SONOHYSTEROGRAM

A Patient’s Guide to Sonohysterogram

When women in their 20’s and early 30’s have abnormal uterine bleeding the cause most likely is “hormone imbalance”. Such women in the past were often offered hormonal therapies most commonly in the form of low-dose birth control pills.

As women get into their late 30’s and 40’s, concerns about endometrial abnormalities, such as polyp, fibroid, precancerous and cancerous lesions increase. Therefore, for the last 50 years, women of such age with abnormal bleeding have been investigated and diagnosed with D&C, hysteroscopy, endometrial biopsy and other invasive procedures to exclude serious abnormalities. After these invasive and painful procedures they are being told they have “hormone imbalance”.

During the past few years by performing sonohysterogram (SIS) which is  less traumatic yet equally accurate office-based alternative, usage of more invasive procedures have been reduced.

What is Sonohysterogram?

Sonohysterogram is a valuable new technique for examining the endometrial cavity. It involves instilling a small amount of normal saline into the endometrial cavity with a flexible catheter while simultaneously visualizing the endometrial surface and its thickness with transvaginal ultrasound. It is being used routinely worldwide at low risk to the patient. The procedure takes only minutes to perform and can be done as part of a regularly scheduled office visit.

Indications

• Abnormal vaginal bleeding
• Unexplained infertility
• Recurrent pregnancy loss
• Pre and post-operative assessment of uterine pathology

Precautions- Who should not get a sonohysterogram?

• Sonohysterography should not be performed if you are pregnant or suspect that you might be pregnant
• Any pelvic infection should also be properly treated and eliminated prior to this procedure

Procedure

A speculum is introduced into the vagina while sterile technique is utilized. The cervical/vaginal area is then cleaned with an antiseptic solution (betadine). A small (few millimeters) catheter is then gently introduced into the cervical canal. The saline solution is then slowly introduced into the uterine cavity with simultaneous visualization using an ultrasound probe. The endometrium and uterus are evaluated. When the procedure is finished, the catheter is gently removed.

You may experience slight pressure and/or cramping as the catheter is inserted and during its removal. Occasionally, patients will experience cramping during the infusion of the saline solution. After the report is completed you will discuss the findings as well as the appropriate follow-up treatment with the physician.

Benefits

In summary, saline infusion sonohysterogram enhances endovaginal ultrasound examination of the uterine cavity. It is easily and rapidly performed at minimal cost. It is extremely well tolerated by patients and virtually devoid of complications. It can prevent further invasive diagnostic procedures in many patients as well as optimize the preoperative triage process for those patients who may require therapeutic intervention.

Patient Preparation

The procedure is extremely well tolerated, with no pain in the overwhelming majority of patients, and minimal cramping in a very few. Nonetheless, it is recommended that 20 - 30 minutes prior to your exam time you take 2 tablets (400 mg. total) of Ibuprofen (Advil or Motrin). If you are allergic to these medications you may use Extra Strength Tylenol (acetaminophen). There is no need for you to fill your bladder prior to this exam.

Insurance Coverage

This procedure is fully recognized and reimbursed by most insurance providers including Medicare. Actual reimbursement amount will vary by insurance providers.