Saline Sonohysterogram

Your doctor may request this test for a number of reasons, including:

• Looking for a lesion in the endometrium, such as a polyp. You may have a pelvic ultrasound that suggests the endometrium is thicker than normal or has a different appearance. The saline sonohysterogram will help confirm or exclude the presence of an endometrial polyp or submucous fibroid.
• Investigation of postmenopausal bleeding, especially if the endometrium is not well seen on a regular pelvic ultrasound, or if the endometrium appears thicker than expected.
• Assessing the shape of the endometrial cavity. The saline sonohysterogram evaluates the contour of the endometrial cavity, detecting conditions such as a uterine septum or bicornuate uterus (these are types of congenital uterine anomalies). 3D/4D imaging of the uterus during the sonohysterogram is particularly useful for the assessment of congenital uterine anomalies. This information may be used to investigate problems like recurrent miscarriages or infertility.

It is important that you are not pregnant when you have this test, as the procedure can disturb the implantation of the embryo. If there is a possibility that you are pregnant, the procedure will need to be postponed until your next menstrual cycle.

The best time to perform a saline sonohysterogram is just after your period has finished, approximately day 7 to day 10 of a regular 28-day (monthly) menstrual cycle (the first day of your period is counted as day 1).

If your menstrual cycle is shorter than 28 days (for example, you usually only have 21 days between periods), you will need to have the test earlier in the cycle.

If your menstrual cycle is longer than 28 days, but still regular (for example, you usually have 35 days between periods), you may be able to have the test later in the cycle if that is more convenient.

If your periods are infrequent or irregular, please discuss the optimal time for this test with your doctor or our reception staff.

If you are postmenopausal, you can usually have a saline sonohysterogram at any time.

The level of pain experienced is usually minimal, with most women experiencing either no pain or only mild cramping period-type discomfort during the test.

We suggest that you take 2 naprogesic tablets 30-60 minutes before the procedure, to minimise your discomfort. No anaesthetic is required for this procedure.

You do not need a full bladder for this test, unless you are also booked for a pelvic ultrasound on the same day. We will ask you to completely empty your bladder before the test begins.

You can eat and drink normally before and after the test.

The first part of the saline sonohysterogram is like the first part of a pap smear, with a vaginal speculum gently inserted into the vagina to visualise the cervix. The cervix is then cleansed with antiseptic solution, to decrease the risk of infection. A thin flexible catheter is inserted through the opening of the cervix, so that the catheter lies within the endometrial cavity. Inserting this intrauterine catheter does not usually cause discomfort. The vaginal speculum is then removed, with the catheter remaining inside. Next, the transvaginal ultrasound (internal scan through the vagina) is used to image the uterus.

A small amount of sterile saline (usually less than 10ml) is introduced into the endometrial cavity through the catheter. This saline distends the endometrial cavity, allowing better assessment of the contour and shape of the endometrium.

The transvaginal ultrasound and catheter are removed at the end of the test.

For more information about transvaginal ultrasound, please go to:

• Pelvic/Gynaecologic ultrasound

Saline sonohysterogram is a safe and well-tolerated procedure for the assessment of the endometrial cavity.

Infection of the uterus/pelvis is not common following this procedure, but it may rarely occur.

You should contact either your referring doctor or our practice immediately if you have the following symptoms:

• Persistent or foul-smelling vaginal discharge
• Increasing lower abdominal pain
• Unexplained fever
• Generally unwell

Such symptoms may indicate an infection requiring antibiotics.

If you have a history of pelvic infection or in other special circumstances, the doctor may give you antibiotics to prevent pelvic infection.

Please tell the doctor before your procedure begins if you have a history of pelvic infection, or another reason for antibiotic prophylaxis. Antibiotics are otherwise not routinely given during this test.

You should wear a sanitary pad after the procedure. There may be some persistent vaginal discharge for a few hours, as the fluid used in the test will leak out the vagina. This discharge is sometimes blood stained so do not be alarmed if this occurs.

Our practice will provide you with a sanitary pad to use following the procedure, although you may prefer to bring your own.

Most women do not find the test too uncomfortable. Some women experience mild cramping period-type pain during the test, but this usually subsides once the test is completed. You should be able to drive and resume normal daily activities after the test.

You can eat and drink normally after the procedure.

The ultrasound doctor will discuss your results once the procedure has been completed (for example, whether an endometrial polyp seen).

Your referring doctor will decide if you need to have further investigations or procedures (for example, hysteroscopy and curettage).