Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Most D&Cs are done under general anesthesia. The procedure is typically very short, and the general anesthetic can be quickly reversed, with the patient going home later the same day. Some patients prefer or require spinal or epidural blocks, but these forms of anesthesia take more time for the anesthesiologist to perform and require more recovery time for the patient. Occasionally, in a very motivated patient, the procedure can be done under a local anesthetic with or without intravenous pain medication or
twilight sleep. Overall, the choice of anesthetic is a generally determined by the anesthesiologist and the patient. The surgeon performing the procedure only requires that the patient not move during the surgery.
How is a D&C performed?
The actual procedure is done in an operating room, either in a hospital, surgery center, or a specially designated room in a physician's office. After adequate anesthesia has been administered, and with the patient in position (similar to that for a
Pap smear), the vagina and cervix are cleansed with an antibacterial scrub (usually Betadine). An instrument is used to grasp the upper portion of the cervix, and then the opening to the uterus is gradually widened with metal dilators to about the size of a large pencil.
Once the dilation has been completed, the curette, which is an instrument with a flat metal loop at the end, is inserted into the uterine cavity and is used to gently scrape the lining of the uterus. When the surgeon feels the gritty layer of cells just above the muscle of the uterus, then he/she knows that the scraping has gone deep enough to sample the tissue adequately. This scraping is done throughout the uterus, and the tissue that is removed is then sent to a pathologist for microscopic examination.
After the surgeon feels that enough tissue has been obtained, that the entire uterine cavity has been sampled, or that any abnormal growths that were seen on ultrasound were removed, then the procedure is stopped. Often, the doctor uses a viewing instrument to examine the uterus visually (hysteroscopy) prior to the D&C to make the procedure more complete. This is not, however, always necessary.
Endometriosis is the growth of cells similar to those that form the inside of the uterus, but in a location outside of the uterus. Endometriosis implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They can also be found in the vagina, cervix, and bladder. Treatment of endometriosis can be with medication or surgery.
Though uterine cancer's cause is unknown, there are many factors that will put a woman at risk, including: over age 50, endometrial hyperplasia, using hormone replacement therapy, obesity, using tamoxifen, being Caucasian, having colorectal cancer. Symptoms of cancer of the uterus (endometrial cancer) include abnormal vaginal bleeding, painful urination, painful intercourse, and pelvic pain. Treatment depends on staging and may include radiation therapy or hormone therapy.
Menopause is the time in a woman's life when menstrual periods permanently stop, also called the “change of life." Menopause symptoms include hot flashes, night sweats, irregular vaginal bleeding, vaginal dryness, painful intercourse, urinary incontinence, weight gain, and emotional symptoms such as mood swings. Treatment of menopausal symptoms varies, and should be discussed with your physician.
Normal vaginal bleeding (menorrhea) occurs through the process of menstruation. Abnormal vaginal bleeding in women who are ovulating regularly most commonly involves excessive, frequent, irregular, or decreased bleeding. Causes of abnormal may arise from a variety of conditions.
A miscarriage is any pregnancy that ends spontaneously before the fetus can survive. Miscarriage usually occurs before the 13th week of pregnancy. The cause of a miscarriage cannot always be determined. The most common causes of a miscarriage in the first trimester are collagen vascular disease (lupus), hormonal problems, diabetes, chromosomal abnormalities, and congenital abnormalities of the uterus.
Uterine fibroids are benign tumors that originate in the uterus and are usually round or semi-round in shape. The most common symptom of a uterine fibroid is abnormal vaginal bleeding. Other symptoms include pressure, pelvic pain, pressure on the bladder, or pain during a bowel movement. Treatment options vary from surgery to medication.
Benign uterine growths are tissue enlargements of the female womb (uterus). Three types of benign uterine growths are uterine fibroids, adenomyosis, and uterine polyps. Symptoms include: abdominal pressure, pelvic pain, and pain during intercourse. Diagnosis and treatment of benign uterine growths depends upon the type of growth.
Amenorrhea is a condition in which there is an absense of menstrual periods in a woman. There are two types of amenorrhea, 1) primary and 2) secondary. Treatment of amenorrhea depends on the type (primary or secondary). In prmiray, surgery may be an option and in secondary amenorrhea medication or lifestyle changes may be treatment options.
Menstruation (menstrual cycle) is also referred to as a "period." When a woman menstruates, the lining of the uterus is shed. This shedding of the uterine linking is the menstrual blood flow. The average menstrual cycle is 28 days. There can be problems with a woman's period, including heavy bleeding, pain, or skipped periods. Causes of these problems may be amenorrhea (lack fo a period), menstrual cramps (dysmenorrhea), or abnormal vaginal or uterine bleeding. There are a variety of situations in which a girl or woman should see a doctor about her menstrual cycle.
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