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Endometritis: causes, types, symptoms and treatment

Endometritis can affect women of different ages, the disease can be one of the obstacles to pregnancy, the cause of chronic miscarriage. Currently, chronic endometritis is significantly “younger” due to the deterioration of the general sanitary level of the population, an increase in random connections and frequent episodes of hypothermia against the background of decreased immunity.


Endometritis - what is it?

As with any medical diagnosis ending in "- it", this term means the presence of an inflammatory process occurring in the endometrium.


The endometrium is the innermost layer of the uterine lining. It is the endometrium that is regularly updated in preparation for receiving a fertilized egg during the period of ovulation. In case this did not happen, then the endometrium is exfoliated and “moves away” in the form of menstruation.

Endometritis is an inflammation of the inner, mucous membrane of the uterus. Since the medical literacy of the population is insufficient, some use the illiterate term "inflammation of endometritis", which is, in addition, excessive.

You should know that in cases where a woman has a hysterectomy, and she is removed as an organ, then all diagnoses that relate to the uterus, this woman no longer belong. Therefore, the request "endometritis after hysterectomy is" is completely illiterate and meaningless.

Endometritis and endometriosis: what is the difference?

The similarity of terms sometimes causes confusion, especially if both diagnoses for one person exist simultaneously. This is possible: endometritis is an inflammatory process, and endometriosis is a condition where parts of this endometrium, or mucosa, are located in other parts of the body, and not just in the uterine cavity.

Such a “lost” endometrium, most often, is still within the female genital organs. Its peculiarity is that it is capable of “menstruation”, that is, it changes and is rejected in accordance with changes in the hormonal background during the course of the menstrual cycle.

Endometriosis creates many problems, the main of which is an abnormally located endometrium, for example, in the thickness of the uterus muscles, there is simply nowhere to be removed when it is cyclically destroyed.

Of course, this process can also exist against the background of endometritis of the uterus, especially if the process is chronic.

Types and classification of endometritis

The first and main classification is the division of acute and chronic endometritis.

  • Acute endometritis is a problem that can even lead a woman to the operating table, and in advanced cases it is possible to completely lose the uterus, since inflammation can lead to pelvicoperitonitis.
  • Chronic endometritis is a sluggish disease, with recurrent exacerbations and remissions, often associated with a cooling and ovarian-menstrual flow. Its treatment is long, and, more often, it is carried out in antenatal clinics, and on an outpatient basis. Only during exacerbations is required hospitalization in a specialized hospital - gynecological department.

There is also an intermediate, subacute form.

The second classification is by the nature of the inflammatory process. Endometritis is divided into:

  • catarrhal (the easiest stage of inflammation);
  • catarrhal - purulent (a purulent process joins);
  • purulent forms;
  • necrotic (with necrosis of the mucous layer);
  • gangrenous (with the addition of anaerobic flora, severe intoxication, the development of peritonitis).

The last two forms are very dangerous: the first is the development of scar tissue in the uterus even with a favorable outcome with the threat of infertility, and the second has a high mortality rate even during an urgent operation.

There are other classifications - for example, postpartum endometritis, which most often develops during adverse pregnancy in the third trimester and various obstetric benefits associated with a high risk not so much for the fetus as for the mother.

Causes of endometritis

Causes of endometritis

Predisposing factors leading to the development of inflammation of the mucous membrane of the uterus are very extensive. It is important to understand that endometritis is most often the result of a “ascending” infection, much less often it enters the uterine cavity by another means. The most important ones are:

  • abortions;
  • profuse and painful menstruation;
  • unprotected sex during menstruation;
  • aggressive vaginal examination;
  • carrying out medical and diagnostic curets against the background of colds and other infectious diseases;
  • violation of the rules of hygiene, for example, washing away from the back to the front, that is, from the anal zone to the genital tract. In this case, the probability of a drift in the vagina and the uterus of Escherichia coli with the development of bacterial vaginosis first, and then endometritis is likely.

Endometritis, the causes of which are associated with depriving the uterus of its protective layer, as is clear from the examples, develops during infectious aggression most often during menstruation or when the uterus mucosa is injured (in the presence of adverse conditions).

Symptoms of acute endometritis

Acute lesion of the uterine mucosa requires urgent consultation with a gynecologist, it is not possible to postpone it for “later”, since the acute process may expand to other layers of the uterus. So, signs of acute endometritis are:

  • Abdominal pain, from aching to intense, more in the center, in the projection of the uterus;
  • Fever to moderate numbers (37 - 38) C, the appearance of chills;
  • Abnormal mucous membranes, mucopurulent discharge from the genital tract or even bleeding, called metrorrhagia. In case of bacterial inflammation, the discharge may have an unpleasant, “scavenging” odor, due to the presence of pathogenic E. coli;
  • At the age when the menstruation has already stopped, signs of acute endometritis can simply be a collection of pus in the uterus. This is a serious condition, which is called pyometra.

So, acute endometritis: the symptoms in women are pronounced, the general condition is severe - urgent hospitalization is required.

Symptoms of chronic endometritis

Symptoms of chronic endometritis Symptoms of chronic endometritis are often more “smoothed” in nature, but this disease brings harm no less - because in the acute process there is an immediate threat to life, and in chronic it is much higher chance of making infertility .

After all, if in the acute process there is only inflammation, then during chronization, atrophic processes occur in the uterine mucosa, chronic edema and the formation of cysts, as well as hypertrophy and hyperplasia of the mucous membrane occur. This makes pregnancