ERAD Radiology

What is a Hysterosalpingogram (HSG) and why could you be referred for one?

Home | Articles | Fluoroscopy | What is a Hysterosalpingogram (HSG) and why could you be referred for one?

Hysterosalpingography or uterosalpingography sounds a lot more complicated than it is. An hysterosalpingogram (HSG) is an X-ray that examines a woman’s reproductive system and allows health care providers to diagnose fertility issues or reasons for miscarriage.

This type of X-ray uses a contrast dye to look at the uterus, womb, and the fallopian tubes to determine whether there are any abnormalities or blockages. Women who are battling to fall pregnant may have a blocked fallopian tube or an irregularly shaped or sized uterus, which the HSG x-ray procedure should identify.

Most commonly, a healthcare provider will refer you to a radiologist for a hysterosalpingogram if you‘re battling to fall pregnant, are prone to miscarriages, or need to be screened prior to IVF (In Vitro Fertilisation).

What does an HSG identify?

HSG scan example

An HSG is most commonly used as a diagnostic tool to determine why a woman is having issues with pregnancy. If a woman is battling to fall pregnant or has had multiple miscarriages, then an HSG can help with diagnosis. This minimally invasive procedure is known to be a highly effective diagnostic tool, used by Radiologists.

There are several factors that can cause a miscarriage or infertility, that an HSG imaging procedure should pick-up.

HSG Can Detect Triggers Miscarriage & Infertility Including:

1. Structural abnormalities:

Genetic or acquired abnormalities in the uterus increases the risk of miscarriage and might affect fertility. Abnormalities include having an irregularly shaped or sized uterus.

2. Blockages:

Blockages in the fallopian tubes are one of the leading causes of infertility. The fallopian tubes are the reproductive pathway for both sperm and eggs. The spermatozoon reaches an egg via the fallopian tubes, and the fertilised egg or embryo travels to the uterus via the fallopian tubes. Blockages therefore affect multiple natural processes and makes it more challenging for a female to fall pregnant.

3. Scar tissue:

A healthy uterus is important in order to fall pregnant and to carry the pregnancy to term. If there is any scar tissue in the uterus or endometrial lining this can interfere with conception and may cause problems during pregnancy.

4. Uterine Fibroids:

Most of the time uterine fibroids are completely harmless. Most women can have a normal pregnancy and childbirth whilst having fibroids. However, there are cases where a medical professional may foresee pregnancy complications, particularly if a fibroid is a certain size (large) and will recommend the best course of action based off your diagnosis. Fibroids are known to cause heavy periods, the frequent need to urinate, and pain.

5. Uterine tumors/polyps:

Uterine Polyps attach to the uterus and are usually benign. There are adenomatous polyps which are known as pre-cancerous polyps. Polyps can cause infertility or problems with your menstrual cycle, so it is best to treat them once diagnosed.

6. Locate an IUD:

Sometimes a pelvic examination isn’t sufficient to locate an IUD (intrauterine device) which needs to be removed prior to getting pregnant.

What is the HSG procedure and when should it be performed?

The HSG is a standard imaging test for evaluating infertility and tubal patency as well as uterine size and defects. If a medical professional recommends an HSG, you’ll need to book an appointment with a radiologist.

An HSG procedure uses the type of X-ray modality called a fluoroscopy, where contrast dye is used to assist the radiologist see the structure being studied, clearly. It differs from standard X-rays because it produces a video image, rather than a still image. During the procedure the radiologist will inject a dye and watch how it flows through the reproductive system. They will be able to identify any fallopian tube blockage or uterine abnormalities by observing how the dye moves through the system.

The procedure needs to be scheduled during the first two weeks of a woman’s menstrual cycle: between the 7 to 10 days after the beginning of your last menstrual period, but prior to ovulation. Keeping this timeframe in mind is important because you don’t want to be pregnant or menstruating during an HSG.

