Diagnosis of Heavy Bleeding: How D&C With Hysteroscopy Can Help

Experiencing heavy periods is tough for most women as they can be painful and stressful. The medical term for heavy periods is ‘Menorrhagia’, wherein women often experience abnormally heavy or prolonged menstrual bleeding, occasionally even heavy bleeding with clots.

To treat the causes of heavy periods, hysteroscopy is often performed using a hysteroscope – a thin, lighted tube that is inserted in the vagina to examine the cervix and the inside of the uterus. A women’s healthcare specialist may also use hysteroscopy to take a tissue/lining sample to perform a biopsy or remove fibroid tumours.

1] Causes of Heavy Bleeding

• Hormonal imbalance: A healthy balance between the estrogen and progesterone hormones is vital for a regular menstrual cycle. If there is an imbalance, the condition can lead to excessive build-up of the endometrium – the lining of the uterus – causing heavy menstrual bleeding.
• Polycystic Ovaries (PCOS): One of the common Menorrhagia causes, PCOS is a hormonal condition that causes severe hormonal imbalance, resulting in a heavy period with clots.
• Thyroid Dysfunction: One of the major reasons for heavy periods is thyroid dysfunction. Hypothyroidism or under-active thyroid can lead to heavy bleeding, as without sufficient thyroid hormone, the body can’t produce the protein to help with blood clots.
• Endometriosis: It is another factor that can lead to long, painful, and heavy periods. Endometriosis is a reproductive disorder, wherein the tissue lining inside the uterus starts growing on the outside. This can cause cysts and other problems.
• Fibroids: Uterine Fibroids are benign tissue growths that form either within, inside, or outside the woman’s uterus. They can lead to heavy and painful menstrual bleeding, sometimes full of clots.
• Uterine Polyps: Polyps are also non-cancerous growths that develop within or on the lining of the uterus (also referred to as endometrium). They are known to induce heavy bleeding. They are likely to cause heavy bleeding between periods or after sexual intercourse.

Further Reading: Difference Between Hysteroscopy and D&C

2] Operative Hysteroscopy and Dilation and Curettage Procedure

2.1] What is Operative Hysteroscopy?

A Hysteroscopy test allows doctors to visualise the uterine canal and uterus with an endoscope. During the procedure, the doctor examines and inspects the pelvic area for abnormal changes. Hysteroscopy can often be a part of the diagnosis process for an operative procedure.

An operative hysteroscopy is performed to find and treat problems within the uterus i.e. remove growths from the uterus, to treat fertility problems or abnormal bleeding.

In operative hysteroscopy, an optical lens is inserted through the cervix. The optical lens is used to view the inside of the uterus. Small instruments are then passed through the hysteroscope to treat the medical condition.

When is Operative Hysteroscopy Performed?

Operative hysteroscopy is needed to correct the following conditions:

• Fibroids and polyps
• Asherman syndrome
• Septums or a malformation of the uterus
• Abnormal bleeding
• Blockage of the fallopian tube
• Removal of fetal tissues after the termination of a pregnancy

2.2] Dilation and Curettage Overview

Dilation and curettage (D&C) is a procedure performed to remove tissues from inside the uterus. Healthcare providers often perform dilation and curettage to detect, diagnose and treat certain uterine conditions like abortion, and cleaning the uterine lining after an abortion, miscarriage or heavy periods.

In a dilation and curettage, the healthcare professional uses small instruments to dilate the lower narrow part of the uterus or the cervix. The provider then uses a surgical instrument known as a curette to remove the uterine lining or the uterine tissue.

Dilation and Curettage (D&C) Procedure

When a D&C procedure is performed to treat the condition, a healthcare professional removes the contents from inside the uterus. This is done to prevent infection or excessive bleeding. D&C is used to:

• Remove tissues that are in the uterus after miscarriage or abortion.
• Remove a tumour formed inside of a typical pregnancy.
• Treat excessive bleeding after delivery by clearing out the placenta that remains in the uterus.
• Remove benign cervical polyps.

3] Using D&C and Operative Hysteroscopy For Diagnosing and Treating Heavy Periods

Before performing a D&C, the healthcare provider may recommend an endometrial biopsy or endometrial sampling to identify and diagnose the cause. Endometrial sampling is performed if:

• there is unusual uterine bleeding
• there is bleeding after menopause
• unusual endometrial cells are discovered during a routine test for cervix cancer

During the test, the healthcare provider collects the tissue sample from the uterus lining, known as endometrium, and sends the sample for lab testing. The test is conducted to check:

• Endometrial intraepithelial hyperplasia
• Uterine polyps
• Uterine cancer

3.1] Using D&C For Diagnosis of Heavy Periods

The D&C is a relatively minor procedure and can be done like a day surgery. However, general anaesthesia is usually administered. A typical D&C procedure includes the following steps:

• After the anaesthesia is administered, the uterus is examined to identify and determine its size and position.
• A general inspection of the vulva is performed
• A speculum is inserted to examine the walls of the vagina
• The cervix is then gently widened using surgical dilators. This enables the healthcare professional to take samples from the uterus lining.
• The samples are then sent to the lab for investigation

3.2] Using D&C with Hysteroscopy For Treating Heavy Periods

A D&C can often be combined with other procedures such as hysteroscopy.

• In hysteroscopy, a slim instrument, with a light and a camera, is inserted into the vagina through the cervix.
• The healthcare provider then views the uterus lining on a screen to check for areas that may look unusual.
• They also check for cervical polyps and take uterus tissue samples if required.
• During hysteroscopy, polyps or fibroid tumours can be removed.

Read: How To Stop Heavy Periods

4] Risks of D&C with Hysteroscopy Procedure

Just like any other surgical procedure, complications may occur in a hysteroscopy with D&C. Some possible complications that may arise, but are not limited to, are as follows:

• Bleeding
• Infection
• Pelvic inflammatory disorder
• Damage to the cervix or tearing of the uterus
• Complications from the fluid used to expand the uterus

A. Perforation of the uterus: This occurs if a surgical instrument pokes a hole in the uterus. While most perforations heal on their own, if a blood vessel or an organ is damaged, a second procedure might be required to repair the damage.

B. Scar tissue on the uterine wall: A D&C procedure may result in the development of scar tissue in the uterus. This condition is known as Asherman’s syndrome. It happens when the D&C procedure is performed after a miscarriage or delivery.

C. Damage to the cervix: If the cervix gets torn during the D&C procedure, the healthcare professional can apply pressure to stop the bleeding or close the wound with stitches. However, this can be prevented if the cervix is softened with medication prior to the procedure.

If the patient encounters any of the following symptoms after the D&C procedure, it is advisable to consult the healthcare provider:

• Excessive bleeding due to which the patient has to change pads every hour
• Cramps that last more than 48 hours
• Fever or dizziness
• Foul-smelling discharge from the vagina

Certain risks that may interfere with a hysteroscopy include the following:

• Pelvic inflammatory disease/disorder
• Vaginal discharge
• Inflamed cervix
• Distended bladder

5] Recovery from the D&C with Hysteroscopy Procedure

The doctor or surgeon will most likely guide you after the procedure. However, general suggestions or precautions include:

• Minor abdominal discomfort or cramping is often considered usual after a procedure. However, consult with the doctor if you have severe pain.
• Take prescribed medication When taking medication, it is advised to complete the course.

The recovery period after the procedure often ranges between 2 to 3 days and most patients can go home the same day. However, if the patient had an anaesthetic, they may be required to stay in the hospital for a few hours until the anaesthesia wears off.

After the D&C procedure:

• Use sanitary napkins instead of tampons
• Avoid sexual intercourse (for at least two weeks)
• Avoid activities like swimming

It is normal to experience light bleeding. Most women are likely to pass small blood clots after the procedure for a few days others may experience light bleeding for several weeks. The D&C hysteroscopy can also cause side effects, including back aches or menstrual cramps. Fatigue is also a common side effect of the procedure due to blood loss.

Most women can return to normal activities like work the same day. However, it is advisable to take a few days off work to rest, particularly if the treatment included fibroid removal. The surgeon will advise you about the activities to avoid while you recover.

• You can eat and drink as normal
• You can also take a shower on the same day or a bath the next day

If the patient experiences any signs of infection, fever or pain, it is advisable to consult with the doctor immediately. Also, unless the doctor advises you differently, it is best to stick to the recovery plan as suggested.

Further Reading: Dilation and Curettage (D & C): All You Need To Know

Neha Goel

Neha Goel, a Psychology alumna and MBA graduate from CASS Business School, London, brings together her expertise as a Reiki Practitioner and Practice Manager. She integrates psychology and business strategies to foster holistic well-being and personal development.