Uterine curettage—commonly known as dilation and curettage (D&C)—remains one of gynecology's most debated procedures. Performed for over a century, this intervention involves scraping or suctioning tissue from the uterine lining (endometrium) for diagnostic or therapeutic purposes 313. While technological advances have refined its application, controversies persist about its appropriate use. This guide examines the evidence-based indications, evolving techniques, and critical patient considerations.
Uterine curettage is a minor surgical procedure with two key steps:
Modern approaches often combine curettage with hysteroscopy—inserting a camera to visualize the uterus—enhancing precision and reducing complications 39.
Table: Evolution of Uterine Curettage
| Era | Technique | Key Limitations |
|---|---|---|
| Early 20th c. | Blind sharp curettage | High perforation risk, incomplete tissue removal |
| 1970s | Suction curettage adoption | Reduced tissue trauma, faster recovery |
| 2000s | Hysteroscopy integration | Real-time visualization, targeted biopsies |
| Present | Vacuum systems (e.g., Olympus Berkeley VC-10) | Office-based procedures, minimized anesthesia 613 |
Historically, D&C was a first-line diagnostic tool for abnormal bleeding. Contemporary guidelines, however, discourage routine use due to risks like Asherman's syndrome (uterine scarring) and high false-negative rates for polyps/cancer 813.
Note: Hysteroscopy with biopsy is now preferred over blind D&C 8
NICE guidelines (2019, updated 2024) explicitly state D&C is "clinically ineffective" for diagnosis or treatment. Alternatives like hormonal IUDs reduce blood loss by 90% with fewer risks 8.
The WHO recommends manual vacuum aspiration over sharp curettage due to lower perforation risks. Medication abortion (mifepristone/misoprostol) is now preferred 13.
Table: Procedural Approaches and Outcomes
| Method | Procedure | Perforation Risk | Scarring Risk |
|---|---|---|---|
| Sharp Curettage | Metal loop scrapes endometrium | 0.3–5.1% 13 | High (up to 30% with repeated use) 13 |
| Suction Curettage | Plastic cannula + vacuum aspiration | <0.5% | Low (1.6%) 1013 |
| Hysteroscopic Guidance | Visual-directed biopsy or excision | <0.2% | Minimal 9 |
Suction methods dominate modern practice, reducing Asherman’s syndrome risk. The Olympus Berkeley VC-10 System exemplifies in-office vacuum aspiration innovations 6.
Highest incidence postpartum (5.1%) due to softened uterine walls 13.
Mitigated by preoperative misoprostol (softens cervix) 3
Fever >38°C, heavy bleeding (>1 pad/hour), foul discharge, or severe pain 913
A 2025 Cochrane review of 4,371 patients confirmed:
Table: Antibiotic Outcomes in Miscarriage Management
| Regimen | Infection Reduction | Side Effects |
|---|---|---|
| Doxycycline 100mg | 43% vs. placebo | Mild nausea (RR 1.2) |
| Azithromycin 500mg | Comparable efficacy | Diarrhea (RR 0.92) |
Office-based, minimizes cervical dilation 6
Q: How soon can I try to conceive after curettage?
A: Physically possible after first menstruation (4–6 weeks), but wait 2–3 months for emotional recovery and endometrial healing 10.
Q: Does curettage impact future fertility?
A: Uncomplicated procedures rarely cause infertility. However, multiple D&Cs increase Asherman’s risk 1013.
Q: Is general anesthesia required?
A: No. Most D&Cs use local anesthesia or moderate sedation 3.
Q: Can polyps be removed without curettage?
A: Yes. Hysteroscopic resection is gold-standard for targeted removal 813.
Uterine curettage remains vital for managing miscarriage and diagnosing cancer but is no longer a first-line solution for heavy bleeding or unexplained infertility. Technological advances—like suction devices and hysteroscopy—have slashed risks, while evidence confirms antibiotics prevent 43% of post-procedure infections 61113.
Patients should seek providers who:
As minimally invasive options expand, curettage’s role narrows to targeted therapeutic applications—a shift ensuring safer, more effective uterine care.