Hysterosonography is a gynecological examination: it is a pelvic ultrasound by endovaginal route coupled with an “opacification” of the uterine cavity with a contrast liquid. Its purpose is a precise study of the uterine cavity via the vagina. 

Ultrasound is a medical imaging technique that uses the properties of ultrasound emitted by the ultrasound machine’s probe to obtain images of the area being examined. In the case of a pelvic ultrasound in women, the objective is to explore the different organs of the lower abdomen: uterus, bladder, ovaries.

Pelvic ultrasound can be done in different ways:

• By suprapubic route: the probe is placed above the pubis;
• By endovaginal route in women: a probe, covered with a condom and gel, is inserted into the vagina to better visualize the uterine lining and the ovaries.

Hysterosonography is a pelvic ultrasound by endovaginal route coupled with “opacification” of the uterine cavity with a liquid, usually physiological saline. The injection of the liquid produces a contrast which makes it possible to observe the relief of the uterine cavity, and the appearance of the endometrium (the lining of the uterus). The examination is performed by a gynecologist.

Prepare for the hysterosonography

Ideally, the hysterosonography should be performed in the first part of the cycle after menstruation. A careful toilet should be done the same day, and the patient should have an empty bladder at the time of the examination.

The main stages of a hysteronosonography

• As with any gynecological examination, the doctor places a speculum at the level of the cervix to remove the walls;
• The cervix and vagina are disinfected;
• A flexible disposable catheter connected to a syringe filled with sterile physiological saline is introduced into the cervix over a few millimeters;
• The speculum is removed, and an endovaginal ultrasound probe is placed;
• The fluid is administered slowly into the uterine cavity under ultrasound supervision;

Hysterosonography is a complementary examination of pelvic ultrasound for:

• The search for malformations in the uterine cavity;
• The location of formations (polyps, tumors, etc.) in the uterus;
• Abnormal bleeding from the genitals;
• Monitoring for complications of tamoxifen treatment which can cause endometrial disease;
• A check-up before medically assisted procreation;
• A balance sheet after miscarriages;
• A study of the endometrium, but the hysterosonography is insufficient for the precise diagnosis of endometrial pathologies and therefore requires the use of an endometrial biopsy.

There are a few limitations to this exam:

• When the uterus is very large or deformed by tumors located on the uterine walls, examining the uterine cavity may be difficult;
• When there is cervical stenosis, that is, a narrowing of the passage of the cervix, hysterosonography is impossible;
• The presence of an IUD in the uterine cavity makes it difficult to analyze the images;
• The examination cannot be performed in cases of pregnancy or suspected pregnancy.

Analysis of the results

The images are analyzed in real time and the videotape recording allows retrospective analysis.

The expected results

Hysterosonography is used to describe:

• The permeability of the cervical canal (junction between the vagina and the uterus);
• The regularity of the uterine cavity;
• Tubal patency to verify the success of a fallopian tube resection operation as a definitive contraceptive technique;
• The thickness of the endometrium.

The days following the exam

A little discomfort in the lower abdomen similar to menstruation is possible and most often stops within hours. To calm persistent pain, the patient can take paracetamol. Small losses of physiological serum are frequent. In the hours following the examination, it is advisable to wear a sanitary napkin to avoid any discomfort. 

Small bleeding can persist for 24 hours. If unusual discharge and abnormal bleeding occur, you should consult your doctor to rule out the risk of infection.