Hysterosalpingogram (HSG) - information for patients

Introduction

You have been invited to have a hysterosalpingogram (HSG) in the fluoroscopy department at Addenbrooke’s hospital

A hysterosalpingogram is an X-ray examination to assess the uterine cavity (womb) and fallopian tubes for any abnormalities and blockages. This can then be used to help plan any treatment you might need or help reassure you of normality. It is an outpatient procedure and usually takes less than half an hour to perform.

Preparation for procedure/examination

The HSG is performed ideally before day 10 of your menstrual cycle but you must not be bleeding. Occasionally your appointment may be booked just after day 10, if this is the case you must abstain from sexual intercourse from day 10 to your appointment. This is to ensure you are not pregnant at the time of the test and to comply with national and European guidelines (IR(ME)R).

When you attend for your procedure, you will be asked to confirm that you are not pregnant. You must let us know if you think you are pregnant.

Please telephone the fluoroscopy department on day 1 of your cycle so an appointment can be booked on 01223 216320 (Monday to Friday, 09:00 to 16:45 except bank holidays)

If you do not have periods or they are very irregular, please ring the department and we can discuss booking options. You will be asked to perform a home pregnancy test on the morning of the appointment.

Benefits

Fluoroscopy examinations provide doctors with information to help them diagnose a variety of conditions. The examination may help to confirm or rule out a suspected diagnosis or occasionally identify a condition that was not suspected.

Risks

An HSG is considered to be a very safe procedure. The risk of infection is very low (<1%) but it can be slightly higher if your fallopian tubes are blocked. If we find your tube/s to be blocked during the procedure we will prescribe antibiotics as a precaution to help reduce the risk of infection.

Rarely a patient may have an allergy to iodine used in the contrast given. If you have previously reacted to intravenous injection of contrast (the same contrast used for a CT scan) you must inform the staff.

Radiation exposure is very low (<1mSv) and does not have any effect on conceiving after the procedure.

You have been referred for an X-ray examination to help make a diagnosis or monitor your treatment. A specialist in radiology agrees that this is the best test to answer the clinical question that has been asked and that the benefit of the examination is greater than the risk. The X-ray involves a very low dose of ionising radiation equivalent to a few days or weeks of natural background radiation which we are all exposed to every day. Ionising radiation can cause cell damage that may turn cancerous however the risk of this happening from your examination is considered minimal. The dose delivered will be kept as low as is practicable.

Staff you are likely to meet

The procedure will be performed by a female specialist radiographer or radiologist. As Addenbrooke’s is a training hospital there may be the possibility of male staff or trainees assisting with the procedure. You will be asked your permission if male staff may be present. In order to comply with Trust policy a chaperone will be present during the examination.

What will happen on the day of my procedure/examination?

Please check in to the reception desk in the fluoroscopy department on level 3. A member of staff will direct you to the fluoroscopy waiting area. You will be asked to change into a hospital gown in a private cubicle.

You will be asked to lie on an X-ray table under the X-ray machine. A speculum will be placed into the vagina (like a smear test) to inspect the cervix (neck of womb). A small tube is inserted and the uterus is gently filled with a contrast liquid. The contrast then flows through the fallopian tubes and X-ray images are taken to see if the tubes are ‘patent’ / open. The fluid that entered the womb will be discharged from the vagina. Sometimes there will be a few spots of blood. It is recommended that you bring a pad or panty liner with you. Do not use a tampon.

Some patients find they get mild to moderate crampy tummy pain (a period-type pain). This usually stops as soon as the procedure is over. Occasionally discomfort can last for several hours so a simple pain killer such as paracetamol or ibuprofen can be taken. Some patients like to take pain relief one hour before the procedure.

Accessibility requirements

If you require support for your appointment, e.g. if you find it hard to hear, see or be understood by others, please let the receptionist or healthcare professional know on arrival or contact us by email: cuh.accessibility@nhs.net or telephone: 01223 256998.

Can I bring someone with me?

Yes, but for reasons of their safety they will not be able to accompany you into the X-ray room. It can be useful to have someone around after the procedure to accompany or take you home in case you are in discomfort.

Childcare whilst in department

Staff are unable to look after or supervise children whilst your procedure/examination is taking place. Please make alternative arrangements if necessary.

Personal belongings

It is recommended that you don’t bring anything valuable to the hospital. Please keep all your belongings with you. You may need to remove certain items, such as earrings or necklaces as directed and we recommend you keep them secure.

What happens after my procedure/examination?

After the HSG you can go home and return to normal activities including sexual intercourse. You may drive if you feel comfortable. Bleeding or spotting may persist for a day or two. In this case, use pads or liners not tampons. The images will be examined after your visit and a written report sent to your referring doctor, which is usually available within 7 days.

How, when and by whom will my results be communicated?

The fertility clinic will be responsible for communicating reports back to you.

Test results are made available via MyChart but there is 3 week delay from when an examination has been reported to when it is available on MyChart, in order to allow time for your clinical team to be able to see and action the results prior to them being released to the individual patient.

Are there any alternative tests?

Occasionally the procedure cannot be completed and you may need to be referred for another procedure such as a Hystero Contrast Sonography (HyCoSy) test (using ultrasound) or laparoscopy.

Contacts/Further information

If necessary please contact the fluoroscopy booking team on 01223 216320 or your referring clinician.

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Directions to the department

The Fluoroscopy department at Addenbrooke’s hospital is located on level 3, at the Outpatient end of the hospital. Please follow signs for Fluoroscopy.

Question, concern or complaint?

Firstly speak to your radiographer or other staff member as soon as you can so they can do their best to put things right straightaway.

If you don’t feel able to speak directly to the people caring for you, contact the patient advice and liaison service (PALS). Please call 01223 216756 9am to 4pm Monday to Friday, via email at cuh.pals@nhs.net, or via a form available via link on the CUH PALS webpage.

PALS is open every weekday, and you can leave a message in the evenings and weekends.

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

More information is available on our website: www.cuh.nhs.uk/visiting-our-hospitals/your-appointment/mychart/