Before you can understand D&C you need to know a little about the uterus and cervix. The uterus is a pear-shaped, muscular organ that sits in the lower abdomen. The top of the uterus is wide and it narrows like the neck of a bottle at the bottom. The lower third portion of the uterus is its neck which is called the cervix. The cervix is round and has a small opening called the OS. During your GYN exam your physician can see the cervix by using a speculum -- an instrument used to separate the walls of the vagina.
The inner wall of the uterus is lined by endometrial tissues. The endometrial tissues thicken during the first part of your menstrual cycle. Once ovulation occurs progesterone acts to stop this thickening, and changes the endometrial lining so that it is ready to accept a pregnancy should it occur. If pregnancy doesn't occur, hormone production ceases and the endometrium breaks up and is shed as menstrual blood.
Who Needs A D&C?A D&C may be required to diagnosed and/or treat a problem such as heavy or prolonged menstruation, as well as unexplained bleeding between periods. The are many possible causes for these menstrual abnormalities, one of the most common being a hormonal imbalance. Hormonal imbalance causes a thickening of the endometrium which sometimes causes irregular or prolonged menstrual cycles. Although this can happen at any age it most commonly occurs in young women just starting menstruation and in older pre-menopausal women.
Abnormal uterine bleeding is also a warning of various types of growths, which are most often non-cancerous. One of these benign growths are polyps which attach either by a stem or a stalk most often to the lining of the uterus or the cervix. Polyps inside the uterus can usually be removed by D&C. Fibroid tumors are another common benign growth that occurs in the uterus. Fibroids can be silent causing no symptoms, or they can cause heavy bleeding and painful cramping. Although fibroid tumors are sometimes detected during dilation and curettage, another surgical procedure is necessary to remove them.
Abnormal bleeding is sometimes a sign of endometrial cancer, particularly in women over 40. Women over 40, especially those past menopause, may have a D&C or another procedure called an endometrial biopsy. Occasionally a hysteroscopy is performed at the same time as a D&C, allowing the doctor a better view of inside the cervix, vagina, and uterus.
Dialation and curettage is also commonly performed following miscarriage or abortion in cases where the uterus fails to fully empty its content. Abortions induced before the 12th week of pregnancy are performed in a manner which is similar to the D&C.
Where Is Dilation and Curettage Performed?
Where your D&C takes place depends on individual factors about your health. It can be performed in a hospital setting using general anesthesia or in your doctor's office using a local anesthetic. An injection around the cervix will minimize pain or discomfort from the procedure and produce numbness in the area.