D-and-C: Once fully awake, you can go home unless there has been some complication. You can expect to feel some cramps and soreness that day and perhaps the day after. Spotting can continue for a few weeks after a D-and-C. Until your bleeding has stopped, it is a good idea to shower instead of bathing to prevent infection as your cervix is still open at first. Your periods may return at any time, usually within three to six weeks. Any excessive bleeding should be immediately reported to your doctor, i.e. soaking through your pad.

HYSTEROSCOPY: Since the procedure is longer, you will take longer to wake up from the anesthetic, depending on what was done. Most procedures are done at day care or short stay units. There will usually be more spotting. In the case of endometrial ablation, there may be considerable discharge of tissue over days or weeks.

At your follow-up visit with your doctor, discuss the findings from the hysteroscope or D-and-C and what they mean, if these procedures were done for diagnostic purposes. If you are using birth control you will need to continue it as usual, right away. However, it is probably a good idea to avoid sex until your bleeding has stopped.

Complications

D-and-C: If you experience fever, abdominal cramps or pain, and a foul smelling vaginal discharge, you should be checked right away for a possible infection. Other potential complications are uncommon and include hemorrhage, perforation of the uterus or surrounding internal organs, injury to the cervix, scar tissue forming inside the uterus and reactions to the anesthesia.

Overall D-and-C is a very safe operation, with a low rate of complications and with a death rate of .4 per 100,000.

However, according to Jill Weiss of the Canadian PID Society, a serious pelvic infection (PID) may follow anywhere between three and 13 percent of abortions. This problem is most marked in younger women. At an abortion clinic, women under 20 had a 28 to 40 percent chance of developing PID after abortion and women over 20, a 15 to 18 percent chance.

HYSTEROSCOPY: Complications unique to hysteroscopy include reactions to the liquid or gas mediums used to expand the uterine cavity. The most common complication is uterine perforation.

Carbon dioxide may cause shoulder tip pain. There is also the small risk of gas embolism (blockage of a blood vessel by gas travelling in the bloodstream) and very rarely death from that cause. Occasionally, there are also irregular heart rhythms that develop as a result of the carbon dioxide.

The fluid mediums like sugar and salt solutions can uncommonly cause fluid overload and heart failure. Severe allergic and lung reactions to a thick medium called dextran can also occur.

Other late onset complications of hysteroscopy include PID (rarely) and formation of scar tissue inside the uterine cavity.

Complications after hysteroscopy are greater than for D-and-C, especially when a general anesthetic is used. The overall risk of major complications is high at three percent compared to hysterectomy which is one to 2.5 percent. This rate includes longer operative procedures under general anesthesia as well as five minute office hysteroscopy. The complication rate from diagnostic hysteroscopy is very low. A 1986 study found a risk of serious complications of .012 percent. The death rate with hysteroscopy is very low at 2.4 per 100,000 compare to two per 1,000 women for hysterectomy.

Both these operations are invasive procedures. So, the benefit-risk ratio has to be carefully considered for each woman and for each situation. However, hysteroscopy has become an indispensable gynecological tool both for diagnosis and treatment. And, in most situations, it offers women a lot of advantages over the traditional blind D-and-C.