Hysteroscopy and dilation and curettage (D&C) are common gynecological procedures involving the uterus. While both address uterine conditions, they are distinct in purpose and method. Understanding their differences clarifies why a doctor might recommend one over the other.
What is a Hysteroscopy?
A hysteroscopy uses a thin, lighted tube (hysteroscope) inserted through the vagina and cervix. This instrument has a camera at its tip, providing a direct view of the uterine lining on a screen.
The primary purpose of hysteroscopy is to diagnose and sometimes treat uterine conditions through direct visualization. It enables the identification of abnormalities such as polyps, fibroids, or scar tissue within the uterus. This procedure can be diagnostic or operative, allowing for the removal of identified issues.
What is a D&C?
Dilation and curettage (D&C) is a procedure that involves widening the cervix and then removing tissue from the uterine lining. This removal is typically done by gently scraping with a spoon-shaped instrument called a curette, or by using suction.
The main goal of a D&C is to remove tissue from the uterus, either for diagnostic examination or for therapeutic reasons. For instance, it can be performed after a miscarriage to clear the uterus or to address abnormal uterine bleeding by removing thickened tissue. The collected tissue is then sent to a laboratory for analysis.
Key Differences
A fundamental distinction lies in their primary purposes: hysteroscopy is about direct visualization, while D&C focuses on tissue removal. A D&C is traditionally a blind procedure, meaning the doctor removes tissue without direct visual guidance, though it can sometimes be performed with hysteroscopic assistance.
Instrumentation also differs; hysteroscopy employs a camera-equipped hysteroscope, whereas a D&C uses dilators to open the cervix and a curette or suction device to collect tissue. Hysteroscopy offers precision, allowing for targeted removal of specific growths under direct observation. A D&C typically samples or removes tissue more broadly from the uterine lining.
Why Doctors Choose One Over the Other
The choice between hysteroscopy and D&C depends on the specific symptoms, suspected condition, and overall goal of the procedure. Hysteroscopy is recommended when direct visualization is needed to identify or precisely remove uterine structural issues.
This includes investigating abnormal bleeding to find polyps, fibroids, or scar tissue, as well as locating lost intrauterine devices (IUDs). It is also used in infertility evaluations to identify uterine abnormalities that might affect conception.
A D&C is chosen when the primary need is to remove tissue from the uterus. Common situations include managing a miscarriage to ensure all pregnancy tissue is cleared, or therapeutically removing thickened uterine lining that causes heavy or prolonged bleeding. While a D&C can provide tissue for diagnosis, hysteroscopy with directed biopsy is often more effective at detecting specific uterine lesions. For certain conditions, like retained products of conception, hysteroscopic removal can be beneficial.