Hysteroscopy D&C

What is Hysteroscopy D&C?

A hysteroscopy with dilation and curettage (D&C) is a minor surgical procedure used to examine and treat conditions inside the uterus (womb).

It combines two techniques:

• Hysteroscopy: A thin, lighted telescope-like instrument (hysteroscope) is gently inserted through the vagina and cervix into the uterus. This allows the specialist to directly view the uterine cavity on a screen.
• Dilation and Curettage (D&C): The cervix is carefully dilated (opened slightly), and a small instrument or suction device is used to remove tissue from the lining of the uterus (endometrium).

The procedure may be performed for diagnostic purposes (to investigate abnormal bleeding or other symptoms) or for treatment (to remove polyps, fibroids, retained pregnancy tissue, or thickened endometrium).

Who is Suitable for Hysteroscopy D&C?

Hysteroscopy D&C may be recommended for women experiencing specific gynaecological concerns. It is not routinely required for all patients and is performed when clinical assessment suggests it is appropriate.

You may be suitable if you have:

• Abnormal uterine bleeding: Heavy periods, bleeding between periods, bleeding after menopause, or irregular cycles.
• Postmenopausal bleeding: Even light bleeding after menopause requires investigation.
• Thickened endometrium on ultrasound: Particularly in perimenopausal or postmenopausal women.
• Suspected endometrial polyps or fibroids: Especially if imaging shows growths within the uterine cavity.
• Recurrent miscarriage: To assess for structural abnormalities inside the uterus.
• Retained products of conception: After miscarriage, termination, or childbirth.
• Difficulty conceiving: In selected fertility cases where intrauterine pathology is suspected.
• Abnormal endometrial biopsy results: When further sampling or visualisation is needed.

It may not be suitable for women with active pelvic infection or certain medical conditions that increase surgical risk.

Benefits of Hysteroscopy D&C

Hysteroscopy D&C offers several important clinical advantages:

• Direct visualisation: Unlike blind D&C alone, hysteroscopy enables direct visualisation of the uterine cavity, thereby improving diagnostic accuracy.
• Accurate diagnosis: Conditions such as polyps, fibroids, adhesions, septa, and early cancer can be accurately identified.
• Targeted tissue removal: Abnormal areas can be precisely removed rather than sampling blindly.
• Improved symptom relief: Many women experience reduced bleeding and pain after the removal of polyps or thickened tissue.
• Minimal invasiveness: No abdominal incisions are required.
• Day procedure: Most patients return home the same day.
• Short recovery time: Many women resume normal activities within a few days.
• Reduced need for major surgery: In some cases, hysteroscopy can prevent the need for more invasive procedures such as hysterectomy.

When performed by an experienced gynaecologist, the procedure is generally safe and effective.

Types of Hysteroscopy D&C

Hysteroscopy procedures are broadly classified as diagnostic or operative.

Diagnostic Hysteroscopy with D&C

This is performed primarily to investigate symptoms.

It may involve:

• Inspection of the uterine cavity
• Endometrial biopsy
• Light curettage for tissue sampling

This type is commonly used in cases of abnormal bleeding or postmenopausal bleeding.

Operative Hysteroscopy with D&C

This involves treatment during the same procedure.

It may include:

• Removal of endometrial polyps
• Resection of submucosal fibroids
• Removal of retained pregnancy tissue
• Treatment of intrauterine adhesions (Asherman’s syndrome)
• Septum correction

Special instruments are passed through the hysteroscope to treat abnormalities directly.

Suction Curettage

Often used in:

• Early miscarriage management
• Termination of pregnancy
• Retained tissue after childbirth

This is typically done with gentle suction rather than sharp curettage.

What to Do Before a Hysteroscopy D&C?

