Stephen R. Wells MD

Trusted and experienced OBGYN diagnosing gynecologic issues for over 10 years

Our office provides on-site ultrasound evaluation for gynecologic issues. I have utilized vaginal ultrasound in the evaluation of abnormal bleeding and pelvic pain for over 10 years. While I feel very comfortable with evaluation of the uterus, fallopian tubes, and ovaries, I tend to refer to radiology centers when I feel the problem is more complex involving non-gynecologic pelvic structures. Vaginal ultrasound is useful in evaluating early pregnancy issues, abnormal bleeding caused by uterine fibroids or polyps, and pelvic pain caused by ovarian cysts or cysts related to endometriosis. In these situations, I prefer performing my own ultrasound examination because it allows me to better understand and treat the condition. Important information may be lost, sometimes, if someone else does the scan.

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Saline sonohysterogram, as it is also called, is probably one of the most accurate yet least invasive ways to diagnose the cause of abnormal bleeding. This office procedure is usually as accurate as the minor surgical procedure called hysteroscopy or another radiologic test called hysterosalpingogram. The saline enhanced ultrasound involves placing a small plastic catheter through the cervix into the uterus (into a location called the endometrial cavity). Sterile saline is then injected into the endometrial cavity, distending the uterus in much the same way as puffing a very small amount of air into a completely flat uninflated balloon. Sound waves from the ultrasound probe bounce off of the different textures of the fluid filled uterus, and the image on the display shows striking contrast between the saline and the lining of the endometrial cavity. If there are polyps or fibroids protruding into the cavity, they will be easily identified. In the same way, a completely normal cavity can be confirmed by performing this minimally invasive examination. The saline enhanced ultrasound produces mild cramps, easily treated with Advil or other non -steroidal anti-inflammatory medications. The discomfort would not interfere with any daily activities.

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This test is critical in the evaluation of abnormal vaginal bleeding when a regular vaginal ultrasound indicates the presence of pathology in the center of the uterus. I have been performing this procedure for over 5 years. It is not a routine test but should be done if bleeding is thought to be caused by a pathologic lesion located in the endometrial cavity. Once identified by saline enhanced ultrasound, lesions can often be removed by a minor hospital based surgical procedure called hysteroscopy. Additionally, if no lesion is identified within the endometrial cavity, and medical therapy for abnormal bleeding has failed, consideration can be given to endometrial ablation, also a minor hospital based surgical procedure that can dramatically reduce bleeding or even stop menstrual bleeding altogether.