Therapeutic Dilation & Curettage

Introduction

If your doctor has advised a therapeutic dilation and curettage — usually shortened to therapeutic D&C — you probably have a lot of questions. You may be dealing with heavy bleeding that has not settled with medication, an incomplete miscarriage, retained tissue after delivery, or an abnormality found on a recent ultrasound. Alongside the medical concern, there are often emotional and personal questions: Will this affect my periods? Could it change my chances of getting pregnant later? How long until I feel like myself again?

This guide explains what therapeutic D&C is, why it is performed, what the day of the procedure looks like, what recovery usually involves, and what is known about its effect on future fertility. The aim is to help you walk into your next conversation with your gynaecologist already understanding the landscape, so the discussion can focus on the choices that matter for you.

What Is Therapeutic Dilation & Curettage?

Dilation and curettage is a short gynaecological procedure with two parts. Dilation refers to gently widening the cervix — the narrow opening at the lower end of the uterus. Curettage refers to removing tissue from the lining of the uterus, called the endometrium. The instruments used can be a curette (a thin, spoon-shaped tool) or a suction device, depending on the situation.

D&C is divided into two broad purposes:

• Diagnostic D&C — performed to obtain a tissue sample for examination under a microscope, usually to investigate the cause of abnormal bleeding.
• Therapeutic D&C — performed to treat a condition by removing tissue, such as retained pregnancy tissue, an overgrown uterine lining, or persistently bleeding endometrium.

In practice, the two purposes often overlap. A therapeutic D&C done for heavy bleeding will usually also send the removed tissue to the laboratory for examination, so the procedure both treats the bleeding and helps confirm its cause.

The procedure is usually carried out in an operating theatre or a day-surgery unit. It typically takes 15 to 30 minutes, is done under some form of anaesthesia, and most people go home the same day.

Why Is Therapeutic D&C Performed?

Therapeutic D&C is recommended in a range of situations. The most common reasons fall into three groups: bleeding problems, pregnancy-related conditions, and abnormalities of the uterine lining.

Heavy or Abnormal Uterine Bleeding

When bleeding from the uterus is heavy, prolonged, or occurs at unexpected times, doctors usually try medical treatment first — hormonal therapy, anti-bleeding medication, or a hormonal intrauterine device. If these treatments do not control the bleeding, or if they cannot be used, therapeutic D&C may be considered to remove the overgrown endometrium and stop the bleeding.

D&C is also sometimes used as a short-term measure when bleeding is severe and needs to be controlled quickly while the underlying cause is being investigated.

Miscarriage and Retained Tissue

When a pregnancy ends before viability, the body does not always pass all of the pregnancy tissue on its own. This is called an incomplete miscarriage. Sometimes, the pregnancy has stopped developing but no bleeding has begun — called a missed miscarriage.

In both situations, current professional guidelines (including those from the Royal College of Obstetricians and Gynaecologists and the American College of Obstetricians and Gynaecologists) describe three reasonable options: expectant management (waiting for the body to complete the process naturally), medical management with tablets, and surgical management with a D&C — usually performed by suction curettage. The choice depends on how far along the pregnancy was, how much bleeding has already happened, how the person feels emotionally, and what is medically safest.

D&C may also be advised if tissue remains in the uterus after a vaginal delivery or caesarean — sometimes called retained products of conception — which can cause prolonged bleeding or infection.

Abnormalities of the Uterine Lining

D&C may be performed when imaging suggests an unusually thickened endometrium, particularly after menopause, or when there is concern about endometrial hyperplasia (overgrowth of the lining). Removing and analysing the tissue helps confirm or rule out pre-cancerous or cancerous changes and, in some cases, treats the bleeding at the same time.

Other Indications

• Persistent bleeding after a previous procedure on the uterus
• Removal of small polyps or fragments of tissue, often combined with hysteroscopy
• Evaluation of postmenopausal bleeding when an endometrial biopsy in the clinic is not possible or has not given a clear answer

Who Is a Candidate for Therapeutic D&C?

Whether therapeutic D&C is right for a particular person depends on the underlying problem, general health, and personal preferences. Your gynaecologist will usually consider it when:

• Medical treatment has not worked or is not suitable
• Tissue is retained in the uterus after pregnancy loss or delivery
• A tissue sample of the endometrium is needed and an office biopsy is not enough
• Heavy bleeding is causing anaemia or interfering significantly with daily life

D&C is generally avoided or delayed if there is an active pelvic infection that has not been treated, or if there is a known viable intrauterine pregnancy that the person wishes to continue. Bleeding disorders and certain medications that thin the blood need to be reviewed and adjusted beforehand. People with significant other health conditions — severe heart or lung disease, for example — will need an anaesthetic assessment to choose the safest form of anaesthesia.

