Hysteroscopy vs. Sonohysterogram

What’s the Difference Between a Sonohysterogram vs. Hysteroscopy?

A sonohysterogram (SIS) is an enhanced form of a transvaginal ultrasound that uses a saline infusion. Your gynecologist introduces sterile saline into your uterine cavity through a thin catheter passed through your cervix. The saline pushes the uterine walls apart so that the ultrasound produces a clearer image of its lining.

A hysteroscopy, on the other hand, uses a lighted scope passed through your cervix. It shows real-time images of the inside of your uterine cavity. While this procedure also uses sterile saline to open up the cavity, the images your doctor sees are clearer because they use light images, not images from sound waves. That’s the main difference between a SIS vs. hysteroscopy.

Felix Cohen, MD, FACOG, who’s the founder of Hysteroscopy Center of New York, adds: “You may think these procedures are very different, but they’re not. They’re closely related tools that answer different questions. The right tool for your condition depends on what I want to see, confirm or treat.”

If you’ve been referred by your physician to a gynecology specialist, but you’re confused about the differences between the hysteroscopy vs. sonohysterogram procedures, rely on the specialist to know the difference. A SIS vs. hysteroscopy consultation in NYC is available at any of the three Hysteroscopy Center of New York locations: Midtown Manhattan, Queens or Columbus Circle.

Am I More Likely to Have a Hysteroscopy or Sonohysterogram First?

When it comes to comparing a hysteroscopy vs. sonohysterogram, you generally get a sonohysterogram first. The procedures are typically performed in order because both tests target different questions. In fact, you often get an ultrasound first, then a sonohysterogram refines and confirms what the ultrasound suggested. Finally, a hysteroscopy treats the condition found.

“The sequence is never an automatic hierarchy, though; it’s a clinical decision tree,” says Dr. Cohen. “We conduct thorough consultations with you and use the least invasive test first. If we have enough information from the first test, we don’t need to order any more.” A typical clinical sequence in your uterine work-up may include:

• The SIS vs. hysteroscopy sequencing starts with a transvaginal ultrasound to evaluate your uterus, ovaries and pelvic anatomy.
• PolypA sonohysterogram follows, if the ultrasound suggested an intracavity finding, such as a polyp, fibroid or thickened endometrium.
• See-and-treatYour gynecologist then uses a hysteroscopy when the sonohysterogram confirmed the initial finding. Your doctor requires the direct visualization from the hysteroscopy to take a biopsy or perform a same-day see-and-treat office hysteroscopy.

The work-up moves naturally from one test to the next, although you may not need all three steps. Some concerns are resolved at the sonohysterogram stage, while others require a hysteroscopy. Again, it’s your gynecologist’s call regarding how best to deal with your condition.

Do I Need a Hysteroscopy if I Already Had a Sonohysterogram?

Usually, your NYC specialist orders a hysteroscopy after a sonohysterogram because the imaging has indicated an abnormality that needs to be addressed. Sometimes, the sonohysterogram can’t fully characterize the abnormality, which is another reason to do a hysteroscopy. Other clinical reasons for a hysteroscopy include:

• When your doctor requires a biopsy
• For polyps or fibroids, only a hysteroscopy can reveal how deeply it’s extended into your uterine wall
• Intrauterine adhesionsFor intrauterine adhesions, an SIS often misses mild bands because the saline passes around them, so your doctor uses a hysteroscopy to show their full extent and treat them
• Uterine septumFor a uterine septum seen on an SIS, a hysteroscopy can surgically correct it
• Embedded or lost IUDsFor embedded or lost IUDs, an SIS can locate the device, but only a hysteroscopy can remove it

“A sonohysterogram is considered a screening step,” says Dr. Cohen. “When it confirms a finding and you’re a good candidate for a no-dilation hysteroscopy, then that procedure follows. The goal of the procedure is the primary difference in the SIS vs. hysteroscopy comparison.”

What Can I Expect from Each Procedure in New York City?

Your experience of a hysteroscopy vs. sonohysterogram is mostly similar. The differentiating factors include:

• How long each procedure takes
• What your recovery looks like
• The cost of each
• How you feel during each procedure

The cost difference is moderate, but since a hysteroscopy offers a treatment during the same visit, it may lower the overall cost, as compared to a sonohysterogram that requires another operative appointment. Your insurance and financing options may influence when each test is medically necessary.

In a SIS vs. hysteroscopy, your preparation for a sonohysterogram is minimal, involving an anti-inflammatory 45 minutes before your appointment. Your sonohysterogram appointment takes about 10 to 15 minutes. You can expect the pain to resemble a menstrual cramp. It resolves within minutes after the catheter is removed. You can return to your normal activities the same day.

Preparation for a hysteroscopy means taking an anti-inflammatory medication 60 minutes before the procedure. Your hysteroscopy is completed in 20 to 30 minutes. You may feel a moderate-to-strong menstrual cramp afterward. Recovery is gentle, with light spotting and some cramping in the first two days. Many women return to daily activities the same day or the day after.

Frequently Asked Questions (FAQs) about a Hysteroscopy vs. Sonohysterogram