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Key Takeaways
- A D&C removes tissue from inside your uterus but does not, on its own, provide a direct view of the uterus cavity. Hysteroscopy uses a thin camera to examine the cavity and can guide a biopsy or treatment. The two are often done together.
- Your gynaecologist may suggest one or both depending on your condition, what your scan has shown, and whether anything such as a polyp or other tissue needs removing.
- Before proceeding with the procedure, discuss with your gynaecologist what you can expect after the procedure, the possible risks, and the cost.
If your gynaecologist has recommended a Dilation and curettage (D&C) or hysteroscopy, you may wonder why they have chosen that procedure, and how it differs from the other. Although both involve the womb, a D&C removes tissue, while hysteroscopy allows your doctor to look inside and, when needed, take a biopsy or carry out treatment.
This article explains the key differences, why one or both may be recommended, and what to expect, including recovery, possible risks and costs in Singapore.
What is a D&C, and how is it done?
During a D&C, a gynaecologist removes tissue from the lining of your uterus
Dilation and curettage is a procedure to remove tissue from the lining of your uterus. “Dilation” means widening the cervix, the opening to the womb. “Curettage” refers to removing tissue using a thin instrument called a curette. A suction tube may be used instead of, or alongside, the curette.
During the procedure, your gynaecologist will widen the cervix – the opening to the uterus – using a speculum and other instrument. They will pass a curette through the cervix and remove tissue from the uterus lining.
Sometimes a thin tube connected to gentle suction is used instead of, or as well as, the curette. This is called a suction D&C, or suction curettage.
The tissue removed is usually sent to a laboratory for examination. Your gynaecologist will explain the results and any next steps once they are available.
What is a hysteroscopy, and how is it done?
A hysteroscopy allows your gynaecologist to examine the inside of your uterus using a thin camera.
A hysteroscopy is a procedure to look inside your uterus. You may have this procedure while you are awake or with medicine to help you relax or sleep.
During the procedure, your gynaecologist passes a thin tube with a light and camera, called a hysteroscope, through your vagina and cervix into the uterus.
They use sterile salt water, called saline, which gently expands the uterus cavity so the lining can be seen clearly. The images appear on a monitor. If you are awake, you may be able to watch the images on the screen.
Hysteroscopy can be used for two purposes:
- Diagnostic hysteroscopy helps investigate unusual bleeding or an unusual finding on a scan. Your gynaecologist may also take a small tissue sample, called a biopsy, to check for abnormal changes.
- Operative hysteroscopy treats certain problems inside the uterus, such as polyps, some fibroids or scar tissue. It can also help remove an intrauterine device (IUD or coil) whose threads cannot be seen.
If your gynaecologist finds a problem, they may be able to treat it during the same appointment, with your agreement. If not, they will discuss whether you need treatment at another appointment.
D&C vs hysteroscopy: What are the differences?
Here’s how the two procedures compare side by side, from what happens during the procedure to when you can expect your results.
Treatment during hysteroscopy depends on what is found, whether it is suitable to treat at that visit, and what you have agreed to beforehand. A separate D&C is not always needed to obtain a tissue sample.
Why might your gynaecologist suggest one?
The choice usually depends on your symptoms, what your scan has shown, and whether anything may need removing.
Your doctor may suggest both D&C and hysteroscopy together if you experience:
- Bleeding after menopause.
- A thickened uterine lining on ultrasound.
- An earlier biopsy result that needs further investigation.
Your doctor may recommend D&C without hysteroscopy to remove tissue remaining after a miscarriage, termination of pregnancy, or birth.
Your doctor may recommend hysteroscopy without a D&C to:
- Investigate heavy, prolonged or irregular periods, or bleeding between periods.
- Assess and remove a polyp or certain fibroids found on a scan.
- Investigate suspected scar tissue, a uterine septum (a wall of tissue dividing the uterus), or growths that may contribute to repeated miscarriages or difficulty getting pregnant.
