“I was cleaned” or “I was cleaned” – these phrases I often hear from my patients, and they sound to me as unbearable as the movement of foam on glass. “Cleaning” is colloquially called “scraping the uterus” – the most common procedure performed in gynecology in the vast majority of cases without any indications for it. Scraping in our country, dominated by the “gynecological feldshers” is a basic primitive instrument of conducting “medical activities”. I will explain this term.
“FELDSHERSKO” is called “treatment” on a “tablet from a headache, a pill for diarrhea”, that is, lack of knowledge about the nature of the disease, its characteristics and nuances of current, and as a consequence – the inability of a differentiated approach to the treatment of the patient. In fact, according to the story, the paramedics came out of barbers who were not engaged in healing, but let blood and set dislocations.
Scraping is an outpatient medical procedure during which the uterine mucosa is removed using a curette.
The name “cleaning” itself reflects a crude, clumsy and primitive approach to solving the problem. By the way, the term has moved smoothly from medical jargon to the lexicon of many women who even believe that they need to be “cleaned” or “cleaned” from time to time. Perhaps they put this in the same sense as the notorious “cleaning the body of toxins”, assuming that this organ accumulates “dirt»…
Before continuing the story, we need to explain what exactly we are talking about.
Scraping is an outpatient medical procedure performed under intravenous anesthesia, during which the removal (scraping) of the uterine mucosa is performed using a special curette. The procedure is called therapeutic and diagnostic, since it removes the tissue changed by the disease (if any), which can be examined under a microscope and make an accurate diagnosis. From the previous sentence, it is clear that scraping is performed not only in the presence of a disease, but if it is suspected, that is, for the purpose of making a diagnosis.
So far, everything is clear, logical and obvious. However, there is another side to this manipulation. The procedure is performed with a sharp iron curette, which actually “peels off” the mucous layer of the uterus, and there is an inevitable injury to the uterus itself. As a result, there is a risk of several serious complications: damage to the growth layer of the endometrium (which disrupts its growth in the future), the appearance of adhesions in the cavity, and the development of inflammation. In addition, this procedure contributes to the development of a disease such as adenomyosis (endometriosis of the uterus), due to violation of the border between the layers of the uterus, which contributes to the germination of the endometrium into the uterine muscle. As a result, the transferred scraping can lead to problems with conception or start the development of adenomyosis.
Scraping ALWAYS injures the uterus.
It is obvious that such a procedure should be done strictly according to the indications and seriously evaluate the benefit-risk ratio. But this is possible anywhere but here, and it is very sad.
I think that in more than 80% of cases, scraping is performed in vain, that is, either completely without indications, or in cases where you can solve the problem medically or by a simple outpatient procedure.
Here are situations in which you may be asked to perform scraping.
• You have long-term spotting or uterine bleeding.
• You were diagnosed with endometrial polyp, endometrial hyperplasia, adenomyosis, uterine fibroids, and chronic endometritis during ultrasound.
• You are scheduled to undergo surgical treatment for uterine fibroids.
• You have a suspected ectopic pregnancy.
• You have complained that you have heavy menstruation, intermenstrual spotting, or brown “smearing” discharge before and / or after menstruation.
It is necessary to do “cleaning” only according to indications.
In General, the” cleaning ” is sent very often, even in the absence of the reasons that I have listed above. Scraping is often accompanied by any surgical treatment in gynecology. It seems to be all the time trying to do “at the same time” to “just in case check” whether everything is normal. This should not be the case, this is too frivolous attitude to a rather traumatic procedure.
So, instructions on how to avoid scraping.
• If you do not have heavy uterine bleeding (as they say, “pours on the legs”), but just go long-term spotting and pregnancy is excluded (uterine and ectopic), check with the doctor to stop the bleeding medically. Yes, it’s possible. Against the background of taking the drug (I will immediately warn you that this is a hormonal drug, but it is safe), the bleeding may stop, and a second assessment of your condition will need to be carried out after the next menstruation. In many cases, the treatment will be sufficient, and nothing more will be needed.
