The information provided by Advanced Healthcare for Women and E. Daniel Biggerstaff, III, M.D. is for informational purposes only. As each woman is unique, do not rely on this information for diagnosis and treatment. We cannot guarantee the accuracy of the content and advise that you see a qualified Health Care Professional for individual needs and care.

What is fluid-contrast ultrasound (FCUS)?

First, what is ultrasound? Ultrasound is an instrument that utilizes sound waves to visualize various internal structures and operates on the same principle as sonar on a submarine. In gynecology, ultrasound is used to evaluate conditions such as uterine fibroids and ovarian cysts. FCUS is a new adaptation of ultrasound which helps evaluate the endometrium (lining of the uterus or womb) and any abnormalities of the uterine cavity (the space inside the womb).

What are we looking for when doing a FCUS?

We are looking for the cause of abnormal uterine bleeding. Initially, the thickness of the endometrium (lining) is measured. Experience has shown that a very thin endometrium is much less likely to contain abnormal tissue than a lining that is thick. This does not mean if a thick lining is present there will always be abnormal tissue (in fact, most of the time it is not.). In addition to measuring the thickness, the endometrium is scanned to see if it is perfectly smooth or if it has any irregularities. Finally, the FCUS allows us to see polyps or fibroids in the uterine cavity that usually cannot be seen using standard ultrasound techniques.

How is a FCUS done, and does it cause pain?

After the cervix (mouth of the womb) is cleansed with an antiseptic, a tiny plastic catheter is gently inserted into the uterine cavity. In most instances the patient will not be aware of the catheter being placed into the uterus. Two situations may make the insertion of the catheter more difficult and as a result cause mild discomfort. These are the retro- or ante-verted uterus (tilted backward or forward) and cervical stenosis (the canal going into the uterine cavity is constricted). In both instances, a paracervical nerve block is given to minimize any discomfort associated with the insertion of the plastic catheter. Usually the patient does not feel the nerve block being administered, which is accomplished by injecting a local anesthetic into the cervix with a needle. Fortunately, the cervix has very few nerve cells which accounts for the nerve block being painless for most patients. Occasionally, the patient will experience lightheadedness, a detached feeling, or ringing in the ears. If this occurs with you, do not panic; these symptoms are transient and will disappear quickly. Once the plastic catheter is in place, the vaginal ultrasound probe is gently inserted into the vaginal canal (this feels very similar to insertion of a speculum for a PAP smear. A small amount of sterile solution is slowly injected through the catheter into the uterine cavity while looking with the ultrasound. Once the measurements and evaluation are completed, the fluid is withdrawn and the vaginal probe removed. In most instances the entire procedure from start to finish takes less than 15 minutes.

What happens next?

If any abnormality (lesion) such as a polyp or fibroid is seen, a hysteroscopy (see Hysteroscopy in Surgery) is scheduled to be done at a later date to remove the lesion. Briefly, hysteroscopy is a surgical procedure performed as an outpatient under a light general anesthetic (patient is asleep). A thin telescope-like instrument is inserted through the cervix (no incisions are necessary), and the inside of the uterine cavity visualized and the lesions removed under direct vision. The "hospital stay" is usually just a couple of hours after the surgery is completed, and there is minimal discomfort after the procedure.

In the case no lesion is seen with FCUS, an endometrial biopsy is done immediately after the ultrasound is completed. If a paracervical nerve block was not utilized for the FCUS (see above), one is usually given just prior to the biopsy. A thin plastic tube is inserted into the uterine cavity, suction applied, and a small amount of tissue removed and sent to the laboratory for evaluation. Most patients report minimal discomfort (occasionally moderate menstrual-like cramping) which only lasts a few seconds. It will usually take several days to get the final results; you will be notified by telephone as soon as these are available. Assuming no evidence of pre-cancer or cancer is found, hormonal therapy will frequently eliminate the abnormal bleeding. If the unlikely happens and cancer is diagnosed, further therapy will be necessary to treat the condition.

In summary

Advancing technology has allowed the development of minimally-invasive techniques which frequently can be done in an office setting and are associated with minimal pain. Additionally, by diagnosing conditions early we are frequently able to prevent a problem before it occurs. A little nervousness is normal when approaching something with which you are not familiar, but hopefully your anxiety will not be too great when you come in for your appointment.