Diagnostic curettage is defined as the process of removing tissue from the uterus. It is used for the diagnosis and treatment of various uterine problems such as excessive bleeding, cleaning of the uterine cavity after miscarriage or pregnancy curettage.
In the procedure, your doctor first dilates the cervix. The cervix is the lower part of the uterus that separates the vagina and the uterus. Then, an instrument called a curette is inserted into the uterus and the necessary tissue is removed.
Why is it done?
Diagnostic curettage can be for diagnostic or therapeutic purposes.
Diagnosis: In diagnostic curettage, a sample is taken from the endometrium, that is, the tissue surrounding the uterus, and studied. This is usually done in the following situations:
- excessive bleeding
- bleeding after menopause
- severe menstrual pain
- inability to get pregnant
- In the presence of abnormal cells that may be suspected of cervical cancer
The retrieved tissue is tested against:
- Uterine cancer
- cervical cancer
- Uterine polyps
- Endometrial Hyperplasia
Treatment: In curettage performed for therapeutic purposes, your doctor takes the contents of the uterus. This can be done for:
- Terminating a molar pregnancy with a tumor in place of the normal placenta
- Treating excessive postpartum bleeding by removing the remaining placenta in the uterus
- Removing polyps in the cervix or uterus
- Removal of uterine tissue after miscarriage or pregnancy curettage to prevent infection or excessive bleeding and to prepare a place for subsequent pregnancies
Diagnostic curettage is usually performed in conjunction with hysteroscopy. Hysteroscopy is a way of looking inside the uterus. With the device called hysteroscope, the diagnosis or treatment of the problem related to the uterus can be made.
Risks: Diagnostic curettage is generally a safe procedure, with a very low probability of complications. However, there are still some risks;
- Perforation of the uterus: this happens when a surgical instrument makes a hole in the uterus. It may occur in 1% of women, but it is more common in women who are pregnant or in menopause. These tissues usually heal spontaneously. However, if a blood vessel or other organ has been damaged, a second procedure may be needed to correct the condition.
- Injury of the Cervix: If the cervix is damaged during a diagnostic curettage, your doctor may treat the condition by applying pressure, giving medication to stop bleeding, or suturing.
- Scar Tissue in the Uterine Wall: In some rare cases, curettage can cause scar tissue in the uterus. The formation of adhesions in the uterus is called Asherman’s Syndrome and usually occurs during procedures performed during miscarriage or postpartum. It can cause abnormal and painful menstrual periods, future miscarriages, and infertility. It can be treated with the use of hormones that trigger the development of healthy uterine tissue or by surgical removal of scar tissue.
- Infection: Infection after curettage is possible but rare.
Preparation: Diagnostic curettage is a procedure performed in a hospital, clinic or practice. Wherever the procedure is done, you will spend several hours there. Do not eat or drink anything before the curettage, ask a relative to accompany you for your return home after the procedure, because you may not be able to recover due to anesthesia. You can resume your normal activities within 1 or 2 days after the procedure.
In some cases, your doctor may prescribe treatment to dilate the cervix a few hours or a day before the procedure. This applies to termination of pregnancy or in certain types of hysteroscopy, where the cervix needs to be enlarged more than standard curettage. In such cases, your doctor dilates the cervix with a medicine that softens the uterus, or inserts an instrument called a laminaria into the cervix to open it. Laminaria gradually dilates the cervix by absorbing the fluid in the cervix.
What Should You Expect?
During the Transaction: During a diagnostic curettage, you will receive general, regional or local anesthesia. You can discuss this with your doctor based on your medical history and preference. Generally, local anesthesia is used in cases related to pregnancy. Diagnostic curettages are usually performed under general anesthesia.
- General Anesthesia: Anesthesia is given through the mask or through the intravenous line. Vascular access can be opened from the hand, arm or neck. Anesthesia allows you to sleep during the procedure, so you do not feel any pain. A tube is inserted from your mouth to your trachea to ensure proper breathing. General anesthesia relaxes the muscles so that the doctor can perform the pelvic examination more comfortably.
- Regional Anesthesia: Anesthesia is injected around the spinal cord and this prevents pain during the procedure. You can also calm down and relax with an intravenous sedative.
- Local Anesthesia: Anesthesia is injected directly into and around the cervix, and the area becomes numb. You can also calm down and relax with an intravenous sedative.
During the procedure, you lie on your back and raise your legs. Your doctor sees the cervix by inserting a speculum into the vagina. It then inserts progressively thickening rods into the cervix to widen the cervix until it is fully dilated (usually 6 to 9 mm). He then begins to curette and takes the tissue. During this procedure, you will not feel any discomfort as you are either asleep or sedated. The process takes about 15 minutes.
After Processing: After the curettage, you need to rest for a few hours. Your doctor will then monitor you for vaginal bleeding or other complications. This gives you the opportunity to recover from the anesthesia. If general anesthesia was applied;
– If a tube is inserted from your mouth to your windpipe, you may have a sore throat.
– You may experience drowsiness.
Side effects that may occur after curettage can last for several days and include:
– Mild cramping
– Stain-style bleeding
Cramps can be treated with pain relievers. It is very important that nothing enters the vagina until the cervix reaches its normal size after the procedure. Because bacteria can enter the uterus and infection can develop. You can ask your doctor when you can have sexual intercourse and use tampons.
If you had a curettage for miscarriage, ask your doctor when it’s safe to get pregnant again.
After curettage, your uterus will develop new tissue, so your next period may not arrive on time.