Sonohysterogram

What is a sonohysterogram?

A sonohysterogram (SHG) is a type of transvaginal ultrasound exam that lets your healthcare provider see inside your uterus. It involves the insertion of saline (sterile fluid) through your cervix to better view your uterine cavity. It’s also called saline infusion sonography (SIS).

A sonohysterogram can help diagnose issues in your uterus and uterine lining (endometrium) that may be causing symptoms.

You may need a sonohysterogram if you have:

• Abnormal uterine bleeding, especially bleeding or spotting between your periods
• Bleeding or spotting after menopause
• Fibroids that may be causing abnormal bleeding
• Infertility or repeated miscarriages
• Periods that are longer or heavier than usual

What should I expect before the test?

You’ll need to schedule the test based on the timing of your menstrual cycle.

The best time to get a sonohysterogram is after your period has ended but before you ovulate (usually days six to 11 of your cycle). This is when the lining of your uterus is thinnest. Your healthcare provider will be able to see it most clearly. If you’re menopausal, taking a continuous birth control pill or have a hormonal IUD, you can get the procedure at any time.

Your provider may prescribe medications to temporarily manage heavy bleeding if needed. It’s more difficult for your provider to get a clear view of your uterine lining if you’re bleeding. If you’re menopausal or have a cervix with a narrow opening, your provider may give you a pill to take the night before to soften your cervix.

Follow any instructions your provider shares to prepare for the sonohysterogram.

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 usually would.
• Take ibuprofen, naproxen or acetaminophen one hour before your appointment to prevent any discomfort during the procedure.
• Wear a pad to absorb any discharge from your vagina after the procedure.

Right before the procedure:

• You’ll empty your bladder (go pee). While peeing, you’ll collect a urine sample for a pregnancy test. You can’t have a sonohysterogram if you’re pregnant. You may have an abdominal ultrasound before you empty your bladder.
• Your provider may do a pelvic exam. They’ll check for signs of infection. You can’t get a sonohysterogram if you have a pelvic infection.

What happens during a sonohysterogram?

In general, you can expect the following during a sonohysterogram:

1. You’ll lie on a table as if you were having a gynecological exam, lying on your back with your knees bent and legs open.
2. Your healthcare provider will insert a slender, lubricated wand (ultrasound transducer) into your vagina.
3. They’ll record images of the inside of your uterus with the wand. When they’re done, they’ll remove it.
4. Your provider will use a speculum to hold your vagina open so there’s easy access to your cervix.
5. They’ll use a swab to clean your cervix. Then, they’ll insert a thin tube called a catheter into your vagina and through your cervix so it reaches your uterus. You may feel some cramping.
6. Your provider will remove the speculum and reinsert the ultrasound wand while the saline fills your uterus through the catheter. You may feel pressure or cramping at this point, too.
7. Once they have enough images, they’ll remove the wand and the catheter.

The sonohysterogram visit should take about 30 to 45 minutes. The part involving the fluid in your uterus only lasts five to 10 minutes.

Is a sonohysterogram painful?

Mild pain or discomfort is common with a sonohysterogram. You may feel cramping when your healthcare provider inserts the catheter into your cervix and pressure when they fill your uterus with saline.

The cramping should improve quickly after the procedure and after the fluid drains out. Taking over-the-counter NSAIDs and using a heating pad may help.

It’s important to remember that everyone experiences pain differently. Some may describe this procedure as causing mild discomfort. Others may have moderate pain.

Tell your healthcare provider if you feel intense pain at any point during the procedure. You don’t have to push through the pain.

What are the risks of the test?

A sonohysterogram is an overall safe test. In rare cases, it can lead to a pelvic infection. Let your healthcare provider know right away if you have these signs of an infection:

• Changes in your vaginal discharge
• Fever
• Intense pain

What can I expect after the test?

You should be able to go home and return to your normal routine after the sonohysterogram. You may experience the following:

• 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. Taking over-the-counter pain relievers may help you feel better.
• You may notice light 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 type of results do you get and what do the results mean?

A sonohysterogram can reveal structures inside your uterus that may be causing issues. It can show:

• Atypical uterus shape
• Excessive thickening of your endometrium
• Fibroids
• Polyps
• Signs of endometrial cancer
• Signs of adenomyosis

Your healthcare provider will explain the results of the test. Don’t hesitate to ask questions.

Depending on the results, your provider may:

• Diagnose a condition.
• Prepare for surgery to remove atypical growths.
• Prescribe treatments.
• Monitor growths or atypical structures in your uterus.
• Recommend more imaging or other tests to make a diagnosis.

What is the difference between ultrasound and sonohysterogram?

The main difference is that a sonohysterogram involves the insertion of saline into your uterus. A standard ultrasound of your uterus — either a pelvic ultrasound or transvaginal ultrasound — doesn’t involve saline.

Taking images of your uterus and other structures before and after the saline insertion allows your healthcare provider to better visualize your uterine cavity and lining.

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

Hysterosalpingography (HSG) uses radiation and contrast dye — instead of sound waves and saline — to record structures in your uterus. Healthcare providers typically use HSG to look for structural issues causing infertility. They tend to use sonohysterography to help diagnose a range of conditions.

An HSG can show if there’s a blockage in your fallopian tubes that may be causing fertility issues. These blockages don’t always show up on a sonohysterogram.