A Hysterosalpingogram (HSG) is a specialized X-ray procedure used primarily to investigate fertility issues. This diagnostic test involves injecting a contrast dye into the uterus and fallopian tubes to visualize their structure and patency. The HSG determines if the fallopian tubes are open and checks for structural abnormalities within the uterine cavity, such as polyps or scar tissue. The procedure uses fluoroscopy to capture real-time images as the dye travels through the reproductive organs.
Eating and Drinking Guidelines
Strict fasting is required for most medical procedures involving sedation, but this is typically not the case for an HSG. Standard instructions allow you to eat and drink normally on the day of the test. Since the procedure is non-surgical and does not require heavy sedation, a completely empty stomach is unnecessary. Clear liquids are almost always permitted right up to the time of the test, and some providers may suggest a light meal a few hours before the appointment.
There are no universal dietary restrictions for this procedure, unlike many other radiology exams. However, it is important to confirm the exact guidelines with the specific clinic performing your test. A few facilities may recommend avoiding food or drink for a short period, such as two hours before the procedure, to minimize the risk of nausea associated with the contrast dye injection. Always follow the preparation instructions given by your healthcare provider.
Essential Preparation Steps
The most important preparations for an HSG revolve around cycle timing, pain management, and infection prevention. The test must be scheduled between day five and day twelve of the menstrual cycle, after the period has ended but before ovulation occurs. This timing ensures the patient is not pregnant and the uterine lining is thinnest for the clearest visualization of the uterine cavity.
Preemptive pain relief is strongly recommended because many patients experience cramping comparable to moderate menstrual discomfort. Providers typically advise taking an over-the-counter Nonsteroidal Anti-Inflammatory Drug (NSAID), such as 400 to 800 milligrams of ibuprofen, 30 to 60 minutes before the procedure. This step helps minimize the intensity of cramping that occurs during the dye injection. Patients may also be asked to empty their bladder before the exam begins.
Some physicians may prescribe prophylactic antibiotics, such as doxycycline, to be taken before and after the procedure, though this is not a universal practice. Prophylactic antibiotics are often given to patients considered at higher risk of infection, such as those with a history of pelvic inflammatory disease (PID). It is also important to refrain from unprotected intercourse from the start of the menstrual period until after the HSG test to eliminate the possibility of an undetected pregnancy.
What Happens During the Test
The HSG test is performed in a radiology suite and typically takes less than 30 minutes to complete. The patient is positioned on an X-ray table, similar to a routine gynecological exam. A speculum is inserted into the vagina to visualize the cervix, which is then cleaned with an antiseptic solution.
Next, a thin plastic tube, or cannula, is inserted through the cervical opening and into the uterus. The speculum is removed once the catheter is securely in place. The physician then slowly injects the iodine-based contrast dye through the cannula and into the uterine cavity.
As the dye fills the uterus and flows into the fallopian tubes, the fluoroscope captures real-time X-ray images. If the tubes are open, the dye spills freely into the abdominal cavity, where it is harmlessly absorbed. If a blockage is present, the dye stops flowing, allowing the physician to pinpoint the obstruction. The sensation of cramping is most often felt when the contrast material is injected.
After the HSG Test
Following the procedure, most patients can resume their normal daily activities immediately, though some prefer to rest for the remainder of the day. It is common to experience mild to moderate cramping that may persist for a few hours. This discomfort can be managed with the same over-the-counter pain medication taken before the test.
Another frequent side effect is a sticky, clear, or slightly bloody vaginal discharge as the contrast dye leaks out of the cervix. Patients should bring a sanitary pad to wear afterward, as tampons must be avoided for a few days to minimize infection risk. Light spotting is also normal for up to 48 hours after the procedure.
Patients should monitor themselves for any signs of complication and contact their doctor immediately if they experience severe symptoms. Warning signs include heavy vaginal bleeding, a fever over 100.4°F (38°C), severe abdominal pain not relieved by medication, or a foul-smelling vaginal discharge. The results of the HSG are often discussed with the patient right after the procedure or delivered by the referring physician within a few days.