Women who are pregnant or have any kind of vaginal infection should not get an HSG. Although an HSG is a minimally invasive procedure, this type of imaging can be harmful to a foetus. As with any other procedure you should always communicate with your healthcare practitioner and inform them whether you have any allergies, if you’ve had any recent infections, or if you suspect you may be pregnant.

What are the risks of having an HSG?

As with all X-ray procedures, an HSG uses radiation to capture the images. However, the amount of radiation is minimal, and it is very low risk. The average radiation dose to the female gonads is 2.7 mGy or an effective dose of 1.2 mSv. To put this into perspective, a person is exposed to background radiation around 3.1 mSv a year or 0.4 mSv per mammogram.

The procedure is classified as low risk, although infection, injury to the uterus, and allergic reactions from the dye have been identified as associated risks. About 3% of women experience an infection after the procedure.

Common symptoms from the test include small amounts of vaginal bleeding and cramping for a few days after the HSG. You may also notice some vaginal discharge. If you are concerned about the symptoms you are experiencing, seek professional medical help immediately.

Preparing for the HSG and what to expect

Your doctor will prepare you before the HSG, and one of the most common questions is, “Does it hurt?”

Patients may experience mild pain or discomfort during and after an HSG, which is why it is recommended that you take over-the-counter pain medication an hour before the procedure.

Cramping is also a symptom of an HSG procedure, particularly when the dye is injected or if there are any blockages in the fallopian tubes.

The procedure takes less than five minutes and you’ll be able to leave once you’ve been carefully monitored to make sure you don’t have an allergic reaction to the dye or have any abnormal bleeding.

Pelvic exams and procedures can be uncomfortable, and you may be a little bit nervous. It is best to try and be as relaxed as possible during the HSG, and part of this is knowing what to expect.

The HSG involves lying on a table as if you are having a pelvic exam. The medical practitioner then inserts a speculum into your vagina. A speculum is a device used to widen your vagina to provide access to the cervix. Your practitioner will then clean your cervix and insert a tube called a catheter or cannula to inject the dye into. The tube may have a balloon on the end of it to hold it in place for the duration of the procedure.

In the next phase of the procedure, you will be asked to lie down flat, whilst the speculum is removed. About a tablespoon of contrast dye will be injected, and this is the stage where you may experience cramping – particularly if there are fallopian blockages. After the imaging procedure has been completed, the catheter or cannula is gently removed.

You may experience mild to moderate cramping for five minutes to a few hours after the procedure. Your doctor may recommend over-the-counter medicine to relieve any cramping. As a safety precaution you should also arrange for someone to drive you home after the procedure, should any other post-procedure symptoms arise. 

What happens after the test?

You may need to take over-the-counter medication after the test for pain and cramping. It is also recommended that you wear a sanitary pad because of discharge from the dye, as well as a small amount of bleeding. Experiencing cramps, dizziness, nausea, and a small amount of bleeding are fairly normal.

A lot of women feel completely fine after an HSG so there is no reason why you can’t resume your everyday activities if you feel up to it.

Consulting your medical practitioner about wanting to fall pregnant immediately after the procedure is important, to ensure that it is safe to do so. 

There are some symptoms that you need to look out for after the procedure. You should contact your doctor immediately if you experience a fever, chills, fainting, vomiting, heavy vaginal bleeding, discharge that smells, and/or severe cramping as this may signal an infection.

How long until I find out the results and what next?

HSGs provide immediate images, which means that the result turnaround time is very quick. However, it may take a few hours to get the full diagnostic report from the radiologist.

Once you’ve received the results of the HSG, your doctor will advise you on the next steps depending on the diagnosis. A doctor may require further tests or examinations depending on what they’ve observed from the HSG.

If you’re based in Namibia and you have your referral letter from your doctor, you can book your appointment at our Walvis Bay branch.


  • Header Image by brgfx via Freepik
Share The News

Receive Exclusive Radiology Insights

Are you interested in staying up to date with the latest medical imaging advancements and news at ERAD Radiology? Sign up to our Newsletter today.