Hearing the words Dilation and curettage can make the heart sink—especially when it comes after a miscarriage scan, postpartum bleeding, or weeks of irregular periods. You may be thinking: Will it hurt? Will it affect future fertility? Do I really need surgery? In India, where families are often closely involved and advice can come from every direction, clarity matters.

A good care team keeps it simple: Dilation and curettage is a short procedure to open the cervix and remove tissue from the uterus, most often by suction. It can help control bleeding, lower infection risk, and sometimes provide a lab diagnosis. In most cases, recovery is steady and predictable.

Dilation and curettage: what it means, in plain language

“Dilation” and “curettage”: two steps, one purpose

Dilation: gently widening the cervix (the lower, narrow part of the uterus).
Curettage: removing tissue from inside the uterus.

Today, Dilation and curettage is usually performed with suction aspiration using a thin cannula (a soft tube). Sharp curettage with a spoon-shaped instrument is less common and generally reserved for selected situations.

What Dilation and curettage is used for

A Dilation and curettage may be offered to:

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Remove retained tissue after miscarriage, abortion, or delivery
Control heavy bleeding linked to retained tissue
Reduce infection risk when tissue remains inside the uterus
Collect an endometrial sample (uterine lining) for histopathology when doctors need more information

If tissue is sent to the lab, the pathology report can confirm what was removed (pregnancy tissue, benign endometrium, a polyp) or point to changes needing follow-up.

Different names you might hear

Depending on the hospital or doctor, Dilation and curettage may be called:

D&C
suction curettage
vacuum aspiration
uterine evacuation

When Dilation and curettage can be helpful

After miscarriage: when the uterus has not emptied fully

After a miscarriage, tissue may pass naturally within hours or days. But sometimes the uterus retains tissue, and bleeding continues or restarts, pain persists, or fever raises concern.

A Dilation and curettage is commonly considered when there is:

Incomplete miscarriage (some tissue remains on ultrasound)
Missed miscarriage (pregnancy stopped developing, but tissue has not passed)
symptoms such as:
ongoing or returning bleeding
pelvic pain or cramping that does not settle
hCG levels dropping too slowly

You may hear “retained trophoblastic tissue” (tissue linked to the early placenta). If it stays attached, it can keep bleeding going and delay the fall in hCG.

Heavy bleeding, severe pain, or fever: when waiting is not wise

A faster approach is often advised when:

bleeding is heavy (pads saturate quickly, large clots, weakness)
pain is intense or worsening
fever appears (≥ 38°C/100.4°F), chills, foul-smelling discharge, or feeling very unwell

Sometimes waiting or medicines are possible. But when infection or heavy bleeding is suspected, the focus shifts to preventing complications like anaemia or endometritis.

Retained products of conception (RPOC)

Retained tissue can happen after miscarriage, after abortion, and occasionally after childbirth. When it remains, cramps and bleeding can continue, and infection risk increases.

In such cases, Dilation and curettage with suction is commonly used, sometimes with ultrasound guidance or hysteroscopy if tissue is focal or difficult to clear.

After childbirth: postpartum bleeding or retained placenta

Postpartum uterus is larger and more vascular, so bleeding control is a priority. A Dilation and curettage may be planned in a setting where the team can act quickly if bleeding increases.

If you are breastfeeding, inform the anaesthesia team, medicines can usually be chosen to suit lactation.

Abnormal uterine bleeding (AUB) and lining assessment

When bleeding is heavy, irregular, or persistent, doctors may recommend Dilation and curettage to obtain a larger sample than an office biopsy, particularly when earlier sampling was insufficient.

Polyps, small fibroids, suspected endometrial hyperplasia

A Dilation and curettage can help diagnose endometrial hyperplasia and can sometimes remove tissue related to polyps. If the problem is focal (one specific area), hysteroscopy often improves accuracy because the doctor can see and target the lesion.

Molar pregnancy care

If a molar pregnancy is suspected, Dilation and curettage is typically used to evacuate abnormal placental tissue. Follow-up relies on serial hCG monitoring.

Alternatives to Dilation and curettage (especially after miscarriage)

Expectant management (watchful waiting)

Waiting may be considered, usually in early pregnancy, if:

you feel well overall
there is no fever
bleeding is moderate and stable

The downside is timing uncertainty, and sometimes the uterus still does not empty fully.

