A Sonohysterogram (SHG), also known as Saline Infusion Sonography (SIS), is a specialized transvaginal ultrasound that provides a detailed view of the inside of the uterus. The procedure involves instilling sterile saline fluid into the uterine cavity, temporarily separating the walls for a clearer image. Providers use SHG to investigate abnormal uterine bleeding, repeated miscarriages, or infertility by looking for structural issues like polyps, fibroids, or scar tissue. Understanding the experience can help alleviate anxiety about potential discomfort during this brief, in-office diagnostic test.
Procedure Overview and Expected Sensations
The primary sensation during a Sonohysterogram is typically pressure and cramping, comparable to moderate menstrual cramps. This discomfort is temporary and does not involve sharp pain. While the entire appointment may take 30 to 45 minutes, the most uncomfortable phase, involving fluid infusion and imaging, is brief, often lasting only five to ten minutes.
Discomfort originates from two main steps. The first is the insertion of a speculum, followed by a thin, flexible catheter guided through the cervix into the uterine cavity. Some individuals may experience a brief, pinching sensation as the catheter passes through the cervix.
The most intense cramping occurs when the sterile saline solution is slowly infused to fill the uterus. This fluid gently stretches the muscular uterine walls, creating contrast for the ultrasound images. The uterus contracts in response to this temporary distension, causing the cramping feeling. Once the fluid is infused and images are captured, the pressure quickly subsides as the instruments are removed.
Preparation and Pain Management Strategies
Taking proactive steps before the procedure can reduce discomfort. The most common strategy is to take an over-the-counter nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, 30 to 60 minutes before the appointment. NSAIDs work by blocking prostaglandins, which signal the uterus to contract and cause cramping pain, thereby substantially lessening the intensity of uterine cramping.
The timing of the procedure within the menstrual cycle is important for image clarity and comfort. Sonohysterograms are typically scheduled in the proliferative phase, between day six and day ten, shortly after menstrual bleeding has stopped. This timing ensures the uterine lining is thinnest, providing the clearest view of any abnormalities, and confirms the patient is not pregnant.
While pharmacological preparation addresses physical pain, mental preparation is also beneficial. Practicing deep, slow breathing exercises during the procedure can help manage muscle tension. It is helpful to communicate openly with the technician or doctor about any anxiety or sudden increase in discomfort. Wearing comfortable, two-piece clothing can also make the process of getting ready for the exam less cumbersome.
Immediate Post-Procedure Experience
Following the Sonohysterogram, patients typically return to their normal daily routine almost immediately. It is common to experience mild-to-moderate cramping, similar to the end of a menstrual period, for a few hours. This residual cramping occurs as the uterus returns to its normal state after the brief saline distension.
A watery discharge is expected immediately following the test, as the sterile saline solution drains out. It is recommended to wear a sanitary pad, not a tampon, to manage this fluid and any potential light spotting. Light spotting or brownish discharge is a common side effect and may continue for one to two days due to minor irritation during instrumentation.
Most patients feel well enough to drive themselves home and return to work, though some may choose to avoid strenuous exercise for the remainder of the day.
While complications are infrequent, contact a healthcare provider immediately if severe pain develops or if there is heavy vaginal bleeding, defined as soaking through more than one pad per hour. Other warning signs include fever or foul-smelling discharge, which could indicate a possible infection.