Difference Between Hysteroscopy and D&C

Hysteroscopy and D&C (dilation and curettage), are investigative tests to identify and diagnose conditions in the uterus. While these are often used interchangeably, they are not the same. Doctors get a clear view of the uterus during hysteroscopy with the use of a telescope-like instrument called a hysteroscope. A hysteroscope can only diagnose the issue; what usually follows is a D&C. It’s a minimally invasive surgical procedure used to remove damaged or harmful tissue in the uterus. In this blog, we’ll take a closer look at understanding the main difference between hysteroscopy and D&C, their benefits, side effects, and which option your condition needs. 

1] What is Hysteroscopy? 

A hysteroscopy test is a procedure mainly used to diagnose and treat various conditions in the uterus. For example, hysteroscopy for fibroids, abnormal bleeding, fertility issues, biopsy tissue material, and IUD removals are done using the hysteroscope. The procedure allows doctors to take a closer look at the uterus’ walls, cavity, cervix, and the inner lining. It’s a simple process done under local anaesthesia or general anaesthesia, depending on the type of procedure. The two types are:

1.1] Two Types of Hysteroscopy

• Diagnostic Hysteroscopy: Being more effective than ultrasound, diagnostic hysteroscopy is mainly used to evaluate the uterus. The doctor can look for abnormalities and easily conduct a biopsy, if needed. This is not a surgical procedure, but it offers a better explanation for infertility, sudden bleeding, or pain. Most times, it is paired with other procedures:
  • To confirm results of hysterosalpingography (HSG), an x-ray dye test is used to check the uterus and fallopian tubes.
  • During laparoscopy, where the doctor inserts a slender tube fitted with a fiber-optic camera that can view the outside of the uterus, ovaries, and fallopian tubes. 

• Operative hysteroscopy: Operative hysteroscopy is used to correct an abnormal condition that might have been detected during a diagnostic hysteroscopy. During operative hysteroscopy, small instruments are used for treatments and are inserted via the hysteroscope. 

1.2] Hysteroscopy and Mirena

Now that we know the types, it is also important to know that in the UK, hysteroscopy and Mirena are more common than hysteroscopy and D&C. 

Mirena plus hysteroscopy is an excellent non-surgical alternative for the treatment of menorrhagia. Moreover, its effects are reversible. Plus, it has proved to be an effective contraceptive. 

On the completion of hysteroscopy, the Mirena coil can be inserted. Or hysteroscopy can be performed efficiently and successfully with a Mirena IUD in place. The advantages of which include flexibility in the timing of the procedure, increased likelihood of a proper follow-up, and assurance of contraception until the confirmation of tubal occlusion. 

2] What is D&C? 

Dilation and curettage (D&C) is a procedure to remove abnormal or unnecessary tissue from the uterus. During dilation and curettage, the gynaecologist uses small instruments to dilate the cervix and a curette to remove uterine tissue. Gynaecologists also use it to treat certain uterine conditions such as heavy bleeding, namely menorrhagia. Additionally, it is used to clear the lining of the uterus post-miscarriage or abortion.

• You’ll be made to lie on your back on an exam table with your feet in the stirrups. 
• The gynaecologist will insert a speculum into the vagina to check the cervix. 
• The cervix is then dilated with the help of a thin rod-like structure. 
• Post dilation, the gynaecologist will insert a curettage to remove the uterine tissue. 

You shall either be unconscious or sedated during the procedure, as a result of which you wouldn’t feel any discomfort.

3] What is the Difference between Hysteroscopy and D&C? 

While the terms hysteroscopy and D&C are often used interchangeably, there are a few significant differences: 

Hysteroscopy is a targeted procedure, while during a D&C, doctors go in blind. Sometimes hysteroscopy with dilation & curettage of the uterus is carried out simultaneously for treatment, but they don’t always need to be.

3.1] When is Hysteroscopy Performed?

A hysteroscopy is performed to investigate problems or symptoms including heavy periods, post-menopausal bleeding, pelvic pain, difficulty getting pregnant and repeated miscarriage. It is also used to diagnose conditions such as fibroids and polyps. A hysteroscopy is performed to treat the following uterine conditions: 

• Polyps and fibroids: Hysteroscopy is used to remove non-cancerous growths found in the uterus.
• Adhesions: Also known as Asherman’s syndrome, uterine adhesions are bands of scar tissue that can form within the uterus leading to changes in the menstrual flow. It can also cause infertility. A hysteroscopy test can help the doctor locate and remove these adhesions.
• Septums: Hysteroscopy can help detect and determine if you have a uterine septum, which is a malformation of the uterus present since birth.
• Abnormal bleeding: Hysteroscopy can help identify the cause of abnormal or heavy menstrual flow as well as bleeding between period cycles. 
• Endometrial ablation: For this, a hysteroscope along with other instruments is used to deplete the uterine lining to treat the causes of heavy bleeding. While a dilation and curettage are performed to diagnose and treat conditions. In cases of diagnosis, the requisites are similar to that of hysteroscopy. 

