by Christine Lewis, PWCG Founder
If you’re a hormone positive breast cancer survivor you may have to have a D&C as a result of side effects from taking hormone blockers such as Tamoxifen. When I took Tamoxifen it caused me to develop uterine polyps that led to abnormal vaginal bleeding. Because I was postmenopausal, I wasn’t supposed to be bleeding. So I and my doctors had to investigate the cause of this situation. Chances are, if you have polyps they’re benign, but a D&C is necessary to be more confident that this is the case – – especially since Tamoxifen can increase your risk of developing uterine cancer. You can read more about my situation here.
D&C is an abbreviated term for dilation and curettage, which is a surgical procedure where tissue from the lining of the uterus is removed with a curettage tool and then examined by a pathologist. They will check for any abnormal cells, and results will determine if any additional treatment is necessary. This is an outpatient surgery, and it wasn’t very painful or complicated (you can read about my experience here).
1) In order to better see your cervix, your surgeon will insert a speculum to spread your vaginal walls.
2) Each rod a little thicker than the one before it, your surgeon will insert a graduating series of rods into your cervical opening in order to dilate your cervix.
3) Once your cervix is adequately dilated, your surgeon will insert a spoon-shaped curette in order to scrape out the uterine lining.
4) A suction device may also be used in conjunction with the currette, in order to remove material that is difficult to loosen otherwise.
5) Once all tissue from the uterine lining is removed, your surgeon will remove any instruments from your body that were used in the procedure.
6) Your surgeon will send any tissue extracted from the D&C to a laboratory, in order to further assess its contents so it can be analyzed for any concerns. You’ll be notified if they’ve found anything alarming, and further plans of treatment will be discussed at your follow-up appointment.
Don't even think about having a piece of candy, after midnight, prior to your surgery.
I don’t know what it is, but every time I’m preparing for a procedure or test where I”m not supposed to eat or drink anything after midnight, Eric Clapton’s “After Midnight” song goes through my head. Regardless as to why this is, it helps me remember this rule that I’m not supposed to eat anything after midnight the night prior to my surgery. That does mean ANYTHING. You’re not even supposed to have any gum or candy! You also should DEFINITELY not consume any alcohol, and you should stop consumption of any CLEAR liquids two hours before your admission. Clear liquids, such as water, coffee, and juice that contains NO PULP are usually allowed up to 2 hours prior to your procedure but consult YOUR providers rather than relying on me for that information. This rule is so important that YOUR PROCEDURE MAY BE CANCELLED OR DELAYED IF YOU IGNORE THESE INSTRUCTIONS.
Discuss all medications with your doctors prior to your D&C.
If you take blood-thinning medications, including Coumadin, Plavix, Pradaxa, or Lovenox, you should NOT stop taking this medication prior to discussing it with your surgeon, cardiologist, or internal medicine doctor first. Stopping these types of medications can be very dangerous for you, especially if you:
a) Had a stent in your heart for any period of time.
b) Had a stroke, heart attack, or heart surgery within the last 6 months.
c) Had a blood clot in your blood vessel or lungs within 3 months, or you get them often.
d) Have a mechanical heart valve.
e) Have a history of atrial fibrillation.
There are other medications you may or not be able to take prior to your D&C. If you’re instructed by your doctor to continue taking certain medications you will probably be allowed to take them with a sip of water on the morning of your procedure BUT DISCUSS THIS WITH YOUR DOCTOR, AND DON’T RELY ON MY WORD.
I hardly ever take off my wedding band, but during a D&C you can't even wear any jewelry.
Do not wear on any of the following to your D&C:
any hair styling products
If you wear dentures, they’ll even tell you to remove them just prior to your D&C.
If you have sleep apnea, and you’ve been prescribed with a CPAP or BiPAP machine, you’ll most likely be instructed to bring it with you to your procedure.
Though this IS an outpatient procedure, you’re not going to be allowed to drive yourself home. They’ll expect someone 18 years or older to drive you home from your D&C. This is so important they they will most likely CANCEL THE APPOINTMENT if you don’t follow this policy.
You’ll most likely have general anesthesia, but don’t take my word for it because there are several possibilities for anesthesia and it may depend on your surgeon’s preferences, or policies of the hospital where your procedure is taking place. I received medication through an intravenous (I.V.) line, which went into a vein in the top of my hand. If you had lymph nodes taken out of an arm be sure to remind the staff of this if they aren’t already aware. They put a limb alert band on my right arm so no one would check my blood pressure or apply needles to that side.
Other anesthesia which may be administered include the following:
Local anesthesia occurs if the doctor injects the anesthesia directly into your cervix. This may be performed if your D&C occurs at a clinic or your doctor’s office. You can expect to feel a pinch and a sting at the moment of injection, but once it’s done your cervix will be numb and you won’t feel any more when your cervix is dilated. The most you may feel is some cramping in your uterus when the surgeon is scraping out the lining with the curette.
