Heavy bleeding after a d&c

Dilation and curettage (D&C) - Mayo Clinic

Overview

Female reproductive system

The ovaries, fallopian tubes, uterus, cervix and vagina (vaginal canal) make up the female reproductive system.

Dilation and curettage (D&C) is a procedure to remove tissue from inside your uterus. Health care providers perform dilation and curettage to diagnose and treat certain uterine conditions — such as heavy bleeding — or to clear the uterine lining after a miscarriage or abortion.

In a dilation and curettage, your provider uses small instruments or a medication to open (dilate) the lower, narrow part of your uterus (cervix). Your provider then uses a surgical instrument called a curette, which can be a sharp instrument or suction device, to remove uterine tissue.

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Why it's done

Dilation and curettage is used to diagnose or treat a uterine condition.

To diagnose a condition

Before doing a D&C, your provider might recommend a procedure called endometrial biopsy or endometrial sampling to diagnose a condition. Endometrial sampling might be done if:

You have unusual uterine bleeding
You have bleeding after menopause
You have unusual endometrial cells, which are discovered during a routine test for cervical cancer

To perform the test, your provider collects a tissue sample from the lining of your uterus (endometrium) and sends the sample to a lab for testing. The test can check for:

Endometrial intraepithelial hyperplasia — a precancerous condition in which the uterine lining becomes too thick
Uterine polyps
Uterine cancer

If more information is needed, your provider then might recommend a D&C, which is usually done in an operating room.

To treat a condition

Hysteroscopy

During a hysteroscopy, your provider uses a thin, lighted instrument (hysteroscope) to view the inside of your uterus.

When performing a D&C to treat a condition, your provider removes the contents from inside your uterus, not just a small tissue sample. This might be done to:

Prevent infection or heavy bleeding by clearing tissues that remain in the uterus after a miscarriage or abortion
Remove a tumor that forms instead of a typical pregnancy (molar pregnancy)
Treat excessive bleeding after delivery by clearing out any placenta that remains in the uterus
Remove cervical or uterine polyps, which are usually noncancerous (benign)

A D&C might be combined with another procedure called hysteroscopy. During hysteroscopy, your provider inserts a slim instrument with a light and camera on the end into your vagina, through your cervix and into your uterus.

Your provider then views the lining of your uterus on a screen, checking for areas that look unusual. Your provider also checks for polyps and takes tissue samples as needed. During a hysteroscopy, uterine polyps and fibroid tumors can be removed.

At times, a hysteroscopy might be done combined with an endometrial biopsy before a full D&C procedure.

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Risks

Complications from dilation and curettage are rare. However, there are risks, including:

Perforation of the uterus. This occurs when a surgical instrument pokes a hole in the uterus. This happens more often in women who were recently pregnant and in women who have gone through menopause.

Most perforations heal on their own. However, if a blood vessel or other organ is damaged, a second procedure might be needed to repair it.
Damage to the cervix. If the cervix is torn during the D&C, your provider can apply pressure or medicine to stop the bleeding or can close the wound with stitches (sutures). This might be prevented if the cervix is softened with medication before the D&C.
Scar tissue on the uterine wall. Rarely, a D&C results in development of scar tissue in the uterus, a condition known as Asherman's syndrome. Asherman's syndrome happens most often when the D&C is done after a miscarriage or delivery.

This can lead to unusual, absent or painful menstrual cycles, future miscarriages and infertility. It can often be treated with surgery.
Infection. Infection after a D&C is rare.

Contact your health care provider if after a D&C you have:

Bleeding that's heavy enough that you need to change pads every hour
Lasting dizziness or lightheadedness
Fever
Cramps lasting more than 48 hours
Pain that gets worse instead of better
Foul-smelling discharge from the vagina

How you prepare

Dilation and curettage can be done in a hospital, clinic or your provider's office, usually as an outpatient procedure.

Before the procedure:

Follow your provider's instructions on limiting food and drink.
Arrange for someone to take you home because you may be drowsy after the anesthesia wears off.
Allow time for the procedure and a few hours of recovery afterward.

In some cases, your provider might start dilating your cervix a few hours or even a day before the procedure. This helps your cervix open gradually and is usually done when your cervix needs to be dilated more than in a standard D&C, such as during pregnancy terminations or with certain types of hysteroscopy.

To promote dilation, your provider may use a medication called misoprostol (Cytotec) — given orally or vaginally — to soften the cervix. Another dilation method is to insert a slender rod made of laminaria into your cervix. The laminaria gradually expands by absorbing fluid in your cervix, causing your cervix to open.