Careful preparation helps ensure that a hysteroscopy with dilation and curettage (D&C) is safe and effective. Your specialist will provide personalised instructions, but general preparation usually includes the following:

• Medical assessment: Your doctor will review your symptoms, menstrual history, pregnancies, medications, allergies, and previous surgeries.
• Pelvic ultrasound: A transvaginal ultrasound is commonly performed beforehand to assess the thickness of the endometrium and identify possible polyps or fibroids.
• Pregnancy test: If you are of reproductive age, a pregnancy test is often required before the procedure.
• Blood tests: These may include a full blood count and other tests depending on your medical history.
• Medication review: You may need to stop certain medications, such as blood thinners, several days before surgery. Always follow your doctor’s advice.
• Fasting: If the procedure is performed under general anaesthesia or sedation, you will need to fast for approximately 6 hours before surgery.
• Infection check: The procedure is usually postponed if there is an active pelvic infection.
• Consent discussion: Your doctor will explain the reasons for the procedure, alternatives, risks, and expected outcomes before obtaining consent.

In some cases, a medication may be given before the procedure to gently soften the cervix, making dilation easier and reducing discomfort.

Hysteroscopy D&C Procedure

Hysteroscopy D&C is usually performed as a day procedure in a hospital or accredited surgical centre.

The steps typically include:

• Anaesthesia: Most procedures are done under light general anaesthesia or intravenous sedation. Some minor diagnostic procedures may be done under local anaesthetic.
• Positioning: You will lie on an operating table similar to a pelvic examination position.
• Cervical dilation: The cervix is gently widened using small instruments.
• Hysteroscope insertion: A thin camera (hysteroscope) is inserted through the cervix into the uterus. Sterile fluid is used to expand the cavity for clear visualisation.
• Inspection: The doctor carefully examines the uterine lining to identify abnormalities such as polyps, fibroids, adhesions, or thickened tissue.
• Curettage or removal: Abnormal tissue is removed using suction or small surgical instruments. If a polyp or fibroid is present, it may be removed at the same time.
• Tissue analysis: The removed tissue is sent to a pathology laboratory for examination.

The procedure typically takes 15-30 minutes, depending on complexity.

After completion, you are moved to recovery for monitoring until you are fully awake.

What to Expect After a Hysteroscopy D&C?

Most women experience:

• Mild cramping for 1–3 days
• Light vaginal bleeding or spotting for up to one week
• Fatigue for 24 hours

You are usually advised to:

• Avoid intercourse and tampon use for 1–2 weeks
• Avoid heavy lifting for a few days
• Monitor for fever, severe pain, or heavy bleeding

Most patients return to normal activities within a few days.

Hysteroscopy D&C Risks

While generally safe, risks can include:

• Infection
• Heavy bleeding
• Uterine perforation (rare)
• Cervical injury
• Intrauterine adhesions (rare)
• Anaesthetic risks

Serious complications are uncommon when performed by experienced specialists.

When to Seek Urgent Medical Care?

Contact your doctor immediately if you experience:

• Fever over 38°C
• Severe abdominal pain
• Heavy bleeding (soaking a pad every hour)
• Foul-smelling discharge
• Dizziness or fainting

What if Hysteroscopy D&C is Delayed?

The consequences of delaying the procedure depend on the reason it was recommended.

Possible risks of delay include:

• Persistent heavy bleeding: This may lead to anaemia and fatigue.
• Worsening symptoms: Pelvic pain or irregular bleeding may continue.
• Missed diagnosis: Delayed investigation of postmenopausal bleeding may postpone detection of endometrial hyperplasia or cancer.
• Fertility impact: If intrauterine abnormalities are affecting implantation, delay may prolong difficulty conceiving.
• Retained pregnancy tissue complications: Delays can increase the risk of infection or heavy bleeding.

However, not all cases require urgent intervention. In some situations, your doctor may recommend monitoring or medical treatment first.

The decision to proceed should always be based on:

• Severity of symptoms
• Ultrasound findings
• Age and menopausal status
• Fertility plans
• Pathology concerns

If you are uncertain about timing, discussing your specific situation with your gynaecologist will help determine whether immediate treatment is necessary or whether observation is appropriate.