Spinal anesthesia, also called a spinal block, occurs when an anesthetic is injected into your spinal cord. In this case, you’ll be awake during your D&C. But don’t worry, you won’t be able to feel anything below the injection site. If you’ve ever had an epidural then you may be familiar with this type of anesthesia. The worst part of the D&C would probably be the anesthesia itself, as you shouldn’t feel any other pain until recovery (and recovery pain differs with each individual).
I found that the D&C was rather uneventful, but experiences with a D&C may vary from patient to patient. If you’re anxious about this upcoming procedure then you can ask your team to sedate you throughout the procedure. This could include taking a pill for anxiety or taking a medication through an I.V. By doing this, you’ll be in a light sleep throughout the D&C, and won’t remember much about the procedure.
If you receive general anesthesia, you will also be hooked up to monitors to keep track of your vital signs.
Once you’re in the room where you’ll be prepped for surgery you’ll be asked to remove your clothes and put on a hospital gown. If you’re receiving general anesthesia, as I did, a nurse will come in to insert a small, plastic catheter into a vein in your hand or arm. They’ll also hook you up to monitors in order to keep track of your vitals, such as blood pressure, breathing, and heart rate. In order to reduce risk of infection the gown you’ll be wearing may be a bear hug gown that attaches to hose that blows warm air on your skin. Doctors usually don’t perform D&C procedures if there is a likelihood that you may be pregnant. for that reason, you may be asked to provide a urine sample to test for the event of pregnancy.
When your doctor is ready to perform the D&C you’ll be placed in a position very similar to having a pap smear, with your feet rested in stirrups and a sheet or blanket covering your knees. One nurse is usually present to assist the doctor, while another monitors your vital signs.
Though it's rare, if you develop a temperature of 101F or greater, you should go to the emergency room immediately.
1) Very RARE complications from anesthesia, to the heart & lungs.
2) Infection – – this is why it’s important not to bathe within 2 weeks after the procedure, nor should you insert anything into your vagina within 2 weeks following a D&C. This means you should only wear pads to protect your clothing from spotting or bleeding. Do NOT use tampons. You should not engage in sex within 2 weeks after a D&C.
3) Blood Clots – – from staying in bed too long. These are usually prevented when staff apply cuffs to massage your legs during the procedure, and following procedure your staff will stress that you need to get up and move around once the effects of anesthesia have worn off.
4) There is a very RARE likelihood of damage to your uterus or cervix.
1) Chills or Fever – – especially if you have a temperature of 101F +
1) Foul-smelling discharge
2) Heavy bleeding
3) Severe pain
Make sure to arrange for someone to take you home after your D&C.
It’s not unusual to feel tired or experience light cramping following a D&C procedure. Your staff will observe your for a short period before discharging you. They want to make sure you can hold down a light amount of food and fluids (such as crackers and juice) and that you’re able to move around without feeling to dizzy. Because you may still feel the effects of anesthesia, they will not discharge you if you don’t have someone to drive you home.
It’s not uncommon to have light bleeding after a D&C. You can wear menstrual pads to protect your clothing from spotting but DO NOT WEAR TAMPONS, because they may increase your risk of developing an infection. You may experience cramping for a few days following your procedure. If you experience considerable pain, it’s usually acceptable to take Tylenol. You can also contact your doctor for follow up or a prescription for pain medication.
Wearing tampons within 2 weeks following your D&C can increase your risk of infection.
It’s not uncommon to experience light bleeding following a D&C. You can wear menstrual pads to protect your clothing from spotting, but DO NOT WEAR TAMPONS, because they may increase your risk of developing an infection. You may experience light cramping for a few days following your procedure. You can take Tylenol, but if your pain is really bad you should follow up with your doctor &/or ask for a prescription for pain medication.
You should get up and about as soon as possible, and you should be resuming your typical routine within 1 or 2 days of your D&C.
Your care staff will mostly likely stress that you get up and about as soon as possible to keep your muscles strong and prevent the likelihood of blood clots forming in your legs. You should be able to pick back up with a majority of your usual routine within a day or two following your procedure.
You can take showers, but DO NOT TAKE BATHS until your doctor says it's safe to do so.
You can take showers but DO NOT TAKE A BATH until your doctor says it’s okay to do so.
If pathology finds any concerns, you’ll receive a report from your doctor’s office with the findings. You may not require a follow up if all results were benign. However, if results show cancerous or pre-cancerous indications, you will most likely be referred to a specialist or discuss treatment plans to go forth in response to such findings so you can know what the next steps should be in your care.
When I was diagnosed with Invasive Ductal Carcinoma in 2015 I wanted my journey with breast cancer to have a purpose. First and foremost, my family was my motivation to fight this disease. I made a lot of lifestyle changes so that I can be around for my family for many years to come, but I also felt inspired to archive my journey so that others could benefit from what I’ve learned and applied.This was why Pink Warrior Calendar Girls was founded.