Dilation and Curettage (D&C) is a brief surgical procedure performed to remove tissue from the inside of the uterus. Seeing blood clots after a medical procedure can be alarming, but post-D&C clotting is a common and expected part of the body’s natural recovery. The presence of clots indicates the body is managing the temporary wound created inside the uterine cavity. Understanding the procedure and subsequent healing steps offers reassurance during recovery.
Understanding the D&C Procedure
A D&C is performed for various reasons, including diagnosis of abnormal bleeding or, more frequently, to clear the uterine lining after a miscarriage or abortion. The procedure involves dilating, or gently opening, the cervix, which is the narrow passageway connecting the vagina to the uterus. Once the cervix is open, a surgeon uses a curette or a suction device to remove the tissue lining the uterus, known as the endometrium. The goal is to ensure the uterine cavity is clear of any tissue that could cause infection or excessive bleeding later on.
This process is essentially a controlled, therapeutic scraping or vacuuming of the uterine surface. Because the procedure directly removes tissue, the uterus is left in a state similar to the beginning of a menstrual period, but on a larger scale. The body must then begin the process of repairing the affected inner layer. This necessary cleaning of the uterine cavity sets the stage for the bleeding and clotting experienced during the recovery period.
The Physiological Reason for Post-Procedure Clotting
The passage of blood clots is a direct result of the body’s response to the tissue removal, which involves a three-part healing process. First, the procedure creates a temporary wound where the endometrial tissue was detached, exposing numerous small blood vessels. The body’s immediate response to this exposure is hemostasis, or blood coagulation, where blood components form clots to seal the vessels and prevent excessive blood loss. These initial clots are then naturally expelled from the body.
Second, the uterus begins muscular contraction, similar to menstrual cramps, working to return to its pre-procedure size. These contractions serve two purposes: they help compress blood vessels to limit bleeding, and they physically push out any remaining blood, fluid, or small pieces of tissue. This expulsion of material often presents as the visible blood clots.
Third, the procedure may not remove the entire decidua, the specialized, thickened uterine lining of pregnancy. Remaining portions of this tissue must be shed as the body resets its hormonal balance and prepares to rebuild the endometrial layer. This shedding mixes with blood and coagulated material, contributing to the volume and texture of the clots passed in the days and weeks following the procedure. The presence of these expelled materials confirms that the uterus is actively cleaning and healing itself.
Distinguishing Normal Clotting from Concern
A certain degree of clotting is expected and usually harmless. In the first few days post-procedure, it is common to pass small to medium-sized clots, often described as the size of a grape or a plum. The discharge consistency may vary, ranging from bright red blood immediately after the D&C to darker, brownish discharge, which indicates older blood.
The bleeding pattern frequently involves light spotting right after the D&C, followed by an increase in flow and clotting a few days later. This secondary increase often corresponds with the body’s delayed efforts to shed residual tissue and contract the uterus. Over time, the size and frequency of the clots should decrease, transitioning back to light spotting before stopping completely, typically within two weeks.
Blood that flows too quickly to allow for coagulation remains liquid. However, blood that pools inside the uterus for a short time forms a clot before being expelled. Passing a small number of clots is generally a sign of healthy uterine healing and cleansing. The physical characteristics of the expelled material, particularly its size, are the most useful indicators of normal progression.
Monitoring and When to Contact a Healthcare Provider
While clotting is normal, certain signs indicate excessive bleeding requiring medical evaluation. Heavy bleeding that saturates more than two maxi-pads in an hour for two consecutive hours is a warning sign. This volume suggests the body’s natural clotting mechanisms are not effectively controlling blood flow.
The size of the passed clots is another important measure. Clots consistently larger than a golf ball or a lemon are outside the expected range and should be reported. These large clots may indicate the uterus is not contracting adequately or that significant residual tissue remains.
In addition to bleeding volume and clot size, systemic symptoms also warrant immediate attention. These symptoms can be signs of an infection or other complication, and prompt medical attention is necessary to ensure a smooth recovery.
Warning Signs
- Developing a high fever.
- Experiencing severe abdominal pain not relieved by over-the-counter medication.
- Noticing a foul-smelling vaginal discharge.