Hysteroscopy vs. Ultrasound

What’s the Difference Between a Hysteroscopy and an Ultrasound?

If you’ve been referred by your physician to a specialist, he can explain the pros and cons of a hysteroscopy vs. ultrasound. The primary difference involves how each views the uterus. A transvaginal ultrasound is a non-invasive imaging technique that uses high-frequency sound waves to create images. If your doctor is starting the process of looking for uterine conditions, this is typically the first step, but it doesn’t perform any corrective actions.

A hysteroscopy is a direct visual assessment of the inside of your uterine cavity. It’s a minimally invasive procedure performed using a small-diameter hysteroscope. Unlike an ultrasound, it can have a diagnostic or operative purpose.

The question of a hysteroscopy vs. ultrasound is best answered by an experienced gynecologist who understands which uterine imaging procedure is best for you. The right tool for you depends on your symptoms and your reproductive history. At a consultation at Hysteroscopy Center of New York with Felix Cohen, MD, FACOG, whether to address your symptoms or following abnormal uterine ultrasound results in NYC, an expert gynecologist determines which procedure best suits you.

When Does My Doctor Use a Hysteroscopy vs. Ultrasound?

The decision between the different uterine imaging techniques depends on what your specialist needs to focus on and what stage of the process you’re in. Dr. Cohen conducts a thorough evaluation with you at your consultation to determine the next step. At the Center, he may recommend a transvaginal ultrasound for evaluation purposes, such as:

• Performing a routine pelvic and uterine check-up
• Investigating unexplained pelvic pain
• Finding the location and size of uterine fibroids that are clearly outside your uterine cavity
• Measuring the thickness of your endometrial lining if you suffer from abnormal bleeding or postmenopausal bleeding
• Checking out your ovarian anatomy
• Searching for retained tissue after a pregnancy loss

Dr. Cohen may suggest an office hysteroscopy after looking at the results of the ultrasound if he needs to directly visualize your uterine cavity, do a biopsy or treat your condition. In cases of endometrial polyps, submucosal fibroids, intrauterine adhesions and uterine septum, a hysteroscopy may be clinically appropriate. Your specialist may also recommend a hysteroscopy to conduct an advanced evaluation or treatment, such as:

• Recurrent pregnancy lossesEvaluating recurrent pregnancy losses
• Removing an embedded, displaced or lost IUD
• Removing retained product of conception that an ultrasound has identified
• Investigating severe abnormal uterine bleeding
• See-and-treat approachPerforming treatment after identifying a condition with the see-and-treat approach

Dr. Cohen adds: “Sometimes, when you need a hysteroscopy after an ultrasound, you may believe there’s something more serious to be found, which is almost never the case. Both tests answer different questions and moving from one to another is just a natural progression of my evaluation. Uterine imaging comparisons are normal.”

Why Is a Hysteroscopy the Next Step After Abnormal Uterine Ultrasound Results?

A hysteroscopy is considered more accurate than an ultrasound since it removes the interpretational gap that a transvaginal ultrasound requires. In an ultrasound, a polyp, a fibroid and a fold of thickened endometrial lining may look almost identical. It means something’s there, but the doctor can’t know exactly what it is. This is especially true under certain circumstances, such as:

• Ultrasound sensitivity can be as low as 40 percent for smaller polyps, while a hysteroscopy detects them with accuracy approaching 95 percent.
• Only a hysteroscopy can confirm how much of a fibroid is buried inside your uterine cavity and whether it can be safely removed in the office.
• Mild intrauterine adhesions are small bands of scar tissue inside your uterus, which are often invisible on ultrasounds, but clearly visible during a hysteroscopy.
• A 3D ultrasound can suggest the existence of a uterine septum, while a hysteroscopy can both confirm and treat it.

A hysteroscopy skips any uncertainty. During the procedure, your doctor inserts a small-diameter scope into your uterus and fills it with sterile saline, which opens the cavity. The scope allows the gynecologist to see the tissue directly to identify and often address uterine abnormalities in a single procedure.

“In a uterine imaging comparison, a hysteroscope tells me where it is and what I can do about it,” says Dr Cohen. “For the patient, it means resolving the issue in the same visit instead of waiting for another appointment.”

What Are the Advantages and Limitations of Each Test?

The advantages and limitations of a hysteroscopy vs. ultrasound varies, depending on why you need it. Although both tests are a part of the same process to reach an accurate diagnosis, your doctor sometimes wants a uterine imaging comparison. The advantages and limitations of a transvaginal ultrasound include:

• It’s quick, non-invasive and comfortable.
• It usually takes 10 to 20 minutes with no special preparation.
• You need no anesthesia, no cervical instrumentation and no recovery period.
• It can leave your doctor with more questions because it can’t be definitive.
• It depends heavily on the skill and experience of the technician interpreting the results, as image quality varies, leading to inconclusive readings that require additional tests.

A no-dilation, awake hysteroscopy takes place in the office. It takes 10 to 20 minutes with no hospital admission. Many women describe moderate cramping that resolves as the procedure ends. Its advantages and limitations include:.

• Your recovery is mild, with light spotting and cramping.
• Its cost is higher than an ultrasound on a per-procedure basis, but it has lower overall cost, as Dr. Cohen can perform a diagnosis and treatment in the same visit.
• It’s minimally invasive, but not always considered a first-line screening tool.
• It’s performed only when there is a clinical reason to look inside your uterus, not as a part of a routine evaluation.

“Women usually assume a uterine imaging comparison is about choosing the easy option, but the real comparison is about choosing the one you need the most,” says Dr. Cohen. “The practical reality is that both of these tests play a major role at different points in your uterine care.”

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