The Uterus and Cervix
The uterus is a muscular organ in the
lower abdomen. The opening of the uterus is called the
cervix.
During your childbearing years, monthly
changes in two female hormones—estrogen
and progesterone—bring about
menstrual bleeding. These hormones are made by your
ovaries.
Estrogen and progesterone prepare your
body for pregnancy. Estrogen is produced throughout the
menstrual cycle. Progesterone is produced in the second
half of the cycle. These hormones cause the lining of the
uterus to grow and thicken each month to prepare for a
fertilized egg. If the egg is not fertilized, hormone
levels decrease. This signals the uterus to shed its
lining. This shedding is your monthly menstrual period.
Reasons for a D&C
A D&C may be done to assess the cause of
abnormal bleeding. It provides a sample of the tissue in
the uterus. This sample can be viewed under a microscope
to tell whether any cells are abnormal. It also may be
done when a woman is having a miscarriage
or after she has had one. In these cases, tissue from the
pregnancy may remain in the uterus. Often a D&C is done to
remove this tissue. This is important because the tissue
may cause infection or heavy bleeding.
The D&C Procedure
A D&C can be done in a doctor's office,
an outpatient clinic, or a hospital. The D&C also may be
done with other procedures, such as hysteroscopy, in which
a slender, light-transmitting device is used to view the
inside of the uterus.
Your
doctor may want to start dilating your cervix before
surgery. If so, a slender rod (called laminaria) will be
inserted into the opening of the cervix. It will be left
in several hours. The rod absorbs fluid from the cervix.
This causes the cervix to swell and the opening to widen.
Another way to open the cervix is to use a medication to
soften it.
Before your doctor begins the D&C, you
may receive some type of anesthesia.
You and your doctor will agree on the type to be used.
With general anesthesia, you will not be
awake during the procedure. You will receive medication
either through an intravenous (IV) line or a mask.
With local anesthesia, you will be
awake. The area around the cervix may be numbed with
medication.
During the procedure, you will lie on
your back and your legs will be placed in stirrups. The
doctor will then insert a speculum
into your vagina as is done with a pelvic exam.
The cervix is held in place with a clamp.
The cervix is then slowly opened
(dilated). Tissue lining the uterus is removed, either
with an instrument called a curette or with suction. In
most cases, the tissue then will be sent to a laboratory
for examination.
Risks
Complications are rare. When they do
occur, they include bleeding, infection, or perforation
(when the tip of an instrument passes through the wall of
the uterus). If perforation occurs, nearby organs may be
damaged and further surgery may be required. You should
contact your doctor if you have any of the following:
In rare cases, after a D&C for
miscarriage, bands of scar tissue, or
adhesions, may form inside the uterus. This
is called Asherman's syndrome. These adhesions may cause
infertility and changes in menstrual flow. In most women,
Asherman's syndrome can be treated successfully with
surgery. Call your doctor if you notice changes in your
menstrual periods after a D&C procedure.
Recovery
After the procedure, you probably will
be able to go home within a few hours. You will need
someone to take you home. You should be able to resume
most of your regular activities in 1 or 2 days.
If you had general anesthesia, you may
have some nausea and vomiting when you wake up. You may
feel groggy and weak for a short while.
During your recovery, you may have:
After a D&C, a new lining will build
up in the uterus. Your next menstrual period may not occur
at the regular time. It may be early or late.
Until your cervix returns to its normal
size, bacteria can enter the uterus and cause infection.
It is important not to put anything into your vagina after
the procedure. Ask your doctor when you can have sex or
use tampons again.
Finally...
A D&C usually is free of problems. The
recovery period is short. If you have a D&C, your doctor
will ask that you make an appointment to see him or her
soon after surgery to discuss the results. If further
treatment is needed, your doctor will discuss it with you.
Glossary
Adhesions: Scarring that binds together the
surfaces of tissues.
Anesthesia:
Relief of pain by loss of sensation.
Cervix: The
lower, narrow end of the uterus, which protrudes into the
vagina.
Endometrium:
The lining of the uterus.
Estrogen: A
female hormone produced in the ovaries.
Hormones:
Substances produced by the body to control the functions
of various organs.
Miscarriage:
Early pregnancy loss.
Ovaries: Two
glands, located on either side of the uterus, that contain
the eggs released at ovulation and that produce hormones.
Pelvic Exam: A
manual examination of a woman's reproductive organs.
Progesterone:
A female hormone that is produced in the ovaries and that
prepares the lining of the uterus for pregnancy.
Speculum: An
instrument used to spread the walls of the vagina.
Uterus: A
muscular organ located in the female pelvis that contains
and nourishes the developing fetus during pregnancy.
