1. Diagnostic—to examine the endometrium (tissue lining the uterus) for abnormalities, including polyps, pre-cancer and cancer. Samples collected can be further examined under a microscope.

2. Therapeutic—to remove any abnormality, such as a polyp, abnormal endometrium, or retained remnants after a miscarriage or birth, or to retrieve certain (stringless) types of IUD.

Indications. Abnormal menstrual bleeding (including heavy or prolonged bleeding, bleeding between periods, or after menopause), or following incomplete miscarriage.

Method. Either under general or local anaesthetic, the woman is placed in ‘lithotomy’ position, which means she is lying on her back, with her legs separated, and supported with the knees bent. A speculum is used to separate the walls of the vagina, and bring the cervix into view. The cervix is gently dilated with a series of thin probes, until about 8 or 9 millimetres in diameter. The doctor then uses a guide wire to assess the size and direction of the uterus. The cavity of the uterus is then checked with a pair of narrow forceps. Then a curette, which is like a little spoon with a hole in the middle, is passed through the cervix into the cavity of the uterus, and the walls of the uterus are gently scraped with the curette, so whatever is inside the uterus comes out. The whole business usually only takes about ten minutes. Variations on the technique include suction curettage. A woman may have a period-like bleed following a D and C.

Complications. It is a very safe procedure. It is commonly performed and the incidence of problems is small (said to be 0.5 to 1 per cent). But as with all procedures, there are potential risks.

Possible (rare) problems include heavy bleeding, damage to the cervix, uterus or, less commonly, the bowel, infection, adhesions within the uterus, and the risks associated with a general anaesthetic.

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Fibroadenomas. These may vary in size from less than a centimetre, to several centimetres in diameter. They are discrete and smooth, slightly firm and regular, and are usually very mobile within the breast. This means that when they are examined with the hand they can tend to slip away under the fingers as you examine them.

Fibroadenomas can occur from puberty onwards, but rarely after menopause. They are not sinister, but can sometimes get bigger with time. Depending on their size, feel, and the age and wishes of the patient, they are often removed surgically. In older women, particularly, the reassurance of having a lump examined under a microscope is important to exclude cancer. In younger women a choice may be made to leave the fibroadenoma there, and review it. Sometimes they disappear on their own.

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• It is usually best to have a tubal ligation separate from other big events in your life, especially if they are stressful. You are more likely to regret having a tubal ligation if it is done when you have an abortion, or straight after you have a baby, or if you are having problems with your relationship.

• If you have a tubal ligation for medical reasons, rather than because you chose to have it, you may have a lot of mixed feelings about it. You could find that talking to a counsellor or a trusted friend or family member will help.

• Remember that tubal ligation is an operation and like all operations, there is a risk of complications. If you are generally healthy, the risk with this procedure is very small.

• Only choose sterilization after thinking it over very carefully. If you already have children, you need to feel as sure as possible that no matter what happens in your life you would not want to have another child. If you have never had children, then it may be an even bigger decision to make.

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How effective is the Progestogen IUD? The Progestogen IUD is more than 99 percent effective. So, if 100 women used the Progestogen IUD as their method of contraception for a year, less than one of them would have an unplanned pregnancy. This makes it more effective than the Pill

Why would I want to choose a Progestogen IUD? Like the Copper IUD, the Progestogen IUD may be a good choice for you if you have had a baby and you want to have a space of two or more years between pregnancies. It could also suit you if you have had all the children you want and you want a very reliable method, but you would also like to know that it can be reversed easily if you change your mind. If you’re likely to forget to use contraception, an IUD is a good choice because it is always in place. An IUD is usually easy for most doctors to remove in their surgery.

The thing that is special about the Progestogen IUD is that after die first few months you have less menstrual bleeding than with other types of IUD. This is an advantage for women who want an IUD but who normally have heavy periods, or periods that last a long time. Women who get heavy or long-lasting periods if they use a Copper IUD can often use a Progestogen IUD without any problems.

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Are there any side effects to using the Pill?

Many women do get some side effects from the Pill for the first couple of months, but they usually settle down after about three months. Some common side effects include breakthrough bleeding or spotting between periods, sore breasts and nausea. You may find that spotting between periods will improve if you are careful to take the Pill at the same time every day.

Some of the less common side effects include putting on weight, less desire for sex and feeling irritable. But these could also be caused by other things happening in your life and might have nothing to do with taking the Pill. So if any of these things happen to you, talk to a doctor or nurse to find out what is causing your symptoms. Then you can decide how to deal with it.

If one type of Pill does give you unwanted side effects, don’t just put up with it Tell your doctor. There are other types of Pills you can try, and you should be able to find one that suits you.

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