Medication management (misoprostol)

Misoprostol helps the uterus contract. It can work well, but parents should be prepared for:

strong cramps
heavier bleeding during expulsion
a chance of incomplete evacuation that still needs suction aspiration

Suction aspiration vs “classic” curettage

If a procedure is needed, suction aspiration is usually preferred as it is generally gentler on the uterine lining. A small additional curettage step may be used if tissue is adherent.

How decisions are usually made

Doctors weigh:

bleeding, pain, fever
prior uterine surgery (caesarean, myomectomy) or prior D&C
follow-up access
your preference: quick closure versus avoiding the operating theatre when safely possible

Types of Dilation and curettage and technique choices

Diagnostic vs therapeutic

Diagnostic Dilation and curettage: primarily for sampling the endometrium when biopsy is inadequate.
Therapeutic Dilation and curettage: for removing retained tissue or treating bleeding.

Suction methods and manual vacuum aspiration (MVA)

Most modern procedures use suction. MVA uses a hand-held suction device and may be suitable in a clinic for selected cases.

With hysteroscopy vs without direct visualisation

A “blind” D&C removes tissue without seeing inside the uterus. With hysteroscopy, a thin camera allows targeted biopsy or removal—useful for polyps, submucosal fibroids, or focal retained tissue.

Clinic procedure vs operating theatre

A clinic setting with local anaesthesia and minimal sedation may work for straightforward cases. Operating theatre is more common when:

deeper sedation or general anaesthesia is planned
hysteroscopy is needed
postpartum bleeding is significant
anatomy or risk is more complex

Who needs extra caution

When Dilation and curettage is not appropriate

A Dilation and curettage is not appropriate in a viable intrauterine pregnancy when the goal is to continue it.

When doctors may adjust the plan

Plans may be adapted if there is:

active pelvic infection (unless evacuation is part of treating a serious infection)
bleeding disorder
anticoagulants or antiplatelet medicines (needs a tailored plan)

Situations that make the procedure more challenging

congenital uterine anomalies
prior uterine surgery or multiple uterine procedures
postpartum uterus (higher bleeding and perforation risk)

Getting ready for Dilation and curettage

Ultrasound confirmation and clinical assessment

Before a Dilation and curettage, teams typically confirm the indication with:

clinical exam
pelvic ultrasound (often transvaginal)
discussion of alternatives

It helps to clearly describe:

bleeding amount (pads used, clots)
pain severity and pattern
fever/chills
prior surgeries and medications

Tests commonly discussed

Depending on the indication:

hCG (in pregnancy-related cases)
complete blood count (anaemia check)
blood group and Rh status
pre-anaesthesia review (allergies, previous reactions, current medicines)

Cervical preparation

To make dilation easier and safer, doctors may use:

misoprostol a few hours before
osmotic dilators in selected situations
gradual dilation in the procedure itself

Fasting and practical planning

If sedation or general anaesthesia is planned, fasting is required (as per hospital instructions). Arrange for someone to take you home and plan rest for the day.

Consent: what you should know

Before the procedure, you should understand why Dilation and curettage is being advised, what alternatives exist, which anaesthesia is planned, and what warning signs to watch for at home.

Anaesthesia and comfort

Local anaesthesia (paracervical block)

Local anaesthetic is injected around the cervix. It may sting briefly. After that, many people feel pressure and cramping rather than sharp pain.

Sedation vs general anaesthesia

Sedation: relaxed, drowsy, still breathing on your own.
General anaesthesia: fully asleep.

Choice depends on urgency, setting, medical history, and comfort.

Pain relief after the procedure

Cramping is common and often improves with:

ibuprofen/naproxen (if suitable)
paracetamol
a heat pad

Pain that worsens over time needs a review.

How Dilation and curettage is done

Step-by-step overview

Check-in and monitoring
Cervical dilation
Tissue removal by suction
Tissue sent for pathology when needed
Ultrasound or hysteroscopy support when helpful

The procedure often takes 15–30 minutes, but the full visit is longer due to preparation and recovery.

