Doctors scrape the uterus in a procedure called dilation and curettage (D&C) for two broad reasons: to collect tissue for diagnosis or to remove tissue that shouldn’t be there. The most common situations include clearing tissue after a miscarriage, investigating unexplained bleeding, and checking for precancerous changes or uterine cancer. It can be done whether you’re pregnant or not, and the specific reason shapes how much tissue is removed and what happens with it afterward.
After a Miscarriage or Abortion
This is one of the most frequent reasons for uterine scraping. When a pregnancy ends but tissue remains inside the uterus, it can cause heavy bleeding or infection. A D&C removes that remaining tissue to prevent both. This applies to incomplete miscarriages (where some tissue has passed but not all), missed miscarriages (where the pregnancy has stopped developing but hasn’t passed on its own), and cases where tissue is retained after an abortion.
A D&C isn’t always the first option after a miscarriage. Depending on how far along you were and your overall health, your doctor may suggest waiting for the tissue to pass naturally or using medication to help it along. But if those approaches don’t fully work, or if you’re bleeding heavily, a D&C becomes the more reliable choice. It’s also used to remove a molar pregnancy, a rare condition where abnormal tissue grows in the uterus instead of a normal pregnancy.
Investigating Abnormal Bleeding
If you’re experiencing unusually heavy periods, bleeding between periods, or any bleeding after menopause, a D&C can help find out why. The scraped tissue gets sent to a lab where pathologists examine the cells under a microscope. They’re looking for things like endometrial hyperplasia (where the uterine lining grows too thick, which can be precancerous), uterine polyps, or cancer.
A D&C usually isn’t the first diagnostic step. Doctors typically try an endometrial biopsy first, which is a simpler office procedure that takes a small tissue sample. But if that biopsy doesn’t collect enough tissue, comes back unclear, or if the cervix is too narrow to allow the biopsy instrument through, a D&C is the next step. It collects a larger, more thorough sample. In studies comparing the two methods, D&C had a lower rate of missed cancer diagnoses: about 15% of cases were upgraded to cancer after D&C, compared to 27% after a simple biopsy.
Treating Heavy Bleeding
Beyond diagnosis, scraping the uterine lining can temporarily stop severe bleeding. If you’re losing so much blood that medication isn’t controlling it, removing the thickened lining provides immediate relief. However, this effect is short-lived. The lining regrows with your next menstrual cycle, so D&C alone isn’t a long-term solution for chronic heavy periods. It’s more of an emergency measure or a bridge to other treatments.
What Actually Happens During the Procedure
The name tells you the two steps. First, dilation: the cervix (the narrow opening at the bottom of the uterus) is gently widened. Then, curettage: the inner lining of the uterus is scraped or suctioned out. In most modern D&C procedures, doctors use a small plastic suction tube rather than a sharp metal scraping instrument, though both tools exist.
The procedure typically happens in an operating room. In one study of D&C for miscarriage, about 72% of patients received general anesthesia (fully asleep) and 28% received deep sedation (heavily drowsy but not fully unconscious). The whole procedure is usually short, often under 15 to 20 minutes.
Recovery After a D&C
Most people return to normal activities within five days or fewer. Mild cramping and light spotting for a few days afterward is normal. You’ll likely be told to avoid sex for about one to two weeks, and to skip tampons, douching, and heavy lifting during that time. The spotting should taper off on its own.
Watch for signs that something isn’t right: fever, bleeding that soaks through a pad in an hour or less, worsening pain rather than improving pain, or discharge with an unusual smell. These could signal infection or other complications that need prompt attention.
Risks and Complications
D&C is considered a safe, routine procedure, but it carries a small set of risks. Uterine perforation, where the instrument pokes through the uterine wall, occurs in about 0.3% of premenopausal women and 2.6% of postmenopausal women (the uterine wall thins after menopause). For procedures related to pregnancy, the perforation rate is roughly 0.5%.
The other concern people often ask about is scarring inside the uterus, known as Asherman syndrome. Scar tissue can form where the lining was scraped, potentially affecting future periods or fertility. Research puts this risk at about 1.6% of women who have a D&C after a pregnancy. The risk is higher with repeated procedures. In mild cases, the scarring can be treated, but it’s one reason doctors don’t recommend D&C as a go-to solution for recurring heavy periods when other options exist.
Excessive bleeding and infection are possible but uncommon. The type of anesthesia also affects blood loss during the procedure itself. Studies have found that patients under deep sedation tend to lose less blood (around 40 to 88 mL) compared to those under general anesthesia with certain inhaled agents (113 to 290 mL).
Why D&C Instead of Medication
For miscarriage management, medication works well for many people, but it doesn’t always clear all the tissue. If an ultrasound shows retained tissue after medication or expectant management, a D&C finishes the job. It’s also preferred when bleeding is heavy enough to be dangerous, because it works immediately rather than over hours or days.
For diagnosis, a D&C provides a more complete tissue sample than an office biopsy. If there’s concern about cancer or precancerous changes, that completeness matters. A biopsy samples a small area and can miss abnormalities, while a D&C covers the entire uterine lining. That said, even D&C isn’t perfect. One study found that D&C results matched the final diagnosis only about 51% of the time when compared to what was found after hysterectomy, which is why it’s sometimes one step in a longer diagnostic process rather than the final word.