Alternatives to Therapeutic D&C

Therapeutic D&C is not always the only option. Depending on the reason it is being considered, your doctor may discuss alternatives.

For Heavy or Abnormal Bleeding

• Hormonal medication — including combined hormonal pills, progesterone-only tablets, or a levonorgestrel-releasing intrauterine device (hormonal IUD). For many people, the hormonal IUD reduces menstrual blood loss substantially and is described in NICE and other guidelines as a first-line option for heavy menstrual bleeding without structural cause.
• Tranexamic acid and other anti-fibrinolytic medications — reduce bleeding during periods.
• Endometrial ablation — a procedure that destroys the lining of the uterus rather than removing it. It is generally considered for people who have completed their family.
• Hysteroscopic procedures — using a thin camera passed through the cervix to remove polyps or small fibroids precisely.
• Hysterectomy — removal of the uterus, considered when other treatments have not worked and pregnancy is no longer desired.

For Miscarriage

• Expectant management — waiting for the body to pass the pregnancy tissue naturally, with close follow-up.
• Medical management — using medication (such as misoprostol, sometimes preceded by mifepristone where available and appropriate) to help the uterus empty without surgery.

The right choice depends on clinical findings, personal preference, and the experience of the team. Major societies stress that, where the situation is not urgent, all three options should be discussed and the decision shared between the patient and the clinician.

Approaches to Therapeutic D&C

The way a therapeutic D&C is carried out can vary depending on the reason for the procedure.

Suction Curettage (Vacuum Aspiration)

Suction curettage uses a thin tube connected to gentle suction to remove tissue from the uterus. It is commonly used for retained pregnancy tissue and incomplete miscarriage and is described in current guidelines as the preferred surgical method in these situations because it is associated with less blood loss and a lower risk of injury to the uterus than older sharp-curettage techniques.

Sharp Curettage

Sharp curettage uses a metal curette to scrape tissue from the uterine lining. It is still used in selected situations, such as obtaining tissue from specific areas of the endometrium or when suction equipment is not appropriate for the case.

D&C with Hysteroscopy

Hysteroscopy involves passing a thin telescope-like camera through the cervix to see inside the uterus directly. Combining hysteroscopy with D&C allows the surgeon to look at the lining, target specific areas (such as a polyp), and confirm that tissue has been removed. This approach is often used when there is a structural concern, such as a polyp, retained tissue suspected on ultrasound, or unexplained bleeding.

Preparing for the Procedure

Preparation for therapeutic D&C is usually straightforward but depends on the reason for the procedure and the anaesthetic plan.

Tests and Assessment

Before the procedure, you will typically have:

• A detailed medical and menstrual history
• A pelvic examination
• An ultrasound scan, often transvaginal, to look at the uterus and its lining
• Blood tests — usually including haemoglobin to check for anaemia, blood group, and basic clotting tests
• A pregnancy test where relevant
• Pre-anaesthetic assessment if general or regional anaesthesia is planned

Medications

Tell your team about all the medications you take, including over-the-counter drugs, supplements, and herbal preparations. Blood-thinning medications such as aspirin, warfarin, and direct oral anticoagulants may need to be paused or adjusted in advance, under your doctor’s guidance. Do not stop prescribed medication on your own.

In some cases, a tablet may be given to soften and gently open the cervix a few hours before the procedure. This makes dilation easier and more comfortable.

Before the Day of the Procedure

• You will be asked not to eat or drink for a set number of hours before the procedure, especially if you will have general anaesthesia.
• Arrange for someone to take you home and stay with you for the first night, as you will not be safe to drive after anaesthesia.
• Wear comfortable clothes and bring sanitary pads — tampons are not recommended after the procedure.
• Tell the team if you have any allergies, especially to medications, latex, or iodine-based skin preparations.

What Happens During the Procedure

Knowing what to expect on the day can reduce anxiety.

Anaesthesia

Therapeutic D&C can be performed under:

• General anaesthesia — you are fully asleep. This is common and allows the surgeon to work without discomfort to the patient.
• Regional anaesthesia — such as a spinal injection, which numbs the lower body.
• Sedation with a paracervical block — the cervix is numbed with local anaesthetic injections and medication is given through a vein to keep you relaxed. This is often used for shorter procedures, particularly suction curettage for early pregnancy loss.