Why are the two often done together
Your gynaecologist may recommend hysteroscopy and D&C in the same session to examine the uterus lining and collect tissue for laboratory testing. A D&C performed without a camera view may miss or incompletely remove a growth in one area, such as a polyp. Hysteroscopy allows your gynaecologist to sample or treat the growth while they can see it.
However, a separate D&C is not always needed. A biopsy can often be taken during hysteroscopy, and some growths can be removed using instruments passed through the scope. Whether both procedures are appropriate depends on what needs investigating or treating.
Recovery: What’s normal and when to call a doctor
You may expect recovery depending on the type of procedure and whether you receive anaesthesia.
After either procedure, you may have mild, period-like cramps and light spotting or bleeding. Your doctor may recommend suitable pain relief to ease cramps. You may also notice watery discharge after a hysteroscopy involving treatment.
After a diagnostic hysteroscopy, you can return to your usual activities as you feel able, but avoid exercise until pain and bleeding have stopped. If your hysteroscopy involved treatment, follow your doctor’s advice about returning to work, exercise and other activities, especially after a more extensive procedure.
After a D&C, you may be able to resume most regular activities within a day or two, unless your doctor advises otherwise.
If you had anaesthesia for either procedure, arrange for someone to take you home and a responsible adult to stay with you for at least 24 hours. During this time, do not drive, operate machinery, drink alcohol, make important decisions or sign legal documents. Follow any longer restrictions given by your care team.
During recovery for either procedure, you need to contact your gynaecologist if you have:
- A fever of 38°C or higher, or chills
- Discharge that smells unpleasant
- Cramps that are getting worse rather than better, even with pain relief
- Large or recurring blood clots
- Bleeding that lasts longer than your discharge instructions say to expect
- Pain, swelling or redness in one calf, as it may indicate a blood clot
Seek immediate care if you’re bleeding very heavily, soaking through one or more pads an hour for two hours or more. The same applies if you have severe abdominal pain that doesn’t ease with recommended pain relief, if you faint or feel very dizzy or light-headed, or if you develop chest pain or difficulty breathing.
Possible risks of each procedure
Serious complications are uncommon, but the risks depend on what is done during the procedure and your individual circumstances. Your gynaecologist will explain the risks relevant to you.
Risks both procedures share:
- Infection of the uterus, which is usually treated with antibiotics
- Bleeding that is heavier than expected
- Injury to the cervix
- A small hole in the wall of the uterus (perforation). This usually heals on its own. Rarely, it can damage the bowel, bladder or nearby blood vessels, which may need further surgery to repair
Risks specific to a D&C:
- Scar tissue inside the uterus (Asherman’s syndrome): This is more likely after a D&C to remove remaining tissue after miscarriage, termination, or birth, particularly if the procedure is repeated.
Risks specific to a hysteroscopy:
- During longer operative procedures, some of the fluid used to open up the uterus can be absorbed into the bloodstream. Your team measures the fluid going in and coming out throughout the procedure to keep this risk low.
If sedation or anaesthesia is used during D&C, hysteroscopy, or both, your team will also explain the associated risks.
When a second opinion may help
If you’re still unsure after discussing the recommendation with your gynaecologist, a second opinion may help you understand:
- Why a D&C, hysteroscopy or both are being recommended.
- Whether another approach would be suitable for you.
- What the procedure is intended to diagnose or treat, and how the results could affect your care.
Bring your ultrasound report, any previous biopsy results and your proposed treatment plan to the appointment. If your gynaecologist has advised prompt investigation or treatment, ask how urgently it is needed before postponing it to seek another opinion.
If you’d like a second opinion but aren’t sure which gynaecologist to see, contact our Care Team. Tell our Care Team what is happening, and we can help match you with suitable specialists based on your condition, preferences and insurance.
What each procedure may cost in Singapore
The Ministry of Health (MOH) publishes bill information by procedure under the Table of Surgical Procedures (TOSP). The figures below show the typical bill range for day surgery, based on actual bills from 2023.
