Have you recently experienced unusual vaginal bleeding, discomfort, or other worrisome symptoms, and your gynecologist has recommended a uterine curettage? Don't be scared, curettage isn't just used for abortions.

This procedure is performed more frequently than you might think, as it can help identify conditions or imbalances that cannot be detected during a regular check-up. In this article, we explain what curettage involves, when it is recommended, and everything you need to know before the procedure.

What is uterine curettage?

Uterine curettage is a gynecological procedure that removes part of the uterine lining (endometrium) or the contents of the uterine cavity. During the procedure, a special spoon-shaped instrument, called a curette, is used to harvest or remove uterine tissue in a controlled manner.

The procedure can be performed for therapeutic or diagnostic purposes in situations related to the health of the uterus, under local or general anesthesia, most often on an outpatient basis, without the need for prolonged hospitalization.

Types of uterine curettage

Depending on the reason it was recommended and the objective of the procedure, there are several types of uterine curettage:

• Biopsy curettage (diagnostic): involves the collection of uterine tissue that will later be analyzed under a microscope during the histopathological examination, in order to determine the causes of abnormal uterine bleeding or to confirm certain endometrial conditions.
• Therapeutic uterine curettage: consists of removing affected tissues or debris from the uterine cavity, such as those left after a pregnancy termination.
• Hemostatic uterine curettage: is recommended in cases of severe uterine bleeding and aims to quickly stop the bleeding by removing excess tissue.
• Fractional uterine curettage: involves the separate collection of tissue from the cervix and uterine cavity, for a more precise assessment of any possible changes.

The purpose of uterine curettage

There are two main purposes for which a uterine curettage may be performed:

• Diagnosis : to detect the causes of abnormal uterine bleeding, polyps or fibroids, as well as to rule out more serious conditions, such as endometrial cancer.
• Therapeutic: with the aim of restoring uterine health and preventing complications after a miscarriage or a pregnancy that has stopped developing, by removing uterine remnants.

When is uterine curettage recommended?

Uterine curettage may be recommended in several situations, always with the aim of identifying or remedying a specific gynecological problem. It is performed at the suggestion of the gynecologist, usually in one of the following situations:

Uterine curettage after spontaneous or incomplete abortion

This is probably the context in which you have most often heard of curettage, namely spontaneous or incomplete abortion . Following such an incident, placental remnants or embryonic tissue may remain in the uterine cavity, which can cause complications such as infections, heavy bleeding, or persistent pain. For preventive purposes, it is recommended to remove the remnants by uterine curettage.

Uterine curettage for pregnancy termination

There are situations when an abortion is necessary, for example in the case of an unwanted pregnancy or a fetal anomaly. Abortion by curettage of the uterus is the surgical method of terminating such pregnancies, usually in the first 12-14 weeks. The procedure is considered effective and safe and consists of the complete removal of the uterine contents.

Uterine curettage in case of abnormal vaginal bleeding

Uterine curettage may be recommended to determine the cause of abnormal vaginal bleeding, whether heavy, prolonged or present outside of menstruation. During the procedure, endometrial tissue is harvested which, through histological analysis, will allow the identification of possible hormonal imbalances, polyps, uterine fibroids, endometrial hyperplasia or other uterine mucosal disorders.

Uterine curettage for oncological diagnosis

For patients with suspected endometrial cancer, hyperplasia, or benign conditions, uterine curettage can be used in the diagnostic process to collect tissue samples for biopsy.

How is the uterine curettage procedure performed?

Uterine curettage is a relatively short procedure with a reduced recovery time, which consists of dilating the cervix and removing the superficial layer of the endometrium. The intervention is preceded by a preparation stage which in turn involves a series of medical tests and the choice of the type of anesthesia.

Preparing for uterine curettage

To ensure that the procedure will be performed safely, your doctor will initially recommend a series of investigations. Usually, blood tests such as a complete blood count and a coagulogram are performed, and in some cases, certain hormonal tests may also be performed.

Also during the preparation phase, you will be explained in detail what the procedure entails, what the risks and benefits are, and how you should prepare, after which you will sign the informed consent.

The next step is to choose the type of anesthesia and inform your anesthesiologist if you are undergoing any treatment, if you have had previous surgeries, or if you suffer from allergies or other known conditions. Depending on your medical indications, the type of curettage, and your preferences, you will be able to opt for local, general, or intravenous anesthesia.

