Sonohysterography

What is sonohysterography?

Ultrasound (sonography) is a safe and painless way of making pictures that show the anatomy of the organs inside the body. 

Sound waves of very high frequency are sent into the body from a transducer (probe) and their echoes are collected back by the same probe, and a computer creates the images on a screen in real-time. There is no ionizing radiation.

Sonohysterography, also known as saline infusion sonography, is a specialized ultrasound technique used to study the inside of a woman’s uterus. It is most often used to evaluate unexplained vaginal bleeding that may be caused by endometrial polyps or other tumors, fibroids, or endometrial scarring. It is sometimes used to investigate the cause of infertility or multiple miscarriages.

How should I prepare?

You should wear comfortable loose fitting clothing for your ultrasound exam. You may need to remove all clothing and jewelry in the area to be examined, and you may be asked to wear a gown during the procedure.

Sonohysterography is best performed one week after menstruation to avoid the risk of infection.  At that point in the menstrual cycle is at its thinnest, which is the best time to determine if the endometrium is normal. Sonohysterography should not be done if you are pregnant. No special preparation is required before the procedure.

How is the procedure done?

You will be lying on your back, with your feet in stirrups. The ultrasound imaging is done with a transvaginal transducer, a small probe inserted into the vagina, after you empty your bladder. The tip of the probe is smaller than a standard speculum used when performing a Pap test.

After the baseline exam, the probe will be removed and a sterile speculum inserted. The cervix is identified, cleansed, and then a very thin sterile catheter introduced into the cervix. Once the catheter is in place, the speculum is removed and the transvaginal transducer is re-introduced. Sterile saline is injected through the catheter to fill the uterine cavity, and ultrasound images taken quickly before the catheter and probe are removed. The entire procedure should be completed in less than 30 minutes.

What will I experience during and after the procedure and when will I get the results?

Ultrasound examinations are generally painless. With transvaginal ultrasound, even though the study is often done to look for a cause of pelvic pain, the study should not be painful or increase your discomfort, and is usually more comfortable than a manual gynecologic exam.

During the sonohysterogram, you may feel cramping after placement of the catheter and infusion of the saline. An over-the-counter pain medication may be helpful. Vaginal spotting for a few days after the procedure is normal. You should be able to resume normal activities immediately. If you develop a fever, you should contact your primary care physician.

The images will be analyzed by a radiologist, and the results will be sent to your primary care physician or specialist who requested the procedure. In some cases, the radiologist may discuss the preliminary results with you at the conclusion of the exam.

What are the benefits and risks?

Ultrasound is safe, does not require any ionizing radiation, and gives a clear picture of the pelvic organs. Sonohysterography is minimally invasive and generally well tolerated, has very few complications, and provides an excellent view of the uterus and endometrial lining. Many abnormalities that may be difficult to see with standard transvaginal ultrasound are readily visible with hysterosongraphy. With this information, unnecessary surgery may be avoided, and necessary surgery may be more successful.

There are very few risks. Patients with active pelvic inflammatory disease should not undergo sonohysterography.

There are a few limitations however. Stenosis or narrowing of the cervix may prevent proper placement of the catheter. Scarring of the endometrial cavity may prevent adequate filling, and limit the value of the study.

Radiologyinfo.org for Patients

The radiology information resource for patients. RadiologyInfo.org tells you how various X-ray, CT, MRI, ultrasound, radiation therapy and other procedures are performed. It also addresses what you may experience and how to prepare for the exams. The website contains over 200 procedure, exam and disease descriptions covering diagnostic and interventional radiology, nuclear medicine, radiation therapy and radiation safety and is updated frequently with new information. All material on the RadiologyInfo.org website is reviewed and approved by experts in the field of radiology from the ACR and RSNA, as well as other professional radiology organizations.

Learn More

Radiologyinfo.org for Patients

The radiology information resource for patients. RadiologyInfo.org tells you how various X-ray, CT, MRI, ultrasound, radiation therapy and other procedures are performed. It also addresses what you may experience and how to prepare for the exams. The website contains over 200 procedure, exam and disease descriptions covering diagnostic and interventional radiology, nuclear medicine, radiation therapy and radiation safety and is updated frequently with new information. All material on the RadiologyInfo.org website is reviewed and approved by experts in the field of radiology from the ACR and RSNA, as well as other professional radiology organizations.

Learn More