What Is Fractional Curettage?
Fractional curettage is a minor gynecological procedure used to gently remove abnormal tissue from the lining of the uterus (endometrium). It is often performed when there are changes in menstrual bleeding, unexplained bleeding after menopause, or abnormal findings on ultrasound or biopsy that need further evaluation. The term “fractional” refers to the fact that both the cervix (neck of the uterus) and the uterine lining are sampled or treated separately during the procedure.
Fractional curettage helps doctors reach a diagnosis, assess the health of the uterine lining, and sometimes relieve symptoms caused by excess tissue. It may be done as part of a diagnostic work-up or combined with other procedures like hysteroscopy. The procedure is usually performed by a gynecologist in an outpatient setting and may be done under local anesthesia, sedation, or general anesthesia, depending on patient comfort and clinical needs.
Who May Need Fractional Curettage?
Fractional curettage may be recommended for individuals who:
● Have abnormal uterine bleeding (heavy, prolonged, or irregular)
● Experience bleeding after menopause
● Have thickened endometrium on imaging
● Need evaluation of endometrial tissue for infection, polyps, or cancer
● Have recurrent miscarriages or fertility concerns with abnormal lining
● Need follow-up after abnormal Pap smear or biopsy findings
Your doctor evaluates your medical history, symptoms, and examination findings before suggesting this procedure.
Types of Fractional Curettage
Fractional curettage involves sampling both the cervix and the uterine cavity:
1. Endocervical Curettage
A curette (small spoon-like instrument) is used to collect cells from the cervical canal to check for abnormalities such as inflammation, infection, or precancerous changes.
2. Endometrial Curettage
Tissue is gently scraped from the lining of the uterus (endometrium) to examine it under a microscope for infection, cancerous cells, hormonal changes, or other abnormalities.
Together, these samples give a more complete picture of conditions affecting the lower reproductive tract.
Fractional Curettage Procedure
Fractional curettage is usually done in a hospital or clinic under sterile conditions:
1. Preparation
You may be asked to avoid eating or drinking for some time before the procedure if sedation or general anesthesia is planned. A consent form is obtained.
2. Anesthesia
Local anesthesia, sedation, or general anesthesia is given depending on clinical need and comfort.
3. Speculum Insertion
A speculum is gently placed in the vagina to allow access to the cervix.
4. Cervical Sampling
A small curette is used to collect tissue from inside the cervical canal.
5. Uterine Sampling
Another curette (or suction device) is passed through the cervix into the uterus to sample the endometrium.
6. Completion
After tissue is collected, instruments are removed. Tissue samples are preserved and sent to the laboratory for analysis.
The procedure typically takes 15–30 minutes.
Recovery & Aftercare
After fractional curettage:
● Short Observation: You may stay for brief monitoring if sedation was used.
● Spotting or Light Bleeding: It is common for a few days after the procedure.
● Mild Cramps: Some cramp-like discomfort may occur and can be managed with pain relievers as advised.
● Activity: You can usually resume normal activities the next day but avoid heavy lifting, intense exercise, or sexual intercourse for a short period (as advised by your doctor).
● Follow-Up: Your doctor will discuss when to expect lab results and any necessary follow-up care.
If heavy bleeding, severe pain, fever, or foul-smelling discharge occurs, contact your doctor promptly.
Risks & Possible Complications
Fractional curettage is generally safe, but a few risks may occur:
● Infection of the uterus or cervix
● Bleeding
● Perforation (very rare) of the uterine wall
● Scar tissue formation in the uterus (Asherman’s syndrome, rare)
● Reaction to anesthesia (if used)
Your gynecologist discusses risks and benefits with you before the procedure.
Obstetricians and Gynecologists
Gynecology