The Hysterosalpingogram (HSG) is a medical procedure used to evaluate the internal structure of the uterus and the condition of the fallopian tubes. This diagnostic tool is commonly used during fertility investigations to determine if a physical blockage is preventing conception. Using fluoroscopy (a type of X-ray), the HSG tracks a contrast dye as it fills the uterine cavity and flows through the fallopian tubes. The test provides information on the shape of the uterus and confirms whether the fallopian tubes are patent (open), which is necessary for the egg and sperm to meet.
How to Prepare for the Test
The timing of the HSG test is carefully managed for safety and accuracy of the results. The procedure should be scheduled after your menstrual period has ended but before ovulation, typically between days 5 and 12 of the cycle. This timing minimizes the risk of performing the test during an undetected pregnancy and ensures the uterine lining is thin for the clearest images. To secure an appointment within this timeframe, call the clinic on the first day of your period, counting that as Day 1.
Taking an over-the-counter NSAID, such as ibuprofen, about 30 to 60 minutes before the procedure is strongly recommended. This prophylactic measure helps to reduce potential cramping and discomfort during the test. Your provider may also prescribe a course of antibiotics to be taken before and after the procedure, especially if there is a history of pelvic infection, to minimize the risk of post-procedural infection.
Before the test, you will need to confirm that you are not pregnant, which often involves a urine test upon arrival at the clinic. To avoid any potential risk to a newly conceived embryo, abstain from unprotected intercourse from the start of your menstrual cycle until after the HSG is complete. Inform the medical team of any known allergies, especially to iodine or X-ray contrast dyes, as these are components of the injected solution.
What Happens During the Procedure
The HSG procedure is usually performed in a radiology lab and is relatively quick, with the imaging portion often taking less than five minutes, though the total appointment time may be 15 to 30 minutes. You will be positioned on the X-ray table similar to a standard pelvic exam, lying on your back with your feet supported. A speculum is gently inserted into the vagina to allow the clinician to visualize the cervix.
The cervix is then cleansed with an antiseptic solution to reduce the chance of introducing bacteria into the uterus. A thin, soft catheter or cannula is carefully placed through the cervical opening and into the uterine cavity. This insertion step may cause a feeling of pressure or mild discomfort. Once the device is in place, the speculum is typically removed, and the X-ray camera, called a fluoroscope, is positioned above your abdomen.
The contrast dye is slowly injected through the catheter into the uterine cavity, which is the point where most women feel cramping. The dye travels from the uterus into the fallopian tubes. The fluoroscope captures a series of images as the dye spreads, outlining the shape of the uterus and the length of the tubes. If the tubes are open, the dye will be seen spilling out of the ends and into the pelvic cavity, confirming tubal patency.
Managing Discomfort and Recovery
The level of discomfort experienced during an HSG is highly variable among individuals, ranging from mild pressure to intense, temporary cramping. This sensation is often described as feeling similar to moderate to severe menstrual cramps. The pain is primarily caused by the uterus contracting in response to the injection of the contrast dye and the pressure as the liquid fills the cavity and tubes.
The pain is usually brief, peaking during the dye injection and subsiding quickly once the fluid has passed through. If a fallopian tube is blocked, the pressure from the dye can increase, which may lead to a more intense, but still temporary, cramping sensation. The pre-procedure ibuprofen helps to manage this uterine cramping by reducing inflammatory responses.
After the procedure is complete, the catheter and any remaining instruments are removed, and you can typically resume normal activities immediately. It is common to experience some immediate side effects, including mild residual cramping that may last for a few hours. You should expect some light vaginal spotting or bleeding for one to two days following the test.
Another common experience is a watery or sticky discharge, which is the contrast dye draining out of the uterus and vagina. It is advisable to use a sanitary pad instead of a tampon to manage this discharge and reduce any risk of infection. While the HSG is a generally safe procedure, contact your doctor immediately if you develop specific warning signs. These signs include a fever, severe abdominal pain that persists or worsens after the procedure, or heavy vaginal bleeding.