What is Sonohysterography?
Saline infusion sono-hysterography is a new technique
developed to better image the uterine cavity and the
lining of the womb.
Sterile saline is infused through a soft plastic catheter
placed in the cervix. The solution distends the cavity of
the womb allowing a much better view with transvaginal
ultrasound.
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.
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 an 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 10 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 into 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 you take a couple of Nurofen or
Naprogesic 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.
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Are there any risks?
Some women feel a bit faint after the procedure, but
after a rest, they recover.
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.
Please talk to the doctor about your history before the
procedure.
Why is HyCoSy more expensive?
The tubal patency studies may need special ultrasonic
contrast fluid called Levovist. It is a sterile solution which
has to be made up specially for each individual patient,
immediately before use. It is the most expensive part of
the procedure.
The other options available to test tubal patency are
laparoscopy and dye, done under general anaesthetic,
or hystero-salpingo-graphy done with x-ray visualisation.
These other tests are more uncomfortable and more
expensive. You may wish to discuss these options with
your doctor.
Sonohysterography showing a normal endometrial cavity.
Saline outlining two endometrial polyps in the cavity.
Dr Philippa Ramsay MBBS FRANZCOG DDU COGU
Dr Linda Atkins MBBS FRANZCOG DDU
Dr Joanne Ludlow MBChB FRANZCOG FRCOG DDU
Dr Karen Mizia MBBS BSc FRANZCOG DDU
Dr Indika Alahakoon MBBS FRANZCOG DDU CMFM
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