• If you have a polyp or endometrial hyperplasia during the ultrasound, do not rush to agree to scraping. Ask the doctor about the possibility to prescribe the drug in this cycle and after a repeat ultrasound after your next period; if a polyp or hyperplasia confirmed – alas, curettage under control hysteroscopy is necessary to do, but you have a very big chance that after menstruation indications for the procedure will be.
- A little about polyps and hyperplasia: a polyp is an outgrowth on the lining of the uterus (similar to a finger or mushroom), most often benign. There are polyps that are rejected during menstruation, and those that grow from the germ layer. The latter require deletion. Hyperplasia – thickening of the mucous membrane of the uterine cavity. There are two types: simple and complex. Simple hyperplasia occurs most often, it is not dangerous, for its development there must be a mandatory cause (functional cyst in the ovary, polycystic ovary syndrome, and several others). Usually 10 days of taking the drug is enough for it to pass and not be repeated. Complex hyperplasia – bad hyperplasia, an error in the structure of the endometrium, usually occurs after 35 years, more often against the background of excess body weight, is treated at the beginning by removing the mucosa (scraping) and then a multi-month course of hormonal drugs or installing an intrauterine hormonal spiral “Mirena”. Accurate diagnosis is possible only with histological examination.
• If you are asked to do scraping only for diagnostic purposes before surgery or to clarify the condition of the mucous membrane, ask the doctor to start with “endometrial biopsy” (another name is “pipel biopsy” or “aspiration biopsy”). This is a simple outpatient procedure that does not require any anesthesia. A thin tube is inserted into the uterine cavity and a small amount of tissue is sucked in, which is then sent to the laboratory for research. This is a fairly informative analysis. Important: the material obtained as a result of scraping or biopsy is only the lining of the uterus, that is, it does not carry any information about other diseases. The fact is that often scraping is prescribed for the purpose of evaluating uterine fibroids for its characteristics; so-no information will be given by scraping.
The main manifestations of endometrial pathology are bleeding, heavy menstruation, and intermenstrual spotting.
- Remember, almost all modern ultrasound devices allow you to evaluate the mucous membrane of the uterus and identify signs of pathology in it. If the doctor at the ultrasound writes that the endometrium is not changed, and you do not have heavy menstruation, intermenstrual bleeding, then the probability that you have a pathology that requires scraping is close to zero.
• In General, the main manifestations of endometrial pathology (only this tissue is targeted for scraping) are bleeding, heavy menstruation and intermenstrual spotting. So, if you don’t have this, discuss with the doctor how justified his desire to make you a scraping.
Chronic endometritis is not diagnosed based on ultrasound data.
- “Chronic endometritis” is a frequent diagnosis during ultrasound and in the results of histological conclusion after scraping. This is a chronic inflammation of the uterine mucosa. So, there are no generally accepted criteria for making this diagnosis by ultrasound in evidence-based medicine. Simple histology also cannot reliably confirm this diagnosis. Often this diagnosis is made where it is not, since they are guided by “white blood cells”. A reliable diagnosis is possible only when conducting a special type of research – immunohistochemistry. This study is not available in all laboratories, and the material for it can be obtained by biopsy, and not by scraping. I think it is now clear that you do not need to do scraping to confirm the diagnosis of “chronic endometritis”. In General, the diagnosis and treatment of this endometrial disease makes sense only within the framework of the problem of infertility and miscarriage.
IN WHAT SITUATIONS SHOULD I AGREE TO SCRAPING?
- Severe uterine bleeding: Yes, scraping is a way to stop it.
- Suspected ectopic pregnancy (difficulty in making a diagnosis).
- Endometrial polyp or hyperplasia that did not disappear after menstruation (medical treatment).
- Remnants of fetal membranes (after abortion, miscarriage, pregnancy).
- Any spotting after menopause.
Now, I hope you have a reliable guide on how to avoid possibly unnecessary surgery for you. Don’t be afraid to ask the doctor questions. Offer alternatives (biopsy of the endometrium, medical treatment). Ask them to justify the need for scraping. The answer “we have so accepted” should not be accepted. Of course, all this applies only to those situations in which you do not have a threat to life and health (heavy bleeding).