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A woman who experiences symptoms like trouble getting pregnant, repeated miscarriages, or abnormal menstrual bleeding may be referred for a sonohysterogram to investigate possible causes. If a transabdominal or transvaginal ultrasound produces insufficiently clear images to locate the source of the problem, then a sonohysterogram may be recommended.
What is a sonohysterogram?
A sonohysterogram is a special ultrasound procedure designed to produce clear images of the uterus. Transvaginal ultrasound images are taken both before and after sterile saline solution is introduced into the uterus via a catheter. The saline expands the uterine cavity and outlines the endometrium (uterine lining) for clearer visualization, helping to identify any polyps, masses, scarring, atrophy, or other abnormalities that may exist.[1]
What is the procedure like?
Typically, a sonohysterogram will be scheduled for approximately one week after the first day of your menstrual cycle (the first day of your period). This is the time when the endometrium is at its thinnest, making it easiest to detect abnormalities. However, the timing of your exam may be different depending on your symptoms and what your doctor suspects may be causing them. Sonohysterography is not performed during menstruation or pregnancy.
When you arrive for your appointment, the radiologic technologist will first take your medical history. Then, you’ll be given a gown and asked to disrobe from the waist down. As you lie on your back on the exam table with your feet in stirrups, initial images will be taken using transvaginal (TV) ultrasound. If you have never had a TV ultrasound before, read our article, "What’s a Transvaginal Ultrasound Like and Why Do I Need One?" for detailed information about this portion of the procedure.
After the initial TV ultrasound exam, the transducer will be removed and replaced with a speculum (like those used in routine gynecologic exams). The cervix will be sterilized to prevent infection, and then a thin, flexible, lightweight catheter will be inserted into the uterine cavity through cervix. Once the catheter is in place, the speculum will be removed. The transducer will again be inserted into the vagina, and additional ultrasound images will be taken.
It is common to experience cramping when the catheter and saline are introduced. For your comfort, you may wish to take up to 600mg of ibuprofen 30 minutes prior to your exam. If ibuprofen is not an appropriate medication for you, consult with your doctor about the best way to minimize pain during and after the procedure. Cramping, spotting, and watery discharge may persist for a couple of days.
Are there any risks involved with sonohysterography?
Relative to other types of imaging procedures, sonohysterography is quite safe. Because a sonohysterogram uses ultrasound rather than X-rays, it does not carry the increased risk of cancer associated with ionizing radiation. Because it uses sterile saline to enhance imaging, it also avoids the potential side effects associated with contrast solutions. On rare occasions, however, patients have developed pelvic infection following the procedure. If you experience fever, escalating pain, or a change in the quality or quantity of vaginal discharge following a sonohysterogram, consult your doctor.[2]
Iowa Radiology provides a wide range of women’s imaging services, including sonohysterography, hysterosalpingography, obstetric ultrasound, and breast imaging. We pride ourselves on putting our patients first and helping them to be as comfortable as possible during their time with us. Feel free to contact us with any questions or concerns you have about procedures scheduled at our clinics in Ankeny, Clive, West Des Moines, or downtown Des Moines.
[1] "Sonohysterography." Radiologyinfo.org. Radiological Society of North America, 8 June 2016. Accessed 26 Feb 2018.
[2] "Sonohysterography FAQ." ACOG.org. American College of Obstetricians and Gynecologists, Dec 2016. Accessed 26 Feb 2018.
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