Saline Sonohysterography

The Procedure

Saline sonohysterography is used to better image the uterine or endometrial cavity. A pelvic ultrasound is performed first, then the sonohysterogram is performed. Saline is injected into the lining of the uterus to improve the visualisation of the lining.

Why have I been referred?

This procedure is commonly helpful to women who have abnormal uterine bleeding; in cases where a mass is suspected in the uterus on ultrasound and its size and position can be better defined prior to surgery; as part of the investigation into infertility; to assess whether there are retained products after pregnancies.

When should it be done?

The procedure is performed in the first 10 days of your menstrual cycle, and prior bladder-filling is not required.

It must not be done when you are or could be pregnant, so it is best planned for the first half of your cycle, before day 12-14 when ovulation usually takes place. The test is ideally done between day 5 and day 10 of the menstrual cycle, counting from the first day of your period. If there is no chance of pregnancy (e.g. you are on the oral contraceptive pill, or have completely abstained from sexual intercourse since the first day of your period), we may be able to do the test later than day 10. If there is any doubt regarding possible pregnancy, the test will be rescheduled for the following month. It should not be done if there is any chance of acute pelvic infection. Discuss this with your referring doctor.

What happens on the day?

The study is performed by the radiologist or gynaecologist along with the sonographer.

You do not need to have a full bladder. A scan through the abdomen may be performed initially, and you will then be sent to the bathroom to completely empty your bladder and put on a gown. You will be positioned on the bed with your feet comfortably resting at a lower level. A transvaginal ultrasound is then performed, where we will assess the shape and appearance of your uterus, the endometrium (lining of the uterus), and the ovaries. One of our doctors will then discuss the procedure with you in detail.

A speculum is inserted into the vagina, similar to a pap smear. The upper vagina is cleansed with antiseptic, and a very thin (2mm) tube, or catheter, is passed through the cervix into the uterus. The speculum is then removed and replaced by the trans-vaginal ultrasound probe. A small balloon on the catheter is inflated to keep the catheter in place. Sterile saline is then injected into the catheter, which gives us information about the inside of the uterus. The speculum is removed and the vaginal probe is positioned in the vagina such that images of the uterine cavity are obtained

What happens afterwards?

We are able to discuss results with you on the day of the test, and a detailed report is sent to the referring doctor.

Most women are able to drive after the procedure. However, as some women may experience faintness or cramping pain, it can be helpful to have someone available to drive you home.

Minor cramping and some watery discharge from the vagina may persist for up to 24 hours. Occasionally there may be light bleeding or spotting. Symptoms of infection include fever, loss of appetite, pelvic pain, or unusual vaginal discharge. If you have any concerns, contact your doctor as soon as possible.

How long does it take?

The preliminary pelvic scan takes approximately 20 minutes and the Saline Sonohystography procedure takes approximately 15 minutes.

Allow 45-60 minutes for your appointment.

How much does it cost?

It does cost more than a normal pelvic examination. It is a consultant led pelvic examination using special contrast and equipment specifically for highlighting the lining of the uterus. Unfortunately the contrast and the equipment required for this procedure is very expensive and this is reflected in our overall cost. Please contact our reception staff for more information.

Is the test painful?

Most women experience only mild discomfort. Others may experience period-type cramping during the procedure. This can be minimised by taking two tablets of an anti-inflammatory medication such as Nurofen or Brufen 1 hour before the procedure. Women who are unable to take anti-inflammatory medications may substitute Panadol or Panadeine.

Are there any risks involved?

Some women feel faint during or after the procedure. It is important to let us know if you are feeling unwell. Infection as a result of the procedure occurs in less than 1% of women, most commonly if there is a history of pelvic infection. It is important to discuss with your referring doctor whether you may be at risk of infection, and, if so, obtain a prescription for antibiotics to be taken a few hours prior to the procedure.