These are MOH bill ranges, not guaranteed prices or personal quotations. They may vary according to your hospital, subsidy status, anaesthesia, doctor’s fees, pathology, medicines and whether additional treatment is performed. MOH does not publish bill ranges for every setting. Where private day-surgery data is unavailable for a procedure code, hospitals can provide a quotation on request.
Depending on your eligibility and the procedure planned, you may be able to pay using:
- MediSave, to pay part of eligible day-surgery or hospitalisation expenses, subject to withdrawal limits. MediSave uses your healthcare savings; it does not reduce the hospital’s charges.
- MediShield Life, to cover part of a claimable hospital or day-surgery bill, subject to claim limits, deductibles and co-insurance. Its benefits are designed around subsidised public-hospital care, and claims for private or unsubsidised care are pro-rated.
- An Integrated Shield Plan, if you have one, which combines MediShield Life with additional private insurance coverage. The amount payable depends on your policy and claim assessment.
Questions to ask your gynaecologist before the procedure
Ask your gynaecologist why the procedure is recommended, what it involves and what to expect afterwards
Before deciding on a D&C or hysteroscopy, these questions can help you understand what is planned and what to expect.
- Why do you recommend a D&C, a hysteroscopy, or both for me? Ask which symptom or scan finding needs investigating, how the results could affect your treatment, and whether there are alternatives.
- Will you only take a sample or also remove anything you find? Clarify what you’re consenting to, including what happens if something unexpected is found during the procedure.
- Will I be awake or under anaesthetic? Ask whether the procedure will be done in a clinic or an operating theatre, whether you can choose, and what happens if an awake procedure becomes too uncomfortable.
- What are the main risks in my case? Ask about the risks of your specific procedure rather than in general.
- When and how will I get my results? Confirm when your follow-up appointment is and what the next steps might be if the results show something that needs treatment.
- How should I prepare, and what will I need afterwards? Confirm fasting and medication instructions, whether someone must take you home, any recovery restrictions, and whom to contact if you develop concerning symptoms.
How Health in Asia can help
A D&C and a hysteroscopy are often discussed together, but they are not the same procedure, and which one you have — or whether you have both — changes the cost, the recovery and what your insurance pays.
Tell our Care Team what has been recommended, what your scan or test results showed, and any treatment you have already had. Your insurance details help too.
The Care Team can help with:
- A shortlist of one to three gynaecologists matched to your situation, with the reasons explained
- Checking your insurance considerations, including your insurer’s panel requirements, likely coverage and whether pre-authorisation applies
- Estimated out-of-pocket costs explained before you book
- Appointment booking and care coordination
- Arranging a second opinion if you are unsure whether the procedure is needed
The matching costs you nothing, and the specialist’s fee is the same as booking directly.
Frequently asked questions
Yes. This is one of the most common reasons people reach out to us, especially before major surgery or high-risk treatments. We arrange the consultation and prepare the full case file, so the specialist has the complete history in hand and you're not left repeating everything from memory.
That’s a good outcome. It means you can move ahead with more confidence and stop second-guessing the plan.
Yes. Send us what you have. If anything's missing, we'll tell you exactly what to request and how.
Yes, the Care Team will remain your point of contact for follow-up appointments, questions about medication, transitions between specialists, and anything new that comes up.
Disclaimer
This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition. For decisions about your health or treatment, speak with a qualified doctor who knows your situation. An…
How we reviewed this article:
Health in Asia has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.
- SI843U - Uterus, Various Lesions, Curettage With/Without Dilatation https://www.moh.gov.sg/managing-expenses/bills-and-fee-benchmarks/cost-financing/tosp-si843u-bill-information/
- SI820U - Uterus, Gravid, Evacuation (Simple) https://www.moh.gov.sg/managing-expenses/bills-and-fee-benchmarks/cost-financing/tosp-si820u-bill-information/
