Sonohysterogram

Why It Is Done

It's usually done because a normal ultrasound has not found the cause of heavy bleeding, repeated miscarriages, or trouble getting pregnant.

This imaging test checks the inside of the uterus for such things as:

• An abnormal shape or structure.
• Abnormal growths or masses, such as fibroids or polyps.
• Scarring inside the uterus (adhesions).

A sonohysterogram may be more accurate than a hysterosalpingogram for finding fibroids and polyps.

How To Prepare

First, schedule your sonohysterogram appointment for:

• When you expect to not have menstrual bleeding. The best time for checking the lining of your uterus is 1 week after your menstrual period ends. That's when the uterine lining is thinnest.
• When you aren't pregnant. (You may have a pregnancy test to be sure.)
• When you don't have a pelvic infection (pelvic inflammatory disease) or sexually transmitted infection (such as gonorrhea or chlamydia). Ask your doctor to check if you're not sure.

Tell your doctor if you are allergic to latex. A latex-free cover can be used for the ultrasound wand.

You may be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to your doctor about any concerns you have about the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?).

How It Is Done

A sonohysterogram can be done in a doctor's office, a hospital, or a clinic. It usually takes about 15 to 30 minutes.

Your doctor may advise you to take an over-the-counter pain medicine before your appointment. This may help prevent cramping pain during the test.

Before a sonohysterogram, you empty your bladder. You then take off your clothes below the waist. You are given a gown or sheet to cover up with during the test.

For the test, you sit on the edge of a padded table. Then you lie back with your feet raised and supported by stirrups.

A sonohysterogram is done in several steps.

1. Transvaginal ultrasound. The tip of a thin ultrasound wand with gel on it is gently inserted into your vagina. You will need to lie very still while the ultrasound is being done.
2. A catheter is put in place. Next, your doctor inserts a smooth, curved tool called a speculum into your vagina. The speculum gently presses the vaginal walls outward, allowing your doctor to see the cervix. The cervix is washed. Then a flexible tube (catheter) is put in the cervix or through the cervix into the uterus.
3. Transvaginal ultrasound while the uterus is filled with fluid. The doctor then removes the speculum and reinserts the ultrasound wand. Onscreen, the ultrasound image shows the inside of your uterus while saline solution is injected through the tube into the uterus. Ultrasound images are taken and reviewed.

After the test, the ultrasound wand and then the tube are removed. Some of the saline solution flows through the fallopian tubes into your abdominal cavity. But most runs out of your cervix and vagina.

How It Feels

You probably will feel some cramping like menstrual cramps from the fluid being injected into your uterus. After the test, you can expect a watery discharge for a few hours.

What Affects the Test

There are times when you may not be able to have the test or when the results aren't helpful. This may be:

• When the cervix is too tight for the catheter to fit in.
• When the uterus won't expand enough to allow a good ultrasound view. Scar tissue or large fibroids can cause this problem.
• During menstrual bleeding, which makes the images hard to read.

Your doctor will not perform a sonohysterogram if you are pregnant or have a pelvic infection.

What To Think About

A sonohysterogram doesn't show how well the fallopian tubes are working. When there is a question about the tubes, a hysterosalpingogram is used.

For looking at the uterus only, a sonohysterogram is a good choice because it:

• Doesn't use radiation.
• Can be done in the doctor's office, rather than at a radiology center or hospital. This means it's likely to cost less than a hysterosalpingogram.