Sonohysterography: A Comprehensive Guide to Uterine Ultrasound Imaging
An in-depth look at sonohysterography, its purpose, procedure, preparation, benefits, and risks for women's reproductive health.

Sonohysterography: An Essential Diagnostic Ultrasound Technique
Sonohysterography, also known as saline infusion sonography (SIS or SHG), is a specialized, minimally invasive diagnostic procedure using ultrasound imaging to evaluate the structure and health of the uterus. This technique plays an important role in investigating abnormal uterine bleeding, unexplained infertility, recurrent miscarriages, and suspected uterine abnormalities such as polyps, fibroids, or scarring. It works by injecting sterile saline solution into the uterus while capturing real-time ultrasound images, offering enhanced visualization of the uterine cavity and endometrium compared to standard ultrasound alone.
Understanding the process, indications, preparation, benefits, risks, and possible limitations of sonohysterography is crucial for patients and healthcare providers alike. This article provides a comprehensive guide to the procedure, answering common questions and helping individuals make informed decisions about their reproductive health.
What Is Sonohysterography?
Sonohysterography refers to a diagnostic imaging procedure designed to obtain detailed pictures of the inside of the uterus using sound waves. Unlike x-rays, ultrasound does not use radiation and presents no known harmful effects. In a standard sonohysterography, a thin, flexible catheter is introduced into the cervix, and sterile saline is infused into the uterine cavity. The saline expands the cavity, providing clearer ultrasound visualization of the endometrium and enabling identification of abnormalities that are otherwise difficult to detect.
The procedure is commonly known as hysterosonography or saline infusion sonography. Additionally, Doppler ultrasound may be used during sonohysterography to assess blood flow and vascular features within the uterus or its lining.
Ultrasound imaging is noninvasive and can display both the structure and motion of internal organs, as well as blood flow through vessels when performed with Doppler technology.
- Purpose: Visualize and evaluate the uterine cavity, analyze endometrial lining for polyps, fibroids, adhesions, congenital defects, and masses.
- Technique: Infuse saline into the uterine cavity while performing vaginal (transvaginal) ultrasound.
- Also known as: Saline infusion sonography, SHG, hysterosonography.
Common Uses of Sonohysterography
Sonohysterography is a valuable diagnostic tool for several medical indications, especially in the evaluation of unexplained or abnormal uterine bleeding and structural abnormalities. Physicians recommend this procedure for:
- Unexplained vaginal bleeding
- Infertility investigations
- Recurrent miscarriages
- Suspected uterine polyps, fibroids, or adhesions
- Congenital uterine defects (e.g., septate uterus)
- Suspected scar tissue (Asherman’s syndrome)
- Malignant lesions or uterine masses
- Pre- and post-surgical evaluation of the uterus
- Clarifying findings from routine ultrasound
Doppler ultrasound as part of sonohysterography can further aid in analyzing blood flow, identifying clots, assessing tumors, malformations, pelvic varicosities, and aneurysms.
Preparing for Sonohysterography
Typically, little or no special preparation is needed for the procedure, but certain steps help ensure safety and optimal results:
- Schedule timing: Preferably performed soon after menstrual period—within 10 days after the first day—to reduce risk of infection and avoid disruption if early pregnancy is possible.
- Inform provider: Notify your doctor if there is a chance you could be pregnant.
- Clothing/jewelry: Remove jewelry and wear loose-fitting clothes. You may be asked to wear a hospital gown.
- Bladder: Empty your bladder just before the procedure.
- Medication: Routine medications are usually continued, unless directed otherwise.
Most women remain completely awake and alert throughout the procedure.
How Sonohysterography Works: Equipment and Technique
Sonohysterography relies on ultrasound equipment and specialized tools:
- Transvaginal ultrasound transducer: A slim device that emits high-frequency sound waves, covered with a disposable sheath and conductive gel.
- Speculum: Used to gently open the vagina, similar to what is used during Pap smears.
- Thin catheter: Flexible tube inserted through the cervix to deliver saline into the uterus.
- Saline solution: Sterile fluid that expands the uterine cavity, creating clearer borders on imaging.
- Doppler feature: Occasionally applied to examine blood flow within the uterus.
Equipment | Purpose |
---|---|
Transvaginal Ultrasound | Produces real-time images of the uterus and endometrium |
Speculum | Keeps vaginal canal open for access to the cervix |
Catheter | Administers saline into the uterine cavity |
Saline Solution | Expands uterine cavity for better visualization |
Step-by-Step: The Sonohysterography Procedure
- You will be asked to empty your bladder and undress from the waist down, lying on an exam table with knees bent.
- A pelvic examination may precede the imaging process to check for tenderness or pain.
- The ultrasound transducer, covered with a special gel and sheath, is inserted into the vagina for standard transvaginal imaging.
- After initial images are taken, the transducer is removed. The provider inserts a speculum into the vagina to access the cervix for cleaning with a swab.
- A thin, flexible catheter is gently guided through the cervical opening into the uterine cavity. You may experience mild pinching or cramping.
- The speculum is then withdrawn, and the ultrasound transducer is reinserted.
- Sterile saline is slowly infused via the catheter, expanding the uterine cavity.
- Real-time ultrasound images are acquired as the saline highlights the uterine lining and potential abnormalities.
- After sufficient imaging, the transducer and catheter are removed. Saline fluid drains out over a few hours, either spontaneously or with mild leakage.
The entire process usually takes less than 30 minutes. Most patients experience mild discomfort or cramping, which resolves quickly.
What to Expect During and After Sonohysterography
Patients remain conscious and may feel mild discomfort at several steps—mainly during catheter insertion and saline infusion. Expect mild cramping, slight vaginal spotting, and some wetness as saline fluid drains from the uterus over a few hours.
- Pain level: Usually minimal; described as similar to menstrual cramps.
- Post-procedure recovery: Most patients resume normal activities immediately.
- Risks: Significant risks are rare; include very slight potential for minor infection, spotting, or mild uterine irritation.
If symptoms persist, worsen, or if fever or significant bleeding occurs, contact your healthcare provider promptly.
How Results Are Interpreted: Getting Your Diagnosis
Images generated during sonohysterography are reviewed by a radiologist or your gynecologist. This expert assesses the uterine contour, endometrial features, and any detected abnormalities, comparing findings with your medical history and other tests.
- Follow-up: Your physician may discuss results the same day or at a follow-up appointment. Additional treatment or diagnostic steps may be advised based on findings.
- Combined techniques: Routine pelvic ultrasound, Doppler imaging, and other gynecologic tests may supplement the results of sonohysterography.
Benefits of Sonohysterography
- Noninvasive and low risk: No surgical incisions or radiation exposure.
- Quick, real-time imaging: Offers immediate visualization with fast interpretation.
- Excellent for soft tissue: Identifies details not visible on x-rays.
- Clarifies uterine abnormalities: Detects fibroids, polyps, adhesions, masses, and abnormalities in structure.
- Guides treatment planning: Informs surgical or therapeutic decisions.
- Widely available: Routine in most gynecologic practices and hospitals.
Risks and Limitations
- Minor infection risk: Rarely, infection may occur at the cervix or uterus.
- Cramping & discomfort: Mild, usually resolving quickly.
- Spotting & saline leakage: Temporary, mild vaginal discharge is common after the procedure.
- Not recommended in pregnancy: The procedure can disrupt a very early pregnancy if not identified beforehand.
- Timing considerations: Should be done just after menstruation for best results and lowest risk.
Benefits | Risks & Limitations |
---|---|
Noninvasive procedure | Mild cramps, rare risk of infection |
No radiation exposure | Cannot be performed during pregnancy |
Real-time organ & blood flow imaging | Temporary vaginal discharge post-procedure |
Excellent for soft tissue visualization | Limited if patient has active pelvic infection |
Frequently Asked Questions (FAQs)
Who should have sonohysterography?
Women with unexplained uterine bleeding, infertility, recurrent miscarriages, or suspected uterine cavity abnormalities may be recommended to have sonohysterography.
Does sonohysterography hurt?
The procedure is generally well-tolerated. You may feel mild cramping, similar to menstrual cramps, especially when saline is infused or the catheter is inserted.
How long does the procedure take?
Most sonohysterography exams are completed in less than 30 minutes.
Can I return to normal activities after the exam?
Yes. Most patients can return to work or daily activities immediately after the procedure.
Are there alternatives to sonohysterography?
Possible alternatives include hysterosalpingography (uses x-ray and dye), MRI, or direct hysteroscopy. Your doctor will decide based on your symptoms and findings.
Is sonohysterography safe?
Sonohysterography is considered safe with very low risk of complications. Serious adverse effects are rare.
Key Takeaways
- Sonohysterography is a safe, reliable way to assess the uterus using saline infusion and ultrasound imaging.
- It offers critical information for diagnosing bleeding, infertility, miscarriage, and uterine abnormalities.
- The test is minimally invasive, quick, and associated with minimal discomfort.
- Most patients resume daily life immediately after the procedure.
- Discuss scheduling, risks, and indications with your healthcare provider in advance.
Leading Medical Insights
Sonohysterography is now a routine gynecologic imaging tool that bridges traditional ultrasound and invasive procedures. It is particularly valuable in situations where regular ultrasound may miss subtle details or cannot distinguish between different types of uterine lesions.
By combining high-resolution imaging with saline-enhanced visualization, clinicians can make rapid, informed decisions about further treatment, surgical intervention, or additional tests.
Frequently Asked Questions (FAQs)
Q: Can sonohysterography help diagnose infertility?
A: Yes. Sonohysterography can reveal uterine structural problems—such as polyps, fibroids, or adhesions—that may contribute to infertility or recurrent miscarriages.
Q: Will sonohysterography interfere with my menstrual cycle?
A: Performed shortly after menstruation, sonohysterography does not typically disrupt menstrual pattern or ovulation.
Q: Will I need pain relief or sedation for the procedure?
A: Pain relief is not typically required—the test is well tolerated and does not need sedation. Over-the-counter pain medication may be suggested for mild cramping.
Q: When should I contact my doctor after sonohysterography?
A: Contact your doctor if you experience fever, heavy bleeding, persistent pain, or foul-smelling discharge after the procedure.
Q: Is sonohysterography suitable during pregnancy?
A: The procedure should not be performed if pregnancy is suspected or confirmed.
References
- https://www.urmc.rochester.edu/encyclopedia/content?contenttypeid=135&contentid=371
- https://www.radiologyinfo.org/en/info/hysterosono
- https://www.yalemedicine.org/clinical-keywords/sonohysterography
- https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/saline-infusion-sonohysterogram-shg/
- https://my.clevelandclinic.org/health/diagnostics/22320-sonohysterogram
- https://pmc.ncbi.nlm.nih.gov/articles/PMC3650208/
- https://healthlibrary.uwmedicine.org/library/testsprocedures/135,371
- https://www.insideradiology.com.au/sis/
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