3.2] When is D&C Performed?

D&C is a procedure performed when the doctor must collect a tissue sample from the cervix to diagnose a certain condition. It is also performed in case of an incomplete miscarriage or abortion, to extract the tissue and prevent infection. D&C is a must if your miscarriage happens after the tenth week of pregnancy. Besides these, the procedure is also performed:

• To remove non-cancerous cervical or uterine polyps.
• To remove the abnormal molar tissue growing in the uterus instead of a baby. This condition is called molar pregnancy. 
• To treat heavy bleeding by removing the lining of the uterus. 

D&C is not the only option to treat such conditions. Contact a trusted gynaecologist in London to find effective alternatives for your condition. 

3.3] How is Hysteroscopy Performed?

• The first step of hysteroscopy is to open the canal of the cervix with a series of dilators. 
• After dilation, the gynaecologist will insert a curette to remove the uterine tissue. 
• Post this, a clear solution is injected into the uterus via the hysteroscope. This solution expands the uterine cavity, clearing the blood and mucus, which enables the doctor to view the internal structure of the uterus more clearly. 

3.4] How is D&C Performed

• The doctor will insert a speculum into the vagina to open the cervix. 
• A clamp is used to hold the cervix in place, and a small instrument is used to dilate the cervix.
• A curette is used to clean out the tissue from the uterus.
• If needed, sample tissue is sent to a laboratory for further analysis.

3.5] What are the benefits of Hysteroscopy and D&C?

The following are the benefits of a hysteroscopy: 

• A shorter hospital stay
• Lesser recovery time
• It is better than hysterectomy and open abdominal surgery
• Fewer painkillers are needed post-surgery

The benefits of a D&C procedure include:

• Minimal physical pain 
• Complete removal of pregnancy remains
• Doesn’t affect future pregnancies
• Short and minimally-invasive procedure 
• Lowers presence of certain risks after miscarriage

3.6] What are the side effects of Hysteroscopy and D&C?

Just like any surgical procedure, there are side effects of D&C and hysteroscopy.

The possible side effects of hysteroscopy are: 

• Infection and bleeding 
• Inflammatory disease in the pelvic region
• Tearing of the uterus or damage to the cervix; both of which are rare
• Complications arising from the fluid or gas used to expand the uterus

The possible side effects of D&C include: 

• Heavy bleeding and infection
• Perforation of the bowel or wall of the uterus
• Development of adhesions (scar tissue) within the uterus 

Side effects are not common when you get the procedure done at a reliable clinic. Consult our private gynaecologists for medical termination of pregnancy or other symptoms for safe treatment. 

Conclusion

While there are certain differences as well as similarities between hysteroscopy and D&C procedures, the effectiveness of both being carried out one after the other has provided successful results. 

Hysteroscopy is a diagnostic procedure, which is also used for the correction of certain uterine conditions ranging from septums to polyps. Dilation and curettage are mostly carried out post a miscarriage to ensure complete removal of pregnancy remains that can be harmful to the women’s body in future. 

Both of these procedures are low-risk and minimally invasive. However, it is imperative to know pre-requisites, such as no consumption of food or fluid on the day of the procedure. Ensure you consult with an experienced specialist in London to discuss the risks and benefits as well as the particulars of the same. 

Update them of your medical history and allergies (if any) and discuss the medications you are currently taking, including the name and frequency of the same.

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Mr Nilesh Agarwal

Mr Nilesh Agarwal (GMC: 6059455) is a highly esteemed consultant gynaecologist based in London, specialising in high-risk obstetrics, minimal access surgery, and fertility. With over 20 years of international experience, he provides comprehensive, patient-centred care for conditions including endometriosis, fibroids, and polycystic ovaries. Known for his holistic approach and clinical excellence, Mr Agarwal is dedicated to empowering women through tailored treatments. He currently practises at leading institutions, including the Clementine Churchill Hospital and the Hospital of St John & St Elizabeth.