Transvaginal Sonohysterography (TSH)

Transvaginal Sonohysterography (TSH), also called hysterosonography is a noninvasive procedure involving the slow infusion of sterile saline solution into the uterus during ultrasound imaging. This is a procedure which evaluates abnormal growths inside the uterus and abnormalities of the tissue lining the uterus (endometrium). TSH does not require either radiation or contrast media or invasive surgical procedures. It is done in all leading medical institutions in North America and has been performed in Ontario for more than eight years

It is performed in Ontario hospitals and many community-imaging clinics.

This exam is a noninvasive procedure which is safe and causes most patients little discomfort. It is used to evaluate the following group of patients:
- peri- or postmenopausal women with unexplained vaginal bleeding.
- women whose endometrium appears abnormal during ultrasound imaging.
- women with fertility problems. Infertility is sometimes related to polyps, fibroids or adhesions (bands or membranes) inside the uterus.
- women receiving Tamoxifen therapy for breast cancer.

TSH is a valuable procedure to minimize the use of more invasive procedures, such as dilation and curettage (D&C) and tissue biopsies.

TSH is preceded by a baseline vaginal ultrasound examination. The doctor then inserts a catheter into the uterus and injects sterile saline fluid while ultrasound imaging is taking place. Patients may experience cramping during the exam.

How long will it take?

The procedure usually takes about 10 to 20 minutes.

There is no special preparation.
The timing of the procedure is important in patients with fertility problems who are examined during the first 10 days of the menstrual cycle.
Patients with active pelvic inflammatory disease (PID) should not undergo TSH until the disease is brought under control.