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Patients with heavy menstrual bleeding do not receive dilation and curettage unless they present acutely with uncontrolled bleeding and medical therapy is ineffective or contraindicated.
Dilation and curettage has historically been used as a treatment and/or diagnostic tool for both acute and chronic heavy menstrual bleeding. Unfortunately, the benefits of this procedure are temporary. When dilation and curettage is performed, simultaneous hysteroscopy should also be performed to decrease the incidence of missed lesions (e.g., polyps) that may contribute to or be the cause of the acute heavy menstrual bleeding. See Statement 8 for additional guidance on treating acute heavy menstrual bleeding.
You should only receive dilation and curettage (D&C) if you have very severe bleeding and if medications did not slow it. D&C removes abnormal tissue from the lining of your uterus. If you have a D&C, hysteroscopy (a procedure to look at the inside of your uterus) should be done at the same time.
Use dilation and curettage only for patients presenting with acute heavy menstrual bleeding where medications are not working to suppress the bleeding. In these cases, use simultaneous hysteroscopy to visualize lesions that may be causing the bleeding.
Ensure systems, processes, and resources are in place such that patients do not receive dilation and curettage for investigation or treatment of heavy menstrual bleeding unless absolutely necessary to treat acute heavy menstrual bleeding unresponsive to medical intervention.
Percentage of patients with heavy menstrual bleeding who underwent elective (i.e., inappropriate) dilation and curettage
Denominator: number of patients with heavy menstrual bleeding
Numerator: number of patients with heavy menstrual bleeding who underwent dilation and curettage (exclude non-elective dilation and curettage)
Data sources: Ontario Health Insurance Plan claims database, Discharge Abstract Database
Percentage of patients with acute heavy menstrual bleeding who underwent dilation and curettage and who also had a hysteroscopy
Denominator: number of patients with acute heavy menstrual bleeding who had dilation and curettage
Numerator: number of patients in the denominator who had a hysteroscopy during the same procedure
Data sources: local data collection
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