Recovery after Dilation and curettage

What is usually normal

cramping like period pain
light to moderate bleeding for a few days, spotting up to 1–2 weeks
fatigue, especially after anaesthesia

Symptoms should ease steadily.

Returning to routine

Many people manage normal activities within 1–2 days. If the Dilation and curettage followed a miscarriage, emotional recovery may shape your timeline more than physical healing.

“Pelvic rest”

Many doctors advise avoiding sex, tampons, menstrual cups, and swimming/baths for about 1–2 weeks or until bleeding stops.

Antibiotics and Rh immunoglobulin

antibiotics may be offered more commonly in pregnancy-related or postpartum cases
Rh immunoglobulin may be advised for Rh-negative people, depending on gestational age and local practice

Follow-up and test results

Pathology report

If tissue is analysed, reports often return within about a week.

Ultrasound or hCG monitoring

Follow-up is commonly planned within 1–2 weeks. In pregnancy-related cases, hCG may be monitored until negative. A slow fall or plateau can suggest retained tissue and needs review.

Risks and complications: what to know without panic

Common, short-lived effects

Cramping, spotting, fatigue, mild nausea.

Heavy bleeding, infection, retained tissue

heavy bleeding is uncommon but needs urgent review
endometritis may present with fever, worsening pelvic pain, foul discharge
retained tissue may cause persistent bleeding and slow hCG decline

Uterine perforation and cervical injury

Uncommon, but risk is higher postpartum or with complex anatomy. Significant pain, heavy bleeding, or fainting requires urgent assessment.

Intrauterine adhesions (Asherman syndrome)

Rare, but more likely with repeated procedures or infection. Signs include:

very light or absent periods
cyclic pain with little bleeding
difficulty conceiving or repeated losses

Diagnosis often involves saline sonography or hysteroscopy.

Anaesthesia-related side effects

Drowsiness, nausea, sore throat (after general anaesthesia), rare allergic reactions.

When to seek care after Dilation and curettage

Seek urgent help if:

you soak one large pad per hour for 2 hours in a row
you have fever ≥ 38°C/100.4°F, chills, foul discharge, or worsening pain
you feel dizzy, faint, very weak, short of breath, or have palpitations
pregnancy symptoms persist strongly or bleeding does not gradually settle

Fertility, periods, contraception, and trying again

Can you conceive again?

For most people, fertility is preserved after Dilation and curettage, especially when suction is used.

When will periods return?

After miscarriage-related D&C, periods often return within 4–8 weeks. Early cycles may be slightly different as hormones reset.

Ovulation may happen earlier

Ovulation can occur before the first period, so pregnancy is possible if sex happens without contraception.

Planning next pregnancy

Many clinicians advise trying again once bleeding has stopped and you feel ready. Some suggest waiting for one normal period for easier pregnancy dating.

Breastfeeding, pregnancy tests, and procedure terms: common worries

If you are breastfeeding, you can usually continue after Dilation and curettage. Many anaesthetic and pain medicines are compatible with breastfeeding, and only small amounts pass into milk. Mention breastfeeding in advance so the team can plan medicines accordingly.

Home pregnancy tests may remain positive for days to a few weeks after a pregnancy-related Dilation and curettage because hCG needs time to fall. If tests stay strongly positive or bleeding persists, a blood hCG or ultrasound follow-up can clarify.

You may also hear D&E (dilation and evacuation). It is typically used later in pregnancy, while Dilation and curettage is more common in early pregnancy loss or endometrial sampling.

Key takeaways

Dilation and curettage is a short procedure to dilate the cervix and remove or sample uterine tissue, most often using suction aspiration.
It may be offered after miscarriage when tissue remains, for retained tissue after abortion or delivery, for postpartum bleeding due to retained placenta, or to investigate abnormal uterine bleeding.
Alternatives after miscarriage can include watchful waiting or misoprostol when you are stable and follow-up is possible.
Recovery is usually quick: cramping and light-to-moderate bleeding that improves over days, follow-up may include pathology, ultrasound, and/or hCG monitoring.
Complications are uncommon but include heavy bleeding, infection, retained tissue, uterine injury, and rare intrauterine adhesions.
Periods commonly return within 4–8 weeks, and ovulation can happen before the first period.
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Dilation and curettage (d&c): procedure, risks, and recovery