving D&C for situations where it’s clearly needed or preferred. If you’ve had multiple D&Cs or plan future pregnancies, it’s worth asking about this risk specifically.
When You Have a Choice
For an uncomplicated first-trimester miscarriage with stable vital signs and no signs of infection, a D&C is one of three reasonable paths: waiting, medication, or surgery. The right choice depends on how far along the pregnancy was, how much tissue remains, your comfort with uncertainty, and whether you’d rather let things happen on a predictable timeline. All three options are considered safe, and choosing one over another doesn’t affect your ability to get pregnant later.
Where there’s no real choice is when bleeding is heavy and uncontrolled, when infection is present or suspected, when a molar pregnancy is diagnosed, or when waiting and medication have already failed. In those situations, a D&C isn’t just recommended, it’s the standard of care.