title: Experience with Instillagel(R) for hysterosonography and analgesia in a complex contraception clinic: a QIPP initiative.
abstract: BACKGROUND
  A significant number of women are referred with bleeding problems related to the use of hormonal contraception, for advice on management of heavy periods or following difficulty with intrauterine device insertion. The authors describe their experience with Instillagel(®) as the contrast medium for hysterosonography in a one-stop clinic for complex contraception referrals. They also comment on its analgesic properties for cervical and uterine instrumentation.
  
  
  METHODS
  The authors reviewed 275 referrals seen over a 6-month period in consultant-delivered clinics provided by a contraception service that serves a single county (population 500 000). They describe the simple technique they use for hysterosonography with Instillagel.
  
  
  RESULTS
  The authors found Instillagel useful as a contrast medium for sonographic assessment of the endometrial cavity. Additionally, presence of gel in the endometrial cavity, with a time interval between insertion of gel and uterine instrumentation, appears to result in analgesia and relaxation of the uterus. There was a very low incidence of difficulties in a group of patients who had previously experienced significant problems with uterine instrumentation.
  
  
  CONCLUSIONS
  Hysterosonography is an efficacious, simple and inexpensive technique for assessment of the endometrial cavity. It has many potential applications in contraceptive care. An additional benefit appeared to be that once gel was instilled in the cavity for 10-15 minutes it facilitated instrumentation of the uterus.
authors.affiliation: Gloucestershire Royal Hospital, Gloucester, UK. mary.pillai@glos.nhs.uk
authors.forename: Mary
authors.initials: M
authors.lastname: Pillai
authors.forename: Julia
authors.initials: J
authors.lastname: Shefras
mesh_terms: D000328:Adult; D002710:Chlorhexidine / Q000008:administration & dosage / Q000627:therapeutic use*; D003287:Contrast Media / Q000008:administration & dosage / Q000627:therapeutic use*; D004338:Drug Combinations; D004717:Endometrium / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007434:Intrauterine Devices; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D008796:Metrorrhagia / Q000175:diagnosis; D017699:Pelvic Pain / Q000175:diagnosis; D014463:Ultrasonography; D016387:Women's Health
chemical_list: D003287:Contrast Media; D004338:Drug Combinations; C008129:chlorhexidine gluconate, lidocaine drug combination; D008012:Lidocaine; D002710:Chlorhexidine