Sonohysterogram

What is a sonohysterogram?

A sonohysterogram is a special kind of ultrasound that lets your healthcare provider see inside your uterus. With a sonohysterogram, an ultrasound records structures and shapes inside your uterus while your uterus is filled with saline. A sonohysterogram can help your provider see problem areas in your uterus and uterus lining (endometrium) that may be causing unwanted symptoms, like bleeding, pelvic pain and infertility. It’s also commonly referred to as an SIS.

When should a sonohysterogram be performed?

The best time to get a sonohysterogram is after your period has ended but before you ovulate, days 6 to 11 of your cycle, counting from your first day of bleeding. This is when the lining of your uterus is thinnest and your provider will be able to see it most clearly. If you are postmenopausal it can be done at any time.

Who shouldn’t get a sonohysterogram?

You shouldn’t get a sonohysterogram if you’re pregnant or if you have pelvic inflammatory disease (PID).

Why do you get a sonohysterogram?

A sonohysterogram is done in your provider’s office and is less invasive than other surgical procedures that help your provider see inside your uterus, like a hysteroscopy. It does a better job providing detailed views of structures inside your uterus that may be causing your symptoms than a standard pelvic ultrasound.

A sonohysterogram can show structures in your uterus that may be causing symptoms like pelvic pain, unexplained bleeding or infertility. Your provider may ask you to get a sonohysterogram if:

• Your periods are heavier or longer-lasting than is typical.
• You have vaginal bleeding in between periods.
• You’ve got pelvic pain that won’t go away.
• You’ve been unable to get pregnant.
• You’ve had two or more miscarriages.

A sonohysterogram can reveal structures inside your uterus that may be causing these symptoms. A sonohysterogram can show:

• Polyps.
• Fibroids.
• Atypical uterus shape.
• Signs of endometriosis.
• Signs of endometrial cancer.
• Blockages in your fallopian tubes.

Knowing the size, shape and location of various structures inside your uterus can help your provider:

• Diagnose your condition.
• Monitor growths or atypical structures in your uterus.
• Prepare for surgery to remove atypical growths.

Who performs a sonohysterogram?

An ultrasound technician takes images while a physician or other provider performs the procedure. Then, a physician (a gynecologist or radiologist) will interpret the findings and write a report that communicates these results with your healthcare provider.

How does a sonohysterogram work?

The procedure for a sonohysterogram is a lot like the one for a transvaginal ultrasound — but images are taken while a few teaspoons of sterile saline is slowly put into your uterus with a small catheter. Like a transvaginal ultrasound, a transducer wand is inserted into your vagina and cervix so that it reaches your uterus. Once inside, the wand releases sound waves that record information about the structures inside your uterus. This information is then used to project an image of what your uterus looks like onto a screen that the radiologist or technician doing your procedure can see.

What should I expect before a sonohysterogram?

It’s important that you only have a sonohysterogram when it’s safe and when your provider can get the best view of your uterus. To make sure this happens your provider will:

• Ensure you’re not pregnant. Your provider may ask that you take a pregnancy test. You can’t have a sonohysterogram if you’re pregnant.
• Ensure you don’t have an infection. Your provider may do a pelvic exam before the procedure to be sure there are no signs of infection.
• Prescribe medications to control irregular bleeding, if needed. If you have irregular bleeding, your provider may prescribe medication to control it. It will be harder for your provider to get a clear view of your uterus lining if you’re bleeding.

What should I expect on the date of my sonohysterogram?

On the day of your sonohysterogram, plan to:

• Eat, drink and take any medications as you normally would.
• Wear comfortable clothes so that it’s easy to change into a gown if asked.
• Take over-the-counter pain medication to prevent any discomfort during the procedure.
• Wear a pad to absorb any discharge from your vagina after your sonohysterogram.

Take care to follow any instructions your provider shares with you to prepare for your sonohysterogram.

What should I expect during a sonohysterogram?

Your sonohysterogram should take about 30 minutes. You may feel some minor cramps or discomfort at times during your sonohysterogram. But for the most part, you can expect a quick, painless experience.

Your provider will ask you to pee first so that your bladder is empty and to collect a sample for a pregnancy test. Then, a sonohysterogram happens in three parts. Your provider will:

1. Do a standard transabdominal and transvaginal ultrasound. You’ll be positioned on a table as if you were having a gynecological exam, lying on your back with your knees bent and legs open. Your provider will insert a thin, lubricated wand into your vagina. Once inside, the wand will record images of the inside of your uterus that will appear on a screen. Your provider will gently move the wand so that it records different angles of your uterus and remove it once enough views have been recorded. Depending on the indication for the procedure and if you've already had a recent ultrasound, pictures may be taken on top of your abdomen as well.
2. Add saline to your uterus. Your provider will use a tool called a speculum to hold your vagina open so that there’s easy access to your cervix. Your provider will use a cotton swab to clean your cervix. Then, they will insert a thin tube called a catheter into your vagina so that it reaches your uterus. Your provider will put a safe saline solution into your uterus through the catheter. You may feel slight cramping once the saline’s added, but taking pain medicine beforehand can help.
3. Do a transvaginal ultrasound with saline. Your provider will reinsert the wand from the first transvaginal ultrasound and go through the imaging process all over again while the saline fills your uterus. The fluid inside your uterus will allow the ultrasound to pick up more detail when compared to the first ultrasound. Your provider may use a feature of the ultrasound called a doppler to see how blood is moving inside your uterus.

What should I expect after a sonohysterogram?

You should be able to go home and return to your normal routine after your sonohysterogram. You may notice the following symptoms. All are harmless.

• You may have a watery discharge a few hours after your procedure. This is just the saline leaving your body.
• You may have mild pain or cramping. Anti-inflammation medications like ibuprofen or acetaminophen can help you feel better.
• You may notice spotting (red or brown discharge from your vagina) over the next few days. This can happen if there’s tissue irritation from the procedure, but it’s nothing to worry about.

What are the risks of a sonohysterogram?

A sonohysterogram is low-risk and has few side effects. You may feel uncomfortable at points during the procedure, but taking pain medications beforehand can help. There’s a slight chance of infection, but your provider can take steps to prevent this.

Pay attention to these warning signs that you may have an infection:

• Fever.
• Intense pain.
• Changes in your vaginal discharge.

Let your healthcare provider know right away if you notice these signs.

What type of results do you get and what do the results mean?

Your healthcare provider will contact you once the physician sends over the results from your sonohysterogram. Depending on the results, your provider may prescribe treatments or recommend more imaging — additional views or a different type of imaging procedure — to diagnose your condition.

What is the difference between a sonohysterogram and hysteroscopy?

A hysteroscopy and a sonohysterogram both allow your provider to see inside your uterus. A sonohysterogram is less expensive, less invasive and quicker than hysteroscopy. But it can only be used to diagnose a condition. Hysteroscopy allows your provider to see structures inside your uterus and remove them at the same time if needed.

What is the difference between a sonohysterogram and hysterosalpingography (HSG)?

Hysterosalpingography (HSG) uses radiation instead of sound waves to record structures in your uterus and project them onto a screen. An HSG can show if there’s a blockage in your fallopian tubes that may be causing you fertility issues. These blockages don’t always show up on a sonohysterogram.

A note from Cleveland Clinic

A sonohysterogram can help your provider diagnose all kinds of conditions that may be causing you unpleasant symptoms. The procedure won’t take up too much of your day, and you’re unlikely to notice any side effects other than mild discomfort and some saline drainage. It’s one of the best tools your provider has for inspecting the inside of your uterus, without surgery.