CURETTING THE UTERUS—CURETTAGE
The term ‘curetting’ is applied to the operation of scraping away the lining membrane of the uterus, either for the relief of some pathological condition or for diagnostic purposes.
The endometrium is not removed in its entirety by curetting, for the uterine glands dip down to a slight extent between the muscle fibres of the uterine wall. The endometrium is removed as far down as the muscular coat, and, consequently, those parts of the glands lying amongst the muscular fibres are left intact.
Indications. These may be divided into the cases in which the operation is (1) Remedial and (2) Diagnostic in nature.
The diseased states of the endometrium are many and their exact pathology is still under discussion. It is, therefore, more practical to consider the remedial indications for curetting from the point of view of symptoms.
(i) Uterine hæmorrhage is the chief symptom which calls for curetting. The causes of the hæmorrhage may be certain forms of endometritis. Thus hæmorrhage is a prominent symptom of the so-called ‘hypertrophic glandular endometritis’, a diffuse overgrowth or adenomatous condition of the endometrium, probably the after-result of a previous inflammation. There is one form which gives rise to specially profuse hæmorrhage—the ‘polypoid’ or ‘villous’ form, which arises usually in women over forty years of age.
The hæmorrhage from fibro-myoma of the uterus may require removal of the endometrium in order to relieve the bleeding temporarily at any rate. When milder measures fail, curetting is of great service in arresting the profuse menorrhagia which so often accompanies subinvolution of the uterus.
Certain cases in which the actual cause of the hæmorrhage is not evident are relieved by curetting; amongst these are such conditions as arterio-sclerosis of the uterine vessels.
(ii) A leucorrhœal discharge is another symptom for which curetting is sometimes indicated.