UTERINE CANCER AND ENDOMETRIAL HYPERPLASIA: The D-and-C is one definitive method for diagnosing uterine cancer or endometrial hyperplasia. The hysteroscope also allows biopsy of suspicious abnormalities of the uterine lining, but under direct visualization, contrasted to the "blind" D-and-C.

Thus either a D-and-C or hysteroscopy is recommended for menopausal women who have started to bleed after their periods have stopped, in order to rule out cancer of the uterus. Some are now advocating that hysteroscopy and directed biopsy replace the D-and-C altogether for the most accurate diagnosis.

Recently, a simple screening test for uterine cancer has now become widely available and can quickly be done in the office without any special instruments. This is known as endometrial aspiration and consists of taking a small piece of the uterine lining to send to the lab, using a tiny tube that is inserted through the cervix. If done with an instrument known as the pipelle, it can be painless. This screening test is particularly useful for post-menopausal women who are taking estrogen alone with their uterus intact.

INFERTILITY: As part of the infertility investigation, the hysteroscope is a valuable test that can confirm the nature of any problems with the structure of the uterus that were detected by X-ray.

CERVICAL ABNORMALITIES: The microcolpohysteroscope is a complex instrument that has the properties of both the telescope and the microscope. Suspicious areas in the cervix can be visualized and biopsied.

New data suggests that the use of this instrument may be as accurate as a Pap smear to detect abnormalities and early cancer of the cervix. It has the advantage over the colposcope of being able to see further up the cervical canal, and could save women from the need to undergo a cone biopsy. At present, this instrument is still in developmental stages.

UTERINE SCARS AND UTERINE SURGERY: Investigation of a uterine scar is sometimes necessary prior to vaginal birth following C-Section. Also, the amount of scarring in the uterine cavity following surgery can also be determined. Both can only be done through the hysteroscope.

TO FIND A MISPLACED IUD: The hysteroscope is the best procedure for this as through it the doctor can see if the IUD is embedded in the uterine wall. The D-and-C can also be used for this purpose, but the location and depth of the IUD cannot be seen.

For Treatment

PREGNANCY AND CHILDBIRTH COMPLICATIONS: The D-and-C can be used as an emergency treatment to stop excessive uterine bleeding.

After the birth of a baby, a D-and-C may be necessary to remove either part or the whole placenta (afterbirth) if it doesn't come out on its own. After an incomplete miscarriage, the D-and-C is also used to clean out the uterus and prevent infection or further bleeding.

THERAPEUTIC ABORTION: Usually a D-and-C is performed using a vacurette instead of a curette. A vacurette is a plastic or metal hollow tube with one or more holes near the tip. The vacurette is passed through the cervix after it has been dilated. The vacurette is connected to a suction machine. The machine is turned on as the vacurette is moved back and forth in the uterus. The suction makes a vibrating noise lasting for one minute. When the fetal material has all been removed, the vacurette is removed. Some doctors will then check with a curette to make sure the uterus is empty.

UTERINE CANCER: Hysteroscopy can also be used to detect, treat and monitor cancerous and precancerous conditions of the uterus as well as endometrial hyperplasia. This can be done with no cervical dilation and without local anesthesia most of the time. Therefore hysteroscopy is being advocated to replace D-and-C as a simpler, safer, and more accurate technique.

REMOVAL OF CERVICAL POLYPS AND SMALL UTERINE FIBROIDS: Hysteroscopy is more sensitive and accurate than D-and-C for removal of polyps and fibroids.

In a 1985 study, Dr. Goldrath and Dr. Sherman found that large numbers of polyps and fibroids were missed at the time of a blind D-and-C because "less than half of the uterine cavity had been curetted in 60 percent of the patients and less than a fourth of the cavity in 16 percent."