This page was printed from The OSCAR website at
Only the electronic version is maintained, once printed this is no longer a controlled document
This commissioning statement refers to:
Hysteroscopy in management of HMB
NICE Heavy Menstrual Bleeding (CG44) – Full Guideline Consultation January 2007:updated August 2016 https://www.nice.org.uk/guidance/cg44
Ultrasound (1st line) or hysteroscopy [with or without biopsy] (2nd line) are recommended as diagnostic techniques to investigate uterine bleeding disorders1, 2, 3 NICE guidance indicates that D&C alone should not be used for diagnostic purposes.
Hysteroscopy with biopsy is also the preferred technique to remove polyps and other benign lesions, as it allows targeted removal. If a tissue sample is required and there is no lesion visible on a scan then an endometrial biopsy may be done (using a small hollow plastic tube that removes a small plug of tissue on gentle suction).
There is limited evidence on the effectiveness of D&C in the management of menorrhagia. The one study identified by NICE showed that any effect was temporary4. NICE guidance states that D&C should not be used as a therapeutic treatment.
Evacuation of retained products of conception (ERPC): where surgical evacuation after incomplete miscarriage or delivery is clinically indicated over medical management and watchful waiting, vacuum aspiration has superceded D&C as it is quicker, safer, easier and less painful.
Gestational trophoblastic disease: Suction/vacuum curettage is the preferred method of evacuation irrespective of uterine size in patients with suspected hydatidiform mole who want to preserve fertility.