After having a miscarriage, it's common that women will undergo a dilation and curettage (D&C) either by necessity or by choice. Serious complications associated with the procedure are rare, but about 8% of women may develop intrauterine adhesions (scar tissue in the uterus) after having a D&C.
Uterine adhesions don't always cause problems, but sometimes they can -- so it's good to be aware of the possibility. Here is what UpToDate, an electronic health reference source for doctors and patients, has to say about the symptoms:
"Intrauterine adhesions can be asymptomatic and of no clinical significance. Symptoms associated with clinically significant intrauterine adhesions include:
- Menstrual irregularities (hypomenorrhea, amenorrhea)
- Cyclic pelvic pain
- Recurrent pregnancy loss.
Infertility is the most common reason patients present for evaluation: 43 percent of women with intrauterine adhesions have some degree of infertility. Menstrual irregularities are also a common presentation; however, the extent of adhesions seen on hysteroscopy does not correlate well with degree of menstrual irregularity and nearly 40 percent of patients with adhesions documented on hysteroscopy report no menstrual irregularities.
As you can see, the symptoms of adhesions may be vague -- trouble getting pregnant, recurrent miscarriages, menstrual cycle disorders, or pain in the pelvic area can all be signs of adhesions. But note that only about half of women with adhesions will have trouble getting pregnant, and a significant percentage may not have any cycle irregularities at all, so it's also worth asking your doctor about testing if you have had a D&C in the past and are suffering from recurrent miscarriages or pelvic pain associated with your menstrual cycle.
Here are some more questions you might have about uterine adhesions and what they mean:
Are adhesions always caused by a D&C?
About 90% of cases of uterine adhesions are believed to occur as a complication of past D&Cs but it's also possible to develop adhesions as a result of an infection, such as genital tuberculosis. The latter is more common in developing countries than in the U.S.
What should I do if my doctor doesn't agree that I need testing?
Ask your doctor to explain why he or she doesn't think you need the tests, and explain to your doctor why you feel you should be tested (such as if you are having recurrent miscarriages and want adhesions ruled out as the explanation) If you don't agree with your doctor's conclusion, you can seek a second opinion. If you are having recurrent miscarriages or infertility issues and will be seeking a second opinion, consider seeing a reproductive endocrinologist or other fertility specialist.
What kind of treatment will I need if I do have adhesions?
The specifics of treatment will vary by the circumstances, but the most common treatment will be hysteroscopic surgery. Doctors may also recommend medication or short-term placement of a Foley catheter after the surgery to reduce the risk that the adhesions will return. Treatment of adhesions improves the odds of a successful pregnancy in most cases, but in severe cases, the adhesions may not be treatable and may result in longstanding problems with infertility.
My doctor is recommending I have a D&C but now I'm scared the procedure could make me infertile. What should I do?
Weigh the risks with the benefits, and remember that most people don't develop significant adhesions after having a D&C. Your doctor probably has a good reason for recommending a D&C, but it's always OK to ask questions and to discuss your concerns with your doctor if you're feeling hesitant. Depending on the reason why your doctor is recommending a D&C, there may or may not be alternative options.
I've just been diagnosed with a miscarriage and was contemplating having a D&C to speed things up, but I had a D&C in my previous miscarriage too. Is it too risky for me to have another D&C?
This concern is something you should discuss with your doctor. Multiple D&Cs do appear to increase the risk of developing uterine adhesions, but D&Cs aren't always optional and sometimes are medically necessary, so the risks have to be weighed with the benefits. If a D&C is optional in your case, you can ask about medical management of the miscarriage or choose to miscarry naturally, but this is really something to discuss with your doctor.
Want to learn more? See UpToDate's topic, "Intrauterine adhesions," for additional in-depth medical information.
Shelly, Wendy B. and Marcelle I. Cedars. "Intrauterine adhesions." UpToDate. Accessed: Dec 2009.