Hysterosalpingogram (HSG) at Brentwood Hospital

What is a HSG?

A HSG or hysterosalpingogram is a type of X-ray test that looks at your uterus (womb) and fallopian tubes. A dye is passed into your womb so that these parts show up clearly on the X-ray pictures.

Why might I need one?

Your doctor may suggest an HSG if you've been trying to get pregnant without success. It shows whether your fallopian tubes are open or blocked, and whether your womb is a normal shape, since problems with either can affect fertility.

If you've had a sterilisation operation, an HSG can sometimes be used afterwards to check that your fallopian tubes are properly blocked.

An HSG can help your doctor spot things such as:

• blocked, damaged or swollen fallopian tubes, or scar tissue (adhesions) around them
• an unusually shaped womb
• growths such as fibroids, polyps or cancer of the womb.

The test can't look at your ovaries. It also can't diagnose endometriosis (a condition where tissue similar to the lining of the womb grows elsewhere in the body), or find fibroids that sit outside your womb lining.

What are the benefits of having it?

An HSG is a simple test that doesn't involve any cuts. It gives your doctor useful information about the shape of your womb and whether your fallopian tubes are open, which helps them recommend the treatment that's most likely to work for you.

Some evidence suggests having an HSG may slightly increase your chances of getting pregnant in the months afterwards, particularly when an oil-based dye is used. Most doctors see the test as a way to diagnose problems rather than treat them.

The amount of radiation used is low, and none of it stays in your body after the test.

Are there different types of the test?

The main difference between HSG tests is the dye (contrast medium) used, which is either oil-based or water-based. Your doctor can talk you through which one is right for you.

How do I prepare for the test?

An HSG needs to be done at a specific point in your menstrual cycle, so that you're not pregnant when the X-rays are taken. It's generally carried out somewhere between day 5 and day 14 of your cycle, always after your period and before you ovulate.

You'll usually need to contact your care team on the first day of your period so they can arrange the right appointment date for you.

Before your test, tell your care team if you:

• could be pregnant
• have a pelvic infection, an abnormal discharge, or symptoms of a sexually transmitted infection
• are allergic to iodine, contrast dye, or shellfish
• have a latex allergy
• have irregular or infrequent periods
• are bleeding heavily.

You shouldn't have unprotected sex from the first day of your period until after the test, to avoid the small chance of X-raying an early pregnancy. Your care team may also ask you to have a pregnancy test just before the procedure, and may prescribe antibiotics beforehand to lower your risk of infection.

It helps to take an over-the-counter painkiller, such as paracetamol or ibuprofen, in the 1 to 2 hours before your appointment. It's also worth arranging for someone to bring you and take you home afterwards, in case you feel uncomfortable.

What happens during the test?

The test can take between 5 and 15 minutes. A female chaperone will be present throughout the procedure to assist you and the clinician if required.

1. You'll be asked to undress from the waist down and put on a gown before going into the X-ray room
2. You'll lie on the X-ray table with your knees bent and legs apart, in a similar position to a cervical smear test
3. A speculum (a plastic or metal instrument that gently holds the vagina open) is inserted so your cervix (the neck of the womb) can be seen and cleaned
4. A thin, soft tube is passed through your cervix into your womb
5. A small amount of dye is slowly injected through the tube into your womb and fallopian tubes, while a series of X-rays are taken
6. You may be asked to change position so the movement of the dye through your tubes can be seen clearly
7. Once enough pictures have been taken, the tube and speculum are removed.

What happens after the test?

You'll be given a sanitary pad, as some of the dye and a small amount of blood may trickle out for a day or two afterwards. Don't use tampons during this time.

You can usually go home the same day and return to your normal activities straight away, although some doctors suggest waiting a few days before having sex. Mild to moderate cramping, similar to period pain, is common and usually settles within a few hours.

Taking a painkiller such as paracetamol or ibuprofen can help with cramping, and you may need another dose a few hours later. You may also notice mild dizziness or an upset stomach, and your results will usually be discussed with you at a follow-up appointment with your consultant or GP.

Contact your doctor urgently if, after your test, you experience:

• a fever, chills, or a feeling of faintness
• heavy vaginal bleeding or an offensive-smelling discharge
• severe abdominal pain that isn't helped by paracetamol or ibuprofen
• vomiting.

What are the risks or side effects?

An HSG is considered a very safe test, and serious complications are uncommon. Mild side effects such as cramping, spotting and dye leakage for a day or two are common, and don't mean anything has gone wrong.

Possible risks include:

• infection, most often in people who've had a pelvic infection before, such as chlamydia; this is why antibiotics are sometimes given beforehand
• an allergic reaction to the iodine-based dye, which is rare and, very occasionally, can be serious
• feeling faint during or shortly after the test
• a small risk of injury to the womb or cervix
• exposure to a low dose of radiation, similar to or less than other X-ray tests, none of which stays in your body afterwards.