Understanding Sonohysterograms: A Physician’s Guide for Patients

As a physician, I often recommend sonohysterograms to patients who are experiencing certain gynecological issues or who are undergoing fertility evaluations. A sonohysterogram is a specialized ultrasound procedure that provides a detailed view of the inside of the uterus. It can be an invaluable tool in diagnosing conditions that may be affecting a woman’s reproductive health. In this blog post, I’ll explain what a sonohysterogram is, why it might be recommended, how the procedure is performed, and what to expect before, during, and after the test.

 What is a Sonohysterogram?

A sonohysterogram, also known as a saline infusion sonography (SIS), is a minimally invasive imaging procedure used to examine the uterine cavity. Unlike a standard transvaginal ultrasound, which provides general images of the uterus, a sonohysterogram offers enhanced visualization by using sterile saline solution to expand the uterine cavity. This allows for a more detailed assessment of the uterine lining (endometrium) and can help identify abnormalities that might not be visible on a regular ultrasound. There are no dyes, radiation or anesthetics involved.

 Why is a Sonohysterogram Performed?

A sonohysterogram may be recommended for several reasons, particularly if there are concerns about the structure or health of the uterus. Some common indications for a sonohysterogram include:

• Abnormal Uterine Bleeding: If you are experiencing irregular, heavy, or postmenopausal bleeding, a sonohysterogram can help determine the underlying cause. It allows your doctor to look for structural abnormalities like polyps, fibroids, or uterine adhesions that may be contributing to abnormal bleeding.

•  Evaluation of Uterine Abnormalities: For women who have had recurrent miscarriages or difficulties conceiving, a sonohysterogram can help identify issues such as uterine septa, submucosal fibroids, or adhesions (scar tissue) that may be affecting fertility.

•  Assessment of the Endometrium: In cases where endometrial hyperplasia (thickening of the uterine lining) or endometrial cancer is suspected, a sonohysterogram provides a clearer view of the endometrium, aiding in diagnosis and treatment planning.

•  Follow-up After Surgery: If you’ve had surgery to remove fibroids, polyps, or other uterine abnormalities, a sonohysterogram may be used to ensure that the uterine cavity has healed properly and that there are no residual issues.

 How is a Sonohysterogram Performed?

A sonohysterogram is typically performed in a doctor’s office or a specialized imaging center. The procedure is relatively quick, usually taking about 10-15 minutes. Here’s what you can expect:

1. Preparation:

• The procedure is often scheduled after your menstrual period but before ovulation, typically between days 5 and 10 of your menstrual cycle. This timing helps ensure that you are not pregnant during the procedure and that the uterine lining is thin, allowing for better visualization.

• For Dr. Dason's patients - report Day 1 of your period to day1@triofertility.com AND dasonoffice@triofertility.com

• You don't need a full bladder for this test (yay!) - empty your bladder after you check-in with the Ultrasound Department (18th floor - 655 Bay St. for Dr. Dason's patients)

• You may be advised to take an over-the-counter pain reliever, such as ibuprofen or naproxen, about 30-60 minutes before the procedure to help minimize any discomfort.

• Bring a sanitary pad with you

• Dr. Dason also typically recommends a 5-day course of antibiotics to prevent infection - doxycycline 100 mg twice per day starting 2 days BEFORE your test

• This test is covered by OHIP - bring your OHIP card with you

2. The Procedure:

• You will be asked to lie on an examination table with your feet in stirrups, similar to the position for a pelvic exam.

• A speculum is inserted into the vagina to allow access to the cervix, and the cervix is cleaned with an antiseptic solution.

• A thin, flexible catheter is gently inserted through the cervix into the uterine cavity. This part of the procedure may cause some mild cramping, similar to menstrual cramps.

• Once the catheter is in place, sterile saline solution is slowly infused into the uterus through the catheter. The saline helps to expand the uterine cavity, providing a clearer view of the uterine walls.

• As the saline is infused, a transvaginal ultrasound probe is inserted into the vagina to capture images of the uterus. The ultrasound images are displayed on a monitor, allowing your doctor to examine the uterine lining and identify any abnormalities.

3. After the Procedure:

• The catheter and speculum are removed, and you can get dressed. Some women may experience mild cramping or spotting after the procedure, but this usually resolves quickly.

• You can typically resume normal activities immediately after the procedure, although you may want to rest for a short period if you feel any discomfort.

 What to Expect After a Sonohysterogram

Most women tolerate a sonohysterogram well, with minimal side effects. However, it’s normal to experience:

• Mild Cramping: Some cramping during and after the procedure is common, similar to menstrual cramps. This usually resolves within a few hours.

• Spotting: Light spotting or a small amount of watery discharge is normal after a sonohysterogram and may continue for a day or two.

• Infection: Although rare (<1%), there is a small risk of infection associated with the procedure. Signs of infection include fever, severe pain, or foul-smelling discharge. If you experience any of these symptoms, contact your healthcare provider immediately. You may be at higher risk of infection if you've had endometrosis or pelvic infections in the past.

 Understanding the Results

The results of your sonohysterogram will help your doctor assess the health of your uterus and determine the next steps in your care. Possible findings include:

• Normal Uterine Cavity: If the uterine cavity appears normal, this helps rule out structural abnormalities as a cause of your symptoms or fertility issues.

• Polyps or Fibroids: These are common benign growths that can develop in the uterine lining. Polyps are usually small, soft growths, while fibroids are larger and firmer. Both can cause abnormal bleeding or interfere with fertility, depending on their size and location.

• Uterine Adhesions (Asherman’s Syndrome): Scar tissue within the uterus can cause the walls of the uterus to stick together, leading to menstrual irregularities and fertility problems. A sonohysterogram can help diagnose and evaluate the extent of these adhesions.

• Uterine Septum: A uterine septum is a congenital condition where a band of tissue divides the uterine cavity. This can increase the risk of miscarriage and infertility. A sonohysterogram can help identify the presence and size of a septum.

• Endometrial Hyperplasia or Cancer: Thickening of the uterine lining may indicate endometrial hyperplasia, which can be a precursor to endometrial cancer. A sonohysterogram can help evaluate the extent of the thickening and guide further diagnostic steps, such as a biopsy.

 Conclusion

A sonohysterogram is a valuable diagnostic tool that provides detailed information about the uterine cavity, helping to identify conditions that may be affecting your reproductive health. Whether you are experiencing abnormal bleeding, struggling with infertility, or have been recommended for follow-up after surgery, a sonohysterogram can provide crucial insights that guide your treatment and care.

If you have been advised to undergo a sonohysterogram or have concerns about your uterine health, don’t hesitate to discuss the procedure with your healthcare provider. They can answer any questions you may have, help you prepare for the test, and ensure that you receive the appropriate follow-up care based on the results. Understanding what to expect can help ease any anxieties and empower you to take an active role in your reproductive health.

Personal note : I've had 3 sonohysterograms myself. I was super nervous about the first one and put it off for a long time. It was fine. The second one, I felt NOTHING. The third one, I felt nothing during the procedure - but I had terrible pain for the rest of the day (probably because they had to use a lot of fluid to see my lining). I get it - it sucks and it's scary. Take the day off work..

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This blog post/handout is intended to provide general information. Please consult with a healthcare professional for medical advice specific to your condition.