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Difference Between Hysteroscopy and D&C

A hysteroscopy is a surgical procedure wherein fibroids or polyps are removed from the cavity of the uterus, while dilation and curettage (D&C) is a surgical procedure for the removal of tissues from the inner lining of the uterus. In D&C, the cervix is dilated and a curette – a spoon-shaped instrument – is inserted into the uterus to remove the tissue. 

In most cases, the procedure of D&C may be performed after hysteroscopy as it allows for a better diagnosis of the tissue. To understand the difference between D&C and Hysteroscopy, we must take a look at them individually. 

 

1] What is Hysteroscopy? 

A Hysteroscopy test is a procedure used for the diagnosis and treatment caused by abnormal bleeding in the uterus. This procedure allows the doctor to look within the uterus with a tool known as a hysteroscope – a thin, lighted tube – which is inserted into the vagina to examine the cervix and the inside of the uterus. The process of hysteroscopy is simple and can be performed under a local as well as a general anaesthetic, depending upon the situation. 

1.1] Two Types of Hysteroscopy

  • Diagnostic hysteroscopy: Diagnostic hysteroscopy is used to detect problems in the uterus. It is also used to confirm the results of other tests such as hysterosalpingography (HSG). HSG is an X-ray dye test used to check the uterus and the fallopian tubes.  

Hysteroscopy can be used with other procedures such as laparoscopy. It can also be used before the D&C procedure. During laparoscopy, the doctor will insert an endoscope, which is 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 tissues post-miscarriage from within the uterus. Gynaecologists also use it to diagnose and treat certain uterine conditions such as heavy bleeding. Additionally, it is used to clear the lining of the uterus post-miscarriage or abortion

During dilation and curettage, the gynaecologist uses small instruments to dilate the cervix and a curette to remove uterine tissue. 

  • 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 between the two. Sometimes hysteroscopy with dilation & curettage of the uterus is carried out simultaneously for treatment. 

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?

A D&C is performed after a miscarriage post the 10th week of pregnancy. If the miscarriage occurs before 10 weeks, it happens naturally without causing any problems. But after the 10th week, there is a higher possibility of an incomplete miscarriage. In such cases, a D&C procedure is performed to ensure the uterus is clear of any pregnancy remains in the form of tissues.  

  • D&C is performed to prevent infection or heavy bleeding by clearing out tissues that remain within the uterus post a miscarriage or abortion. 
  • It is performed to remove the formation of the tumour instead of a typical pregnancy.
  • It is also performed to remove non-cancerous cervical or uterine polyps. 

3.3] How is Hysteroscopy Performed?

  • The first step of hysteroscopy is to open the canal of the cervix with a series of dilators. 
  • Post dilation, a hysteroscope is passed through the cervix into the lower end of the uterus. 
  • 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 Hysteroscopy 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 

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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