Dilatation and Curettage for the treatment of Menorrhagia or for Diagnostic purposes
Q10 Curettage of uterus
Q101 Dilation of cervix uteri and curettage of products of conception from uterus
Q103 Dilation of cervix uteri and curettage of uterus NEC
Q108 Other specified curettage of uterus
Q109 Unspecified curettage of uterus
Dilation and Curettage (D&C) is a procedure performed under general anaesthetic in which the lining of the uterus (the endometrium) is biopsied (diagnostic D&C) or removed (therapeutic D&C) by scraping with a sharp metal instrument (curette) in a systematic fashion.
This commissioning policy is needed because these surgical procedures are of limited clinical value and are currently not routinely commissioned. Such requests therefore have to be made on the grounds of clinical exceptionality via the Individual Funding Request Panel (IFR).
NHS Scarborough and Ryedale and Vale of York CCGs do NOT commission D&C:
- As a diagnostic tool for uterine bleeding disorders
- As a treatment for heavy menstrual bleeding
- As a therapeutic treatment for other uterine bleeding disorders
- As a method of removing unwanted tissue, endometrial polyps or benign tumours from the womb or an IUD that has become embedded in the wall of the womb
All requests for D&C should be submitted to the IFR Panel.
Summary of evidence
Diagnostic D&C: Ultrasound (1st line) or hysteroscopy (with or without biopsy) (2nd line) are recommended as diagnostic techniques to investigate uterine bleeding disorders. Hysteroscopy and biopsy is also the preferred technique to remove polyps and other benign lesions, as it allows targeted removal. If a tissue sample is required and there is no lesion visible on a scan then an endometrial biopsy may be done.
Therapeutic D&C: There is limited evidence on the effectiveness of D&C in the management of menorrhagia. The one study that was identified by NICE showed that any effect was temporary. NICE guidance states that D&C should not be used as a therapeutic treatment.
Evacuation of retained products of conception (ERPC): where surgical evacuation after incomplete miscarriage or delivery is clinically indicated over medical management and watchful waiting, vacuum aspiration has superseded D&C as it is quicker, safer, easier and less painful.
Gestational trophoblastic disease: Suction/vacuum curettage is the preferred method of evacuation irrespective of uterine size in patients with suspected hydatidiform mole who want to preserve fertility