Your anaesthetist will discuss the options with you and choose the safest one for your situation.

Step by Step

1. You lie on a table with your legs supported, similar to a routine pelvic examination.
2. Anaesthesia is given.
3. The vagina and cervix are cleaned with an antiseptic solution.
4. A speculum is placed to allow the surgeon to see the cervix.
5. The cervix is gently widened using thin rods of gradually increasing size.
6. Tissue is removed from the lining of the uterus using suction, a curette, or both.
7. If hysteroscopy is being used, the inside of the uterus is inspected before and/or after curettage.
8. Any bleeding is checked and controlled.
9. The instruments are removed and you are taken to the recovery area.

The First Hours

You will be observed in a recovery area until the anaesthesia wears off. Mild cramping — similar to period pain — and some vaginal spotting or light bleeding are common. Pain is usually controlled well with simple painkillers such as paracetamol or ibuprofen. The team will check that you are stable, able to drink, and able to pass urine before you go home.

The First Week

• Bleeding: Light bleeding or spotting can last from a few days up to about two weeks. It often becomes brown or pink before stopping.
• Cramping: Mild to moderate cramps may continue for a day or two.
• Rest: Most people feel ready for light activities within a day or two and return to normal routine within a few days.
• Hygiene: Use sanitary pads rather than tampons. Shower as normal.
• Sex and tampons: Doctors generally advise avoiding sexual intercourse, tampons, and douching for at least one to two weeks, or until bleeding has fully settled, to reduce the risk of infection.
• Swimming and baths: Avoid swimming pools and soaking in baths until bleeding has stopped.

Your Next Period

Periods usually return within four to six weeks after a D&C. The first period may be lighter or heavier than usual and the timing may be slightly different. If the procedure was performed for a miscarriage, ovulation can return within a few weeks, even before your first period.

Follow-Up

A follow-up visit is usually arranged two to six weeks after the procedure to:

• Check that you are healing well
• Review the pathology report on the tissue that was removed
• Discuss next steps — including contraception, plans for future pregnancy, or further treatment if needed

When to Seek Urgent Care

Contact your doctor or go to the nearest emergency department if you have:

• Heavy bleeding — soaking through a pad every hour for more than two hours
• Passing large clots
• Severe abdominal pain not relieved by usual painkillers
• Fever above 38°C (100.4°F)
• Foul-smelling vaginal discharge
• Fainting, severe dizziness, or rapid heartbeat

Risks and Complications

Therapeutic D&C is generally considered safe when performed by experienced gynaecologists, but, like any procedure, it carries some risks.

Common, Usually Minor

• Cramping and light to moderate bleeding for a few days
• Temporary nausea from anaesthesia
• Sore throat (if a general anaesthetic involved a breathing tube)

Less Common

• Infection — of the uterus or pelvis, usually treatable with antibiotics if detected early.
• Heavy bleeding — sometimes needing medication or, rarely, a repeat procedure.
• Incomplete removal of tissue — particularly after miscarriage; a small number of people need a repeat procedure.

Rare

• Uterine perforation — a small hole made in the wall of the uterus by an instrument. Most heal without further treatment, but in rare cases additional surgery is needed.
• Cervical injury — small tears that usually heal on their own.
• Intrauterine adhesions (Asherman’s syndrome) — scar tissue inside the uterus that can affect periods and fertility. This is uncommon, and the risk is higher after repeated D&C procedures, infection, or D&C for retained pregnancy tissue.
• Anaesthetic complications — rare with modern anaesthesia but discussed during the pre-anaesthetic assessment.

Your gynaecologist will discuss the risks that are most relevant to your situation. Careful patient selection, ultrasound or hysteroscopic guidance where appropriate, and gentle technique help keep complication rates low.

Effect on Fertility and Future Pregnancy

One of the most common concerns after being advised to have a therapeutic D&C is whether the procedure will affect future fertility. For most people, a single, uncomplicated D&C does not have a significant long-term effect on the ability to become pregnant. The uterine lining usually regenerates fully, and menstrual cycles typically return to their usual pattern within one or two months.

A few points are worth knowing:

• The main fertility-related concern after D&C is intrauterine adhesions, which are uncommon but more likely with repeated procedures or when D&C is done in the presence of infection or for retained pregnancy tissue.
• If periods become much lighter, irregular, or stop altogether after a D&C, this should be reported to your gynaecologist, as it may be a sign of adhesions that can often be treated.
• If the D&C was performed for a miscarriage, doctors generally consider it reasonable to start trying again once you feel emotionally and physically ready. The timing is usually discussed at the follow-up visit.
• If you do not wish to conceive immediately, contraception should be started promptly, as ovulation can return before the first period.

For people with recurrent miscarriage or with specific gynaecological conditions, further investigation may be advised before trying for another pregnancy.

Emotional Recovery

It can help to:

• Give yourself time and permission to grieve
• Talk to a partner, trusted friend, or family member
• Connect with others who have had similar experiences, in person or through support groups
• Speak to a counsellor or mental health professional if feelings of sadness, hopelessness, or anxiety persist or interfere with daily life

If your D&C is for heavy bleeding or another non-pregnancy reason, recovery can still bring strong feelings, particularly if symptoms have been going on for a long time. Acknowledging these emotions is part of healing.

Life After Therapeutic D&C

For most people, life after therapeutic D&C returns to normal within a few weeks. Periods usually settle into their previous pattern, bleeding that was problematic before the procedure often improves, and energy levels recover, especially if anaemia is corrected.

Long-term outcomes depend on the underlying reason for the procedure:

• If D&C was performed to control heavy bleeding caused by a hormonal imbalance, ongoing treatment may still be needed to prevent the bleeding from coming back.
• If D&C was performed for endometrial hyperplasia, further treatment and surveillance — sometimes including hormonal therapy — are usually recommended.
• If the pathology report shows pre-cancerous or cancerous changes, further specialist care will be arranged.
• If D&C was for miscarriage, no specific long-term follow-up is usually needed, but pre-pregnancy advice can be helpful when you are ready to try again.

The follow-up consultation is the right place to discuss what your individual results mean and what comes next.

Frequently Asked Questions

Will the D&C be painful?

The procedure itself is performed under anaesthesia, so you should not feel pain during it. Afterwards, mild to moderate cramping is common and usually responds well to simple painkillers.

How long does the procedure take?

The active part usually takes 15 to 30 minutes. With preparation, anaesthesia, and recovery, expect to be in the hospital for several hours.

Will I stay overnight in hospital?

Most people go home the same day. An overnight stay may be advised if you had complications, significant bleeding before the procedure, or other medical conditions that need closer monitoring.

How long will bleeding last after a D&C?

Light bleeding or spotting can last from a few days up to about two weeks. Heavy bleeding, large clots, severe pain, or fever should be reported promptly.

When will my next period come?

Periods usually return within four to six weeks. The first period may be different in flow or timing compared with your usual pattern.

When can I have sex again?

Doctors generally advise waiting until bleeding has stopped and for at least one to two weeks, to lower the risk of infection. Your gynaecologist will give specific advice based on your situation.

Can I get pregnant after a therapeutic D&C?

For most people, fertility is not affected by an uncomplicated D&C. If you do not want to become pregnant immediately, start contraception soon after the procedure because ovulation can return quickly.

Can a D&C be done more than once?

Yes, but repeated procedures slightly increase the risk of intrauterine adhesions. If you have had more than one D&C, your gynaecologist may suggest hysteroscopic evaluation in some situations.

Will I need general anaesthesia?

Not always. Depending on the reason for the procedure and your overall health, options may include general anaesthesia, regional anaesthesia, or sedation with a paracervical block. The anaesthetist will discuss the safest option with you.

Is therapeutic D&C the same as an abortion?

No. The instruments and steps can look similar, but therapeutic D&C is performed to treat a medical condition — such as heavy bleeding, an incomplete miscarriage, or an abnormal uterine lining. The intention, indication, and clinical context are different.

What happens to the tissue that is removed?

In most therapeutic D&Cs, the tissue is sent to a pathology laboratory for examination under a microscope. The report helps confirm the underlying cause and guides further care if needed.

Conclusion

Therapeutic D&C is a short, well-established gynaecological procedure used to treat heavy bleeding, manage pregnancy loss and retained tissue, and address certain abnormalities of the uterine lining. For most people, recovery is quick, fertility is preserved, and the underlying problem is significantly improved.

The most useful next step is a clear conversation with your gynaecologist about why the procedure is being suggested in your case, what alternatives exist, what the procedure and recovery will look like for you, and what the pathology results will mean for your future care. Understanding the procedure in advance — medically and emotionally — helps you take part in that conversation with confidence.