In sonohysterogram, sterile saline solution is slowly infused into a woman‘s uterus while the organ is being examined using transvaginal ultrasound. The saline slightly distends the uterine cavity and enhances the quality of the ultrasound images, providing more detailed views of the uterus and endometrium (the tissue lining the uterus).

Purpose of the Sonohysterogram

  • To evaluate abnormalities of the uterus and endometrium—for example, benign growths (such as polyps or fibroids), cancer, or endometrial thickening—that were first identified by pelvic or transvaginal ultrasound
  • To evaluate abnormal vaginal bleeding in peri- or postmenopausal women
  • To evaluate fertility problems in women
  • To monitor the uterus in certain women who take the drug tamoxifen (Nolvadex) for breast cancer (this drug has been associated with an increased risk of developing uterine cancer)
  • To examine the condition of the uterus after uterine surgery

Who Performs It

  • A gynecologist or a radiologist

Special Concerns

  • This procedure should not be done in pregnant women and may not be possible in women with cervical stenosis (narrowing of the lower end of the uterus) or large fibroid growths of the uterus.
  • Women with active pelvic inflammatory disease (PID, an infection of the uterus, fallopian tubes, and adjacent structures) should not undergo this test until the disease is brought under control.
  • If the test is being performed to assess fertility problems, it should be done during the first 10 days of the menstrual cycle. To evaluate the uterus for the presence of polyps, the test should be done in the latter part of the menstrual cycle.
  • Before the Sonohysterogram

    • Some women—including those with chronic PID or heart problems—may be prescribed an antibiotic medication to take on the day before the procedure, in order to reduce the risk of infection.
    • Your doctor may advise you to take an over-the-counter nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, about 1 hour before the test.
    • You will be asked to undress from the waist down and put on a drape or hospital gown.
    • Empty your bladder before the test.

    What You Experience

    • You will assume a position similar to the one used for a pelvic exam—lying on your back with your knees bent and feet placed in stirrups. Breathe slowly and deeply and try to relax your pelvic muscles throughout the procedure.
    • A preliminary ultrasound exam is performed to ensure the test can continue safely. A sterile latex condom is placed over a special oblong transducer, and a small amount of lubricant gel is applied to the device. The transducer is gently inserted into the vagina and rested against the cervix. The examiner manipulates the device to obtain different views of the uterus on a viewing monitor.
    • The transducer is withdrawn, and a lubricated speculum—a metal or plastic instrument that pushes apart the walls of the vagina to provide the examiner with a view of the cervix—is inserted into the vagina. This may feel cold and cause some pressure.
    • The cervix is cleansed with an antiseptic (which will cause a brief, cold sensation), and a thin, flexible tube (catheter) is then passed through the vagina and into the uterus.
    • A balloon at the tip of the catheter is inflated with saline to hold the device in place. Sterile saline is then infused through the catheter into the uterus. You may feel some mild to moderate cramping due to the saline infusion.
    • After the speculum is removed, the ultrasound transducer is reinserted into the vagina and more images are obtained. These pictures are recorded on film or video for later analysis.
    • The transducer and catheter are then gently withdrawn.
    • The test takes about 10 minutes.

    Risks and Complications

    • There are no risks associated with ultrasound itself.
    • The most common side effect is mild to moderate cramping. Rare but serious complications associated with the insertion of a catheter and infusion of saline include perforation of the uterus and infection.

    After the Sonohysterogram

    • You may return home and resume your normal activities.
    • Mild bleeding (spotting), cramping and watery discharge are common after this test. NSAIDs, such as ibuprofen, should ease any discomfort.
    • Inform your doctor immediately if you develop abnormal bleeding, fever, or abdominal pain.


    • A gynecologist or a radiologist reviews the recorded images and video for evidence of any abnormality.
    • If a definitive diagnosis can be made, appropriate treatment will be initiated.
    • If this test fails to yield a definitive diagnosis, other diagnostic tests, such as a hysteroscopy and endometrial biopsy, may be needed to provide more specific information or to further evaluate abnormal findings.


    The Johns Hopkins Consumer Guide to Medical Tests

    Simeon Margolis, M.D., Ph.D., Medical Editor

    Updated by Remedy Health Media

    Publication Review By: the Editorial Staff at

    Published: 24 Jan 2012

    Last Modified: 08 Jan 2015