The doctor may also recommend that you not consume any solid food or liquids for at least 6-8 hours before the procedure.

Stages of uterine curettage

The actual procedure begins with the dilation of the cervix, which is done gradually with the help of progressive dilators.

Once the cervix is sufficiently dilated, the doctor inserts a curette or suction cannula into the uterine cavity and removes the tissue that lines it (the endometrium). The entire procedure is performed under anesthesia, so you will not feel any pain during it.

If the curettage is performed for diagnostic purposes, this tissue is subsequently sent to the laboratory for histopathological examination.

Duration and conditions of hospitalization

Uterine curettage is a short procedure that usually takes between 10 and 20 minutes. In most cases, overnight hospitalization is not required, and the patient can be discharged the same day.

Recovery after uterine curettage

Uterine curettage is commonly performed, and is considered safe and effective in most cases, with a short recovery period. However, as with any surgery, there is a risk of rare complications. It is important to know what symptoms are normal after the procedure and how long it should take for them to go away, so that you know when to seek medical advice.

Normal symptoms after uterine curettage

It is normal to experience light to moderate bleeding in the first few days after curettage. This is similar to a lighter period and may be accompanied by moderate abdominal pain and a feeling of fatigue or general discomfort that will gradually improve over a few days. To feel protected and increase your level of intimate comfort, use 100% organic cotton pads with an appropriate absorbency.

How long does recovery take after uterine curettage?

For most women, it takes 7 to 14 days for the body to fully recover from a hysterectomy, and menstruation usually returns within 3 to 6 weeks. However, recovery time can vary depending on each woman's health and the reason for the hysterectomy.

Recommendations after uterine curettage

It is advisable to pay special attention to your body and intimate hygiene following a uterine curettage. The purpose of these recommendations is to support the healing process and reduce the risk of complications:

• Use gentle, fragrance-free products to maintain rigorous intimate hygiene.
• Avoid sexual contact for at least 10 days after curettage, or as directed by your doctor.
• In the first few days after the procedure, avoid intense physical exertion and baths.
• Schedule a gynecological check-up 2-4 weeks after the procedure to check the results of the curettage and monitor your health.

Risks and complications after uterine curettage

Even though uterine curettage is considered a safe medical procedure, there are rare cases in which it may be associated with certain risks or complications, just like any gynecological intervention.

Post-curettage uterine infections

Uterine or genital tract infections are one of the most common complications after a hysterectomy, especially if you do not follow the hygiene conditions or the antibiotic treatment prescribed by your doctor. They can manifest as fever, persistent abdominal pain, abnormal bleeding, unusual vaginal discharge or an unpleasant odor. It is important to see a doctor as soon as possible, because in some cases, hospitalization may be necessary.

Hemorrhage and perforation of the uterus

Hemorrhage, or excessive bleeding, is rare after curettage, but can occur if there are lesions in the uterine lining.

In very rare cases, a perforation of the uterus can occur. Especially in women who have had multiple pregnancies or who have previously had uterine surgery, the curette can pierce the uterine wall and cause internal bleeding or even damage nearby organs such as the intestines or bladder.

In such cases, further surgery may be necessary to remedy the situation.

Intrauterine adhesions – Asherman's syndrome

A rare complication, known as Asherman's syndrome, is the formation of intrauterine adhesions. This involves the appearance of scars inside the uterus, which can cause reduced, absent or painful menstruation and, in some cases, can affect fertility.

Secondary infertility after uterine curettage

In the case of repeated curettages or when complications such as injuries, uterine adhesions, or severe infections occur, the patient may suffer from secondary infertility. However, in most cases, a properly performed curettage does not affect your ability to get pregnant.

Uterine curettage and female fertility

Are you concerned about the impact that the curettage procedure may have on your fertility? Although there are situations that can affect your uterine health in the long term, the reality is that such an intervention, performed correctly by specialized medical professionals, does not affect your ability to achieve pregnancy.

The impact of uterine curettage on the endometrium

The lining of the uterus, called the endometrium, has the ability to regenerate after a hysterectomy. This regeneration normally occurs within a few weeks, with the resumption of the menstrual cycle, and fertility is not affected.

What can happen, however, is that this endometrium can thin or certain lesions can appear in the uterine lining when curettages are performed frequently or in a short period of time. These consequences can, indeed, make it more difficult to achieve a pregnancy.

