First - fun, right?! Secondly, this is not as scary as you think it may be from googling what the procedure actually includes. I have had many over the years, so consider me your resident expert from an end user standpoint. The reasons why I have had these tests so many times is because of my ongoing my ongoing chronic condition. Most of my life I have experienced menorrhagia and eventually also bleeding outside my period, also known as "breakthrough bleeding". These tests have confirmed that I have had (or have) fibroids, polyps, an ovarian cyst, adenomyosis, and the approximate size and location of them.
A sonohysterogram (let's keep it short and call it a "sono") typically involves a transvaginal ultrasound a few days in advance during your cycle. In the week before your sono your doc may request you take preventative antibiotics as there is a risk of infection give the invasive nature. You will also have to sign some forms acknowledging risks and outlining what happens during this procedure beforehand. I recommend you bring pads with you to both appointments as you may experience spotting afterward.
The majority of the time it has been a female who has conducted these tests, and there is often another person or two in the room who identify themselves first, advising their role. In the two rare cases I have had a male do this test, a female tech or doctor will be the one to insert the probe or speculum first, and they stay in the room.
Appointment #1: Transvaginal Ultrasound
Before the ultrasound you have a full bladder, drinking at least a litre of water the hour before your appointment. Yes, you gotta wait until your appointment to pee, that part is not great. The first half of this appointment is an external pelvic ultrasound where a technician will put some jelly on your lower belly while they scan. Once that part is complete, you will get to (finally!) use the bathroom to vacate your bladder.
The second part of this you will need to remove your clothes from the waist down, and get those feet into those stirrups. The second part of this appointment has begun, my friend. The technician will take a wand-life device aka probe and put a condom on top of it, with some jelly. The tech will give you an advance notice when they are inserting the probe and ask it if it okay to begin. Once they do, you will feel pressure internally, and depending what you are having this imaging for, some positions may hurt more than others. You can tell your tech to stop, take a break anytime.
This appointment is super quick, in my experience not longer than 10 minutes. No pain afterward.
Appointment #2: Sonohysterogram
There is not any prep for this appointment, other than the antibiotics which I noted earlier (if required by your doc) or taking Advil. Personally I always take two extra strength Advil in advance to help with the cramping that inevitably comes along with this and I avoid caffeine. Otherwise you can eat and drink beforehand as normal. Similar to the transvaginal ultrasound, you will remove your clothes from the waist down.
Once you are all straddled into those stirrups and ready to go, the doctor will insert a speculum, similar to what you would experience during a pap smear. Next, a catheter is inserted, and as crazy as this sounds, this is not painful. Saline is then injected to fill up your uterus for imaging, think similar to a balloon. This imaging is even more clear than what is seen during the transvaginal ultrasound, but these tests together are complimentary to provide a full picture. Lastly, the doctor will inject more fluid to see if your fallopian Fallopian tubes are open. This, in my experience, is the most painful part only because my uterus cramps at this stage. I will ask the doctor to stop for a moment so I can take a few deep breaths, and once that feeling passes, I advise I am good to proceed. Once the doctor is satisfied that the imaging is complete, the catheter and speculum are removed, and yes, that saline flows out of you. The most uncomfortable part of this is just the feeling that you are leaking, because you are, but it's just saline. You should be provided with some privacy and those paper sheets that help.
I would estimate that this test takes less time than the first appointment. I did experience some cramping a few hours later which eventually passed.
Most recently I had this imaging in late April and I will be meeting with my surgeon to review how things are healing and if there is any scar tissue. This is also important to help my fertility journey. I can understand for someone who has not had this test before that it can be scary, and maybe because I have had so many of them it is not. I am grateful to have access to this kind of medical testing that has helped me through my 10+ year journey.
Definitions:
Menorrhagia = heavy menstrual bleeding often beyond 7 days
Fibroid = (typically) non-cancerous tumours that may grow within, outside and/or in the wall of the uterus, made of muscular and connective tissues. Can trigger heavy bleeding, cramps, and may be associated with miscarriages.
Polyp = (typically) non-cancerous endometrial tissue growths on the inside of the uterus, can trigger same symptoms noted for fibroids.
Ovarian cyst = fluid-filled sac attached to an ovary. Associated with pain, and if it twists, can cause extreme pain of the Fallopian tube or ovary itself, and even burst.
Adenomyosis = when endometrial tissue that grows along the uterine wall grows into the muscular wall of the uterus
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