What you can expect

During the procedure

Dilation and curettage (D&C)

During a dilation and curettage procedure (D&C), your provider uses a vaginal speculum to hold the walls of the vagina apart. Then your provider inserts a series of rods (dilators) of increasing thickness to open (dilate) your cervix and allow access to your uterus. Next, your provider inserts a long, thin instrument (curette) through your cervix into your uterus and carefully removes the tissue lining the inside of the uterus.

For dilation and curettage, you'll receive anesthesia. The choice of anesthesia depends on the reason for the D&C and your medical history.

During the procedure:

You lie on your back on an exam table while your heels rest in supports called stirrups.
Your provider inserts an instrument called a speculum into your vagina, as during a Pap test, to see your cervix.
Your provider inserts a series of increasingly thick rods into your cervix to slowly dilate it until it's open enough.
Your provider removes the dilation rods and inserts a spoon-shaped instrument with a sharp edge or a suction device and removes uterine tissue.

Because you're either unconscious or sedated during a D&C, you shouldn't feel any discomfort.

After the procedure

You'll likely spend a few hours in a recovery room after the D&C so that you can be monitored for heavy bleeding or other complications. This also gives you time to recover from the effects of anesthesia.

Typical side effects of a D&C can last a few days and include:

Mild cramping
Spotting or light bleeding

For discomfort from cramping, your provider might suggest taking ibuprofen (Advil, Motrin IB, others) or another medication.

You should be able to resume your activities within a day or two.

To prevent infection, don't put anything in your vagina until your provider says it's OK. Ask when you can use tampons and resume sexual activity.

Your uterus must build a new lining after a D&C, so your next period might be early or late. If you had a D&C because of a miscarriage, and you want to become pregnant, talk with your provider about when it's safe to start trying again.

Results

Your health care provider will discuss the results of the procedure with you after the D&C or at a follow-up appointment.

By Mayo Clinic Staff

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Dilation and Curettage (D and C)

What is a dilation and curettage (D&C)?

(Dilatation and Curettage, D&C)

A dilation and curettage procedure, also called a D&C, is a surgical procedure in which the cervix (lower, narrow part of the uterus) is dilated (expanded) so that the uterine lining (endometrium) can be scraped with a curette (spoon-shaped instrument) to remove abnormal tissues.

Other related procedures used for diagnosing and treating the endometrium include endometrial ablation, hysteroscopy, and hysterectomy. Please see these procedures for additional information.

What are female pelvic organs?

The organs and structures of the female pelvis are:

Endometrium . This is the lining of the uterus.
Uterus (also called the womb). The uterus is a hollow, pear-shaped organ located in a woman's lower abdomen, between the bladder and the rectum. The uterus sheds its lining each month during menstruation, unless a fertilized egg (ovum) becomes implanted and pregnancy follows.
Ovaries. Two female reproductive organs located in the pelvis in which egg cells (ova) develop and are stored and where the female sex hormones estrogen and progesterone are produced.
Cervix. The lower, narrow part of the uterus located between the bladder and the rectum, forming a canal that opens into the vagina, which leads to the outside of the body.
Vagina (also called the birth canal). The passageway through which fluid passes out of the body during menstrual periods. The vagina connects the cervix and the vulva (the external genitalia).
Vulva. The external portion of the female genital organs.
Fallopian tube. Two thin tubes that extend from each side of the uterus, toward the ovaries, as a passageway for eggs and sperm.

The menstrual cycle

With each menstrual cycle, the endometrium prepares itself to nourish a fetus, as increased levels of estrogen and progesterone help to thicken its walls. If implantation of the fertilized egg does not occur, the lining of the endometrium, coupled with blood and mucus from the vagina and cervix (the lower, narrow part of the uterus located between the bladder and the rectum), make up the menstrual flow (also called menses) that leaves the body through the vagina. After menopause, menstruation stops and a woman should not have any bleeding.

Reasons for the procedure

A D&C may be used as a diagnostic or therapeutic procedure for abnormal bleeding. A D&C may be performed to determine the cause of abnormal or excessive uterine bleeding, to detect cancer, or as part of infertility (inability to become pregnant) investigation.

Causes of abnormal bleeding include the presence of abnormal tissues, such as fibroid tumors (benign tumors that develop in the uterus, also called myomas) polyps, or cancer of the endometrium or uterus. Tissues obtained from the D&C can be examined under a microscope. Abnormal uterine bleeding may also be due a hormone imbalance or disorder (particularly estrogen and progesterone) especially in women approaching menopause or after menopause.

A suction D&C uses suction to remove uterine contents. A suction D&C may be used following a miscarriage to remove the fetus and other tissues if they have not all been naturally passed. Infection or heavy bleeding can occur if these tissues are not completely removed.

Occasionally following childbirth, small pieces of the placenta (afterbirth) remain adhered to the endometrium and are not passed. This can cause bleeding or infection. A D&C may be used to remove these fragments so that the endometrium can heal properly.

There may be other reasons for your doctor to recommend a D&C.

Risks of the procedure

As with any surgical procedure, complications may occur. Some possible complications of a D&C may include, but are not limited to, the following:

Patients who are allergic to or sensitive to medications, iodine, or latex should notify their doctor.

If you are pregnant or suspect that you may be pregnant, you should notify your health care provider.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

A vaginal, cervical, or pelvic infection may interfere with a D&C.

Before the procedure

Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
If your procedure requires general, spinal, or epidural anesthesia, you will be asked to fast for eight hours before the procedure, generally after midnight. If your procedure is to be done under local anesthesia, your doctor will give you instructions about fasting.
If you are pregnant or suspect that you are pregnant, you should notify your health care provider. He or she may recommend a pregnancy test prior to the procedure.
Notify your doctor if you are sensitive to or are allergic to any medications, iodine, latex, tape, and anesthetic agents (local and general).
Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
If a sedative is given before the procedure, you will need someone to drive you home afterwards.
You may want to bring a sanitary napkin to wear home after the procedure.
Based on your medical condition, your doctor may request other specific preparation.

During the procedure

A D&C may be performed in a doctor’s office, on an outpatient basis, or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.

The type of anesthesia will depend on the specific procedure being performed. Some D&C procedures may be performed while you are asleep under general anesthesia, or while you are awake under spinal or epidural anesthesia. If spinal or epidural anesthesia is used, you will have no feeling from your waist down. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

Generally, a D&C follows this process:

You will be asked to remove clothing and be given a gown to wear.
You will be instructed to empty your bladder.
You will be positioned on an operating or examination table, with your feet and legs supported as for a pelvic examination.
An intravenous (IV) line may be started in your arm or hand.
A urinary catheter may be inserted.
Your doctor will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart to expose the cervix.
Your cervix may be cleansed with an antiseptic solution.
For local anesthesia, the doctor may numb the area using a small needle to inject medication.
If general or regional anesthesia is used, the anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during surgery.
A type of forceps, called a tenaculum, may be used to hold the cervix steady for the procedure.
The inside of the cervical canal may be scraped with a small curette if the cervical tissue needs to be examined.
A thin, rod-like instrument, called a uterine sound, may be inserted through the cervical opening to determine the length of the uterus. If you have local anesthesia, this may cause some cramping. The sound will then be removed.
The cervix will be dilated by inserting a series of thin rods. Each rod will be larger in diameter than the previous one. This process will gradually enlarge the opening of the cervix so that the curette (spoon-shaped instrument) can be inserted.
The curette will be inserted through the cervical opening into the uterus and the sharp spoon-shaped edges will be passed across the lining of the uterus to scrape away the tissues. In some cases, suction may be used to remove tissues. If you have local anesthesia, this may cause cramping.
The instruments will be removed.
Any tissues collected with the procedure will be sent to the lab for examination. Pregnancy tissues (called products of conception) may be sent to the lab for culture or testing for genetic or chromosomal abnormalities.

After the procedure

The recovery process will vary depending on the type of procedure performed and type of anesthesia that was administered.

If you received regional or general anesthesia, you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home. If this procedure was performed on an outpatient basis, you should plan to have another person drive you home.

After a D&C using local anesthesia, you may rest for about two hours before going home.

You may want to wear a sanitary pad for bleeding. It is normal to have some spotting or light vaginal bleeding for a few days after the procedure.

You may experience cramping for the first few days after a D&C.

You may be instructed not to douche, use tampons, or have intercourse for two to three days after a D&C, or for a period of time recommended by your doctor.

You may also have other restrictions on your activity, including no strenuous activity or heavy lifting.

Because a D&C removes the lining of the uterus, the lining must build back up. Your next menstrual period may begin earlier or later than usual.

You may resume your normal diet unless your doctor advises you differently.

Take a pain reliever for cramping or soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Your doctor will advise you on when to return for further treatment or care.

Notify your doctor if you have any of the following:

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

Online resources

The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your doctor. Please consult your health care provider with any questions or concerns you may have regarding your condition.

This page contains links to other websites with information about this procedure and related health conditions. We hope you find these sites helpful, but please remember we do not control or endorse the information presented on these websites, nor do these sites endorse the information contained here.

American Cancer Society

American College of Obstetricians and Gynecologists

American Society for Reproductive Medicine

National Cancer Institute (NCI)

National Institutes of Health (NIH)

National Library of Medicine

National Women's Health Information Center

Expansion and scraping procedure | Memorial Sloan Kettering Cancer Center

Time to read: Approximately 4 min.

This information will help you prepare for your dilation and curettage (D&C) procedure. It will tell you what to expect before, during and after your procedure.

D&C is a procedure that dilates (slowly opens) the cervix and removes tissue from the uterus. Tissue removal is done with a thin instrument called a curette.

You may also have a hysteroscopy at the same time as your D&C procedure. This is a procedure during which a thin endoscope with a flashlight and a camera at the end is inserted into the uterus through the vagina. This gives your doctor a chance to examine the lining of your uterus for any abnormalities.

D&C Purpose

Typically, a D&C procedure is performed to identify the cause of abnormal uterine bleeding (bleeding from the uterus). Examples of abnormal uterine bleeding:

bleeding between periods;
bleeding after vaginal intercourse, including small spots of blood;
profuse, irregular or prolonged menstruation;
sudden vaginal bleeding after a year or more without menstruation.

This bleeding can be caused by:

Endometrial cancer. Endometrial cancer is cancer of the lining of the uterus. The D&C procedure helps diagnose cancer at an early stage.
Fibromyomas. Fibromyomas are growths on the uterus, consisting of connective tissue and muscle fibers. In most cases, they are benign (not cancerous).
Polyps. Polyps are growths that form on the inner wall of the uterus and protrude into the uterine cavity (the space inside the uterus). They are usually benign, but some may be cancerous or precancerous (leading to cancer). Polyps can be removed during the D&C procedure.
Hyperplasia. Hyperplasia is an abnormal growth of the inner lining of the uterus. Hyperplasia may be precancerous.

The D&C procedure may also be performed to diagnose or treat other uterine disorders. In addition, it is used to clean the inner lining of the uterus after a miscarriage or induced abortion.

Before your procedure

Ask questions about your medicines

You may need to stop taking some of your medicines before your procedure. Talk to your doctor about which medications you can stop taking. Below are some common examples.

Arrange for someone to drive you home

You must arrange for someone at least 18 years of age to drive you home after your procedure. If you do not have such a person, call one of the agencies below. You will be provided with an escort to take you home. These services are usually chargeable and you will need to provide transportation.

New York agencies

New Jersey Agencies

Partners in Care: 888-735-8913

Caring People: 877-227-4649

The day before your procedure

Write down the time you have your procedure

The Admitting Office will call you after 2:00 pm the day before your procedure. If your procedure is scheduled for Monday, you will receive a call the previous Friday.

A staff member will tell you what time you should arrive at the hospital for your procedure. He will also tell you where to go. If no one has contacted you by 7:00 pm, please call 212-639-5014.

Instructions for eating and drinking before the procedure

Do not eat after midnight the night before your procedure. This also applies to lozenges and chewing gum.
Between midnight and two hours before your scheduled arrival time at the hospital, you can drink no more than 12 ounces (350 ml) of water (see picture).
Refrain from eating and drinking two hours before your scheduled arrival time at the hospital. This also applies to water.

The day of your procedure

Things to remember

Take only the medicines your doctor has told you to take on the morning of your procedure. Wash them down with a few small sips of water.

What to expect

You will be shown to a dressing room and asked to remove all clothing, jewelry, dentures and contact lenses. One of the employees will give you a hospital gown.

After changing into a hospital gown, you will meet with a nurse. The nurse will take you to the procedure room and help you lie down on the operating table. If you get cold, ask the nurse for a blanket.

Ask the nurse for a blanket if you get cold. First, you will be given intravenous fluids, and then they will give you anesthesia (a drug that will make you fall asleep) through the same drip. You will also be connected to equipment to monitor your heartbeat, respiration and blood pressure.

You will be given an anesthetic (drug that will make you sleep) through an IV catheter. When you fall asleep, the doctor will begin the procedure.

After your procedure

At the hospital

You will be transferred to the Post Anesthesia Care Unit (PACU). There, a nurse will monitor your body temperature, heart rate, breathing, and blood pressure. You may be receiving oxygen through a thin tube placed under your nose. You will be in the recovery room until you are fully recovered.
When you finally wake up, you will be transferred to the recovery area. You will be able to drink tea or juice, have a light snack and see your visitors.
You may experience aching, spasmodic pain in your lower abdomen (belly). Ask your nurse for pain relief medication. Your doctor or nurse may also give you a prescription for pain medication to take at home.
Your nurse will give you instructions on how to take care of yourself at home. When you are cleared to leave the recovery area (discharged), you must have an escort at least 18 years of age with you.

At home

You may feel sleepy while still under anesthesia. It is important to have someone by your side for the first 24 hours after your procedure.
For 2 weeks after your procedure, or as directed by your doctor, refrain from:
- douching;
- use of tampons;
- vaginal intercourse.
Showering is allowed. Ask your doctor when you can take a bath.
You may have cramps and vaginal bleeding, as during your period. This may continue for several days after the procedure. Use sanitary pads for vaginal bleeding.
Call your doctor to make an appointment for follow-up.

Call your doctor or nurse if you:

have a temperature of 101°F (38.3°C) or higher;
vaginal bleeding more than normal menstrual bleeding;
pain that does not go away after taking the medicine recommended by your doctor;
swelling in the abdomen;
Foul-smelling vaginal discharge.

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What should be explained in more detail?

Date last updated

Thursday, March 12, 2020

How long after D&C should you bleed (and why)?

Last updated: August 26, 2022 / author Sandeep Bhandari / Fact verified / 4 minutes

Exact answer: 10-14 days

You may experience some bleeding that can last up to two weeks. The bleeding will be similar to light periods and may become heavier if you are doing heavy work. Things like lifting weights and increasing your daily activities can increase blood flow and become heavy. You can use sanitary pads during this process.

D&C is nothing more than a shortened form of dilatation and scraping, which is a surgical procedure performed on women. During this procedure, the lining of the uterus is removed. However, other contents could be removed with this surgical procedure.

How long after D&C should bleeding occur?

Bleeding after D&C	Bleeding is normal after a surgical procedure and may continue for several weeks.
Signs and symptoms of infection after D&C	Severe bleeding, fever, seizures and bad breath.

You should always be aware of the signs and symptoms of infection after a surgical procedure. Things like the aforementioned symptoms can also be normal, but if they appear completely, then it is best to see a doctor as soon as possible.

For example, toothaches may be normal, but if they last more than 48 hours, then there is a problem. If you are experiencing fever, bad breath, then these are other symptoms that you should look out for.

D&C is an operation performed on women who want to lightly scrape the inside of the uterus. The procedure is carried out using a dilator and a curette. The doctor performing the surgery uses a dilator to expand the uterus and then cleans the uterus or uterine lining with a curette.

During the operation, you will be given local anesthesia and you will not feel any pain. Most women say that they did not feel pain during the procedure, but they had some cramps during the procedure.

Why does it take so long to bleed after D&C?

Bleeding for a few weeks after surgery is considered normal, but if the bleeding becomes heavy, it may be a sign of an infection. Be sure to see a doctor if you experience more severe symptoms that shouldn't be happening.

However, there are certain things you need to keep in mind after the successful completion of the operation. If you can take care of yourself after surgery, there will be less chance of complications.

Things like avoiding strenuous activity or any activity that uses judgment skill should be avoided. Some of the more common ones include cooking, making hot drinks, and if you are a mother, babysitting.

In addition, you must stay at home for a few days after the operation. This means that you cannot be socially active during the healing process. You will also be asked to stay in the hospital for the first day and then you will be discharged from the hospital.

Other things you should avoid are drinking alcohol, driving a car, making important decisions such as signing important documents, and the like. After you are released from the hospital, you can return to your normal lifestyle within a day or two.

You should also remember that during the first week you should avoid swimming, bathing or going to a spa, having sex, and using tampons.

Conclusion

After all, you want to get back to your normal routine as soon as possible, because as a mother, you have to take care of your children. But while your body is healing, you must have a guardian both for yourself and for your children.

Do not do what you are not allowed to do, because it will only harm your body. You can take paracetamol and other medicines prescribed by your doctor as soon as you get home from the hospital.

You can also use a heat pack to keep you comfortable. If any serious pain or problem occurs, you should contact your doctor immediately.

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