When can you get pregnant again?

As a general recommendation, it is advisable to wait at least 2-3 complete menstrual cycles following curettage before trying to get pregnant again, to allow the endometrium to recover.

However, the optimal time for a new pregnancy may vary for each patient, especially depending on the reason for the curettage. So always take into account the individual recommendations received from your gynecologist.

Risks of repeated curettages

Repeated curettages can increase the risk of intrauterine adhesions, secondary infertility, and complications in future pregnancies. For this reason, it is important that the procedure is performed only when medically necessary and is followed by regular gynecological check-ups to monitor uterine health.

Alternatives and complementary procedures to uterine curettage

Uterine curettage is not always the only option available to you. Depending on the situation, your symptoms and health status, as well as the diagnostic or therapeutic purpose, your gynecologist may recommend less invasive alternatives or complementary investigations to evaluate uterine health:

• Diagnostic hysteroscopy: a minimally invasive procedure that allows direct visualization of the uterine cavity using a thin instrument equipped with a video camera to identify endometrial polyps, submucosal fibroids, intrauterine adhesions, or other structural changes, and which can provide an accurate diagnosis without the need for curettage.
• Transvaginal ultrasound: routine gynecological examination, frequently recommended as an initial analysis in cases of abnormal vaginal bleeding to observe the thickness of the endometrium and the presence of uterine formations or changes in the ovaries.

• Drug treatment for uterine evacuation: the treatment stimulates uterine contractions and the evacuation of uterine contents, and is recommended by the doctor in situations such as spontaneous abortion or pregnancy that has stopped developing, in order to avoid surgical intervention. However, this approach is not suitable for all patients and requires careful monitoring.

  

Frequently asked questions about uterine curettage

Do you have questions about uterine curettage and haven't found answers yet? Are you about to have a curettage for the first time and are you overwhelmed by emotions? Below you will find concise answers to the most common questions about this procedure, which will help you feel more prepared and informed until your next discussion with your doctor.

Is uterine curettage painful?

Uterine curettage is performed only under local, intravenous or general anesthesia, precisely so that you do not feel pain during the procedure. After the intervention, mild to moderate pain, similar to menstrual cramps, may occur, which usually improves within a few days.

How long does a uterine curettage take?

The actual curettage generally takes between 10 and 20 minutes. But this time is added to the time needed for preparation and post-procedure monitoring, so the entire experience can take several hours.

Can uterine curettage be performed on an outpatient basis?

Yes, uterine curettage is most often performed on an outpatient basis, without the need for hospitalization. You can go home the same day if your general condition is good and there are no complications.

What happens if uterine remnants remain after curettage?

In the rare case that uterine remnants remain after the procedure, persistent bleeding, pain, or infection may occur. Your doctor may recommend medication or an additional procedure to completely evacuate the uterine cavity.

What tests are necessary before uterine curettage?

As a rule, blood tests such as a complete blood count, a coagulation test and, depending on the case, hormonal tests or imaging investigations are recommended before the procedure. Their purpose is to assess your general health and reduce the risks associated with the intervention.

What are you not allowed to do after uterine curettage?

Physical exertion, sexual intercourse, bathing in a bathtub, and the use of intravaginal tampons are contraindicated after uterine curettage for at least 10 days, or as directed by your doctor. The purpose of these guidelines is to support proper healing and prevent complications.

When does menstruation return after uterine curettage?

Following a uterine curettage, menstruation usually resumes after approximately 3-6 weeks, but the interval may vary depending on the purpose of the curettage and the particularities of each organism.

How much does a uterine curettage cost in Romania?

The cost of a uterine curettage in Romania varies depending on factors such as the type of procedure, the chosen clinic and the type of anesthesia. Most of the time the listed price does not include the costs of anesthesia and histopathological examination. It can start from a few hundred lei (300-500 LEI) and can reach several thousand lei in private clinics (1,800-2,000 LEI).

How does uterine curettage affect fertility?

Properly performed uterine curettage does not usually affect fertility. Risks usually arise with repeated curettages or complications such as infections or intrauterine adhesions, which can affect your ability to get pregnant.

What happens after a repeated uterine curettage?

Repeated curettages frequently or within a short period of time can increase the risk of endometrial thinning, intrauterine adhesion formation, and secondary infertility. For this reason, doctors recommend this procedure only when strictly necessary.

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