D

dilation and curettage (D&C) A surgical proce-
dure, also called dilatation and curettage, in which
the gynecologist widens the opening of the CERVIX
enough to allow passage into the UTERUSof a nar-
row scraping instrument called a curette. The
gynecologist uses the curette to gently scrape the
inside wall of the uterus, removing accumulated
BLOODand tissue that may be causing DYSFUNC-
TIONAL UTERINE BLEEDING(DUB) or that remains after
a spontaneous ABORTION (miscarriage) or an
induced abortion using abortifacients (drugs that
terminate PREGNANCY).
The doctor performs a D&C in a hospital oper-
ating room or AMBULATORY SURGICAL FACILITYwith
the woman under general ANESTHESIA. The proce-
dure itself takes about 15 minutes; most women
are able to go home a few hours after, when they
have completely emerged from the effects of the
anesthesia. Discomfort similar to moderate men-
strual cramps and mild bleeding may occur for up
to two weeks after the D&C. Uncommon compli-
cations include unusual bleeding during or after
the procedure, postoperative INFECTION, and uter-
ine perforation, in which the curette penetrates
the wall of the uterus (a small wound that typi-
cally heals without intervention). Most women
are able to return to normal activities (except SEX-
UAL INTERCOURSE) within a few days though may
feel discomfort for up to a week.
Before undergoing a D&C, a woman should
confirm with her gynecologist that the benefits of
the procedure outweigh the discomfort and poten-
tial complications compared to noninvasive proce-
dures such as ULTRASOUNDfor diagnostic purposes
or medications to treat DUB. Minimally invasive
procedures such as endometrial sampling (in
which the gynecologist inserts a very thin catheter
through the cervix, without dilation, and into the

uterus to withdraw a small sample of tissue from

the uterine wall) and HYSTEROSCOPYoften can pro-

vide the same diagnostic information as would

D&C but with less risk and discomfort for the

woman.

See also SURGERY BENEFIT AND RISK ASSESSMENT.

dysfunctional uterine bleeding (DUB) Bleeding

from the UTERUS through the VAGINAthat occurs

outside the hormonal bleeding normally associ-

ated with the MENSTRUAL CYCLE. Doctors believe

DUB results from an imbalance between ESTROGENS

and PROGESTERONE, the hormones that regulate the

menstrual cycle, which allows the endometrium

(lining of the uterus) to grow unchecked. The

excess tissue dies and sloughs away, producing

clotty bleeding.

Vaginal bleeding that saturates more

than eight pads in 24 hours for longer

than two days may signal a health con-

cern other than DUB and requires

prompt medical evaluation.

Symptoms and Diagnostic Path

Because there are numerous causes for abnormal

vaginal bleeding, DUB is a diagnosis of exclusion:

The doctor concludes the situation is one of DUB

after ruling out other possible causes for the

bleeding. The essential symptom of DUB is exces-

sive vaginal bleeding. Though the bleeding often

has the characteristics of a heavy menstrual

period, it may not follow the timing of the

woman’s menstrual cycle. Some women experi-

ence DUB as episodes of bleeding that occur

between menstrual periods and for other women

the bleeding may be fairly constant or occur with

no predictable pattern. Further symptoms of DUB

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