Sonohysterography

What is Sonohysterography?
Saline infusion sono-hysterography is a new technique developed to better image the uterine cavity and the lining of the womb.

This technique may be used to assess abnormalities of the uterus and endometrium (lining of the womb). If your doctor also wants us to test for tubal patency, a special occlusive catheter and special ultrasonic contrast agent are used.

How is it performed?
In our rooms, in a private room, you have a transvaginal ultrasound examination. Then the gynaecologist inserts a speculum into the vagina to visualise the cervix. A soft plastic tube is inserted into the womb (uterus) and sterile saline is infused while the sonographer watches with ultrasound. The solution distends the cavity of the womb allowing a much better view of the lining and uterine wall.

Why is it performed?
This procedure is used when:
There is abnormal vaginal bleeding (before or after menopause):
Many women have unusual bleeding around the time of menopause. This is often due to hormonal changes. But sometimes it can be because of pathology like a polyp. If no obvious problems are seen within the uterus on sonohysterography there is no need for further investigation. Sometimes the ultrasound can point to a problem with the hormone replacement therapy. Sometimes the sonohysterogram can show why the periods are very heavy or why there is bleeding after intercourse.
A mass is suspected in the womb on ultrasound:
If a mass is found within the uterus, its type and size can be assessed prior to surgery. The most common findings are benign endometrial polyps, fibroids or a thickened uterine lining.
When should it be done?
If the bleeding is really irregular, the test can be done at any time. If you are having regular cycles and there is a chance of pregnancy, the procedure should be performed in the first 12 days of the menstrual cycle, before ovulation.
This avoids the chance of the sonohysterography interfering with the implantation of the embryo.

Investigating infertility & recurrent miscarriage
Sonohysterography can detect benign endometrial polyps or adhesions within the uterus which may prevent conception.
Recurrent miscarriage may be due to fibrous bands (septations) within the uterine cavity or to an abnormal uterine shape.
These can be difficult to see, using ultrasound alone but become clear on sonohysterography.

Assessing the uterine lining in patients on Tamoxifen therapy
A side effect of Tamoxifen therapy for breast cancer can by polyps, thickening, or even cancer of the uterine lining. Sonohysterography can distinguish true abnormalities from thickening that happens beneath the uterine lining that is a common finding of no significance.

Seeing if the Fallopian tubes are blocked (tubal patency)
Blocked tubes are a common cause of infertility.

Hysterosalpingo-contrast-sonography is a modification of the sonohysterography procedure that involves injecting a special solution that is easily identified on ultrasound in the uterus.
The fluid can be seen as it passes along the Fallopian tubes and this will show if there is any blockage. This test can also be used to prove that the tubes are blocked after a tubal ligation or the Essure procedure.

Will it be painful?
Sonohysterography does not required hospitalisation, anaesthetic or analgesia. Some women have some period-like pain during or shortly after the procedure.
Tubal patency studies can cause a bit more cramping. We recommend that you take a couple of Panadol or Naprogesic tablets beforehand.

After the procedure?
We recommend that you sit and rest for 10 minutes or so after the test. We will explain the results to you. The report will be forwarded to your doctor. Your doctor will plan whether or not you need further treatment.

Are there any risks?

Feeling faint:
Some women feel a bit faint after the procedure, but after a rest, they recover.
Bleeding:
Some women have a small amount of bleeding afterwards, or over the next few days. This is due to the balloon or the tube rubbing on the endometrial lining and causing it to shed before the normal period. This is nothing to worry about.
Infection:
There is a risk of introducing infection, though this is extremely rare. If there is a chance that you already have a pelvic infection the procedure should be avoided because of the risk of it being exacerbated.

If you have an artificial heart valve or any other reason to need prophylactic antibiotics, it is best to take the antibiotics before the procedure or as soon as possible afterwards.

Please talk to Dr Farag about your history before the procedure so that we can best look after you.