Uterine Curettage – Biopsy – What it is and when it is recommended

Have you recently experienced unusual vaginal bleeding, discomfort or other worrying symptoms, and your gynaecologist has recommended a uterine curettage? Don't worry – curettage isn't only used for terminations of pregnancy.

This procedure is carried out more often than you might think, as it can help identify conditions or hormonal imbalances that wouldn't show up during a routine examination. In this article, we explain what a curettage involves, when it's recommended and what you should know before the procedure.

What is a uterine curettage

Uterine curettage is a gynaecological procedure in which part of the uterine lining (the endometrium) or the contents of the uterine cavity are removed. During the procedure, a special spoon-shaped instrument called a curette is used, allowing the doctor to collect or remove uterine tissue in a controlled manner.

The procedure may be carried out for therapeutic or diagnostic purposes relating to the health of the uterus – under local or general anaesthetic and, in most cases, as a day case, without the need for a lengthy hospital stay.

Types of uterine curettage

Depending on why it has been recommended and the aim of the procedure, there are several types of uterine curettage:

• Diagnostic curettage (biopsy): Uterine tissue is collected and then analysed under the microscope as part of a histopathological examination – with the aim of clarifying the causes of abnormal uterine bleeding or confirming certain conditions of the endometrium.
• Therapeutic curettage: Here, abnormal tissue or retained material is removed from the uterine cavity, for example tissue remaining after a termination of pregnancy.
• Haemostatic curettage: This is recommended in cases of heavy uterine bleeding and serves to stop the bleeding quickly by removing the excess tissue.
• Fractional curettage: Tissue is collected separately from the cervix and from the uterine cavity, allowing any changes to be assessed more precisely.

The purpose of uterine curettage

A uterine curettage may essentially be performed for two reasons:

• Diagnostic: to clarify the causes of abnormal uterine bleeding, polyps or fibroids, and to rule out more serious conditions such as endometrial cancer.
• Therapeutic: to restore the health of the uterus and prevent complications following a miscarriage or a non-viable pregnancy, by removing any retained tissue.

When is a uterine curettage recommended

A uterine curettage may be recommended in a variety of situations – always with the aim of identifying or treating a particular gynaecological problem. It is carried out on the recommendation of a gynaecologist, usually in one of the following situations:

Uterine curettage after a miscarriage or incomplete miscarriage

This is probably the context in which you've most often heard of curettage: miscarriage or incomplete miscarriage. Following such an event, remnants of placental or embryonic tissue may remain in the uterine cavity, which can cause complications such as infection, heavy bleeding or persistent pain. To prevent this, it is recommended that these remnants be removed by curettage.

Uterine curettage for termination of pregnancy

There are situations in which a termination of pregnancy is necessary, for example in the case of an unwanted pregnancy or a foetal abnormality. In the UK, termination is legal up to 24 weeks of pregnancy; the method depends on how far along the pregnancy is. The procedure is considered effective and safe and involves the complete removal of the uterine contents.

Uterine curettage for abnormal vaginal bleeding

A curettage may be recommended to establish the cause of abnormal vaginal bleeding – whether it is heavy, prolonged or occurs outside of menstruation. During the procedure, endometrial tissue is collected, and histological examination can reveal possible hormonal imbalances, polyps, uterine fibroids, endometrial hyperplasia or other conditions affecting the uterine lining.

Uterine curettage for oncological diagnosis

In patients with suspected endometrial cancer, hyperplasia or benign changes, curettage may be used as part of the diagnostic process to obtain tissue samples for biopsy.

How a uterine curettage is performed

Uterine curettage is a relatively short procedure with a short recovery time, in which the cervix is dilated and the uppermost layer of the endometrium is removed. The procedure is preceded by a preparation phase, which in turn involves a series of medical tests and the choice of anaesthetic.

Preparing for a uterine curettage

So that the procedure can be carried out safely, you will first be advised to have a number of tests. Blood tests such as a full blood count and a coagulation screen are usually performed, and in certain cases hormone tests as well.

Also during the preparation phase, you will be given a detailed explanation of what the procedure involves, what the risks and benefits are and how you should prepare – after which you will sign the consent form.

The next step is choosing the type of anaesthetic. Tell the anaesthetist whether you are taking any medication, whether you have had surgery in the past and whether you have any known allergies or other medical conditions. Depending on the medical indication, the type of curettage and your preferences, you may be able to choose between local anaesthetic, general anaesthetic or intravenous sedation.

You may also be advised not to eat or drink anything for at least 6 to 8 hours before the procedure.

How the curettage is carried out

The procedure itself begins with dilation of the cervix, which is done gradually using progressively larger dilators.

Once the cervix has been sufficiently dilated, the doctor inserts a curette or a suction cannula into the uterine cavity and removes the tissue lining it (the endometrium). The entire procedure takes place under anaesthetic, so you won't feel any pain.

If the curettage is being carried out for diagnostic purposes, this tissue is then sent to the laboratory for histopathological examination.

Duration and hospital arrangements

Uterine curettage is a short procedure, usually lasting between 10 and 20 minutes. In most cases there is no need to stay in hospital overnight, and the patient can go home the same day.

Recovery after a uterine curettage

Uterine curettage is performed frequently, is considered safe and effective in most cases, and has a short recovery period. As with any procedure, however, there is a risk of rare complications. It's important to know which symptoms are normal after the procedure and how long they may last, so that you can recognise when to seek medical advice.

Normal symptoms after a uterine curettage

Light to moderate bleeding in the first few days after the curettage is normal. It is similar to a lighter period and may be accompanied by moderate abdominal pain as well as a feeling of tiredness or general malaise, all of which gradually ease within a few days. To help you feel protected and to boost your intimate comfort, use pads made from 100% organic cotton with a suitable level of absorbency.

How long does recovery after a uterine curettage take

For most women, the body needs 7 to 14 days to recover fully after a uterine curettage; menstruation usually returns within 3 to 6 weeks. Recovery time can vary, however, depending on your state of health and the reason for the curettage.

Recommendations after a uterine curettage

After a uterine curettage, you should pay particular attention to your body and your intimate hygiene. The aim of these recommendations is to support the healing process and reduce the risk of complications:

• Use gentle, fragrance-free products to maintain careful intimate hygiene.
• Avoid sexual intercourse for at least 10 days after the curettage, or follow your doctor's instructions.
• Avoid strenuous physical activity and taking baths in the first few days after the procedure.
• Arrange a gynaecological check-up 2 to 4 weeks after the procedure to discuss the results of the curettage and monitor your health.

Risks and complications after a uterine curettage

Although uterine curettage is considered a safe medical procedure, there are – as with any gynaecological procedure – rare cases in which it may be associated with certain risks or complications.

Uterine infections after curettage

Infections of the uterus or genital tract are among the most common complications after a curettage, particularly if hygiene instructions or the prescribed course of antibiotics are not followed. They may present as fever, persistent abdominal pain, abnormal bleeding, unusual discharge or an unpleasant odour. Contact your doctor as soon as possible, as in some cases hospital admission may be necessary.

Bleeding and uterine perforation

Heavy bleeding is rare after a curettage, but it can occur if there is injury to the uterine lining.

In very rare cases, perforation of the uterus can occur. Particularly in women who have had several pregnancies or previous uterine surgery, the curette can pierce the uterine wall and cause internal bleeding or even injure neighbouring organs such as the bowel or bladder.

In such cases, further surgery may be needed to put things right.

Intrauterine adhesions – Asherman's syndrome

A rare complication known as Asherman's syndrome involves the formation of intrauterine adhesions. Scar tissue forms inside the uterus, which can lead to light, absent or painful periods and, in some cases, may affect fertility.

Secondary infertility after a uterine curettage

With repeated curettages, or if complications such as injury, intrauterine adhesions or severe infection occur, secondary infertility can develop. In most cases, however, a correctly performed curettage does not affect your ability to conceive.

Uterine curettage and female fertility

Are you worried about the effect a curettage might have on your fertility? While there are situations that can affect the long-term health of your uterus, a procedure performed correctly by qualified medical professionals will not affect your ability to conceive.

The effects of curettage on the endometrium

The lining of the inside of the uterus – the endometrium – is able to regenerate after a curettage. This regeneration normally takes place within a few weeks, with the return of the menstrual cycle, and fertility remains unaffected.

What can happen, however, is that the endometrium becomes thinner or that injury to the uterine lining occurs if curettages are performed frequently or at short intervals. These consequences can indeed make it harder to conceive.

When can you try for a baby again

As a general recommendation, wait at least 2 to 3 complete menstrual cycles after a curettage before trying to conceive again, to allow the endometrium to recover.

The optimum time for a new pregnancy can vary from patient to patient, however, depending above all on the reason for the curettage. So always follow the individual advice given by your gynaecologist.

Risks of repeated curettages

Repeated curettages can increase the risk of intrauterine adhesions, secondary infertility and complications in future pregnancies. It's therefore important that the procedure is only carried out when it is medically necessary, and that it is followed by regular gynaecological check-ups to monitor the health of the uterus.

Alternatives and complementary procedures to uterine curettage

Uterine curettage isn't always the only option available to you. Depending on your situation, symptoms and state of health, as well as on whether the aim is diagnostic or therapeutic, your gynaecologist may recommend less invasive alternatives or additional tests to assess the health of your uterus:

• Diagnostic hysteroscopy: a minimally invasive procedure that allows direct viewing of the uterine cavity using a thin instrument fitted with a video camera – to detect endometrial polyps, submucosal fibroids, intrauterine adhesions or other structural changes. This allows a precise diagnosis to be made without the need for a curettage.
• Transvaginal ultrasound: a routine gynaecological examination often recommended as the first step in investigating abnormal vaginal bleeding, to assess the thickness of the endometrium and the presence of any changes in the uterus or ovaries.

• Medical management to empty the uterus: This treatment stimulates uterine contractions and the expulsion of the uterine contents, and is recommended in situations such as miscarriage or a non-viable pregnancy in order to avoid surgery. This approach isn't suitable for all patients, however, and requires careful monitoring.

  

Frequently asked questions about uterine curettage

Do you have questions about uterine curettage and haven't yet found the answers? Are you facing a curettage for the first time and feeling overwhelmed? Below you'll find concise answers to the most common queries about this procedure, to help you feel better prepared and informed before your next conversation with your doctor.

Is a uterine curettage painful?

Uterine curettage is only ever carried out under local, intravenous or general anaesthetic – precisely so that you don't feel any pain during the procedure. Afterwards, you may experience mild to moderate pain, similar to period cramps, which usually eases within a few days.

How long does a uterine curettage take?

The curettage itself generally takes between 10 and 20 minutes. On top of this, however, there is the time needed for preparation and post-procedure monitoring, so the whole process can take a few hours.

Can a uterine curettage be done as a day case?

Yes, uterine curettage is usually carried out as a day case, without the need for a hospital stay. You can go home the same day provided your general condition is good and there are no complications.

What happens if tissue remains in the uterus after the curettage?

In the rare event that tissue remains in the uterus after the procedure, persistent bleeding, pain or infection can occur. Your doctor may then recommend medication or an additional procedure to empty the uterine cavity completely.

Which tests are needed before a uterine curettage?

As a rule, blood tests such as a full blood count and a coagulation screen are recommended before the procedure, and depending on the case, hormone tests or imaging as well. These serve to assess your general state of health and reduce the risks associated with the procedure.

What should you avoid after a uterine curettage?

Strenuous physical activity, sexual intercourse, baths and the use of tampons should all be avoided for at least 10 days after a uterine curettage – or as advised by your doctor. These measures support proper healing and help prevent complications.

When do periods return after a uterine curettage?

After a uterine curettage, menstruation usually returns after around 3 to 6 weeks, although this can vary depending on the purpose of the curettage and the particularities of each individual body.

How much does a uterine curettage cost in the UK?

On the NHS, a uterine curettage (D&C) carried out for medical reasons is free. Private costs depend on factors such as the type of procedure, the clinic chosen and the type of anaesthetic. In most cases, the cost of the anaesthetic and the histopathological examination is not included in the quoted price. Private prices vary widely between clinics, so ask for an itemised quote that includes the consultation, anaesthetic and any lab tests.

How does a uterine curettage affect fertility?

A correctly performed uterine curettage does not usually affect fertility. Risks generally arise with repeated curettages or with complications such as infection or intrauterine adhesions, which can affect your ability to conceive.

What happens after a repeat uterine curettage?

Curettages repeated frequently or at short intervals can increase the risk of the endometrium becoming thinner, of intrauterine adhesions forming and of secondary infertility developing. For this reason, doctors only recommend this procedure when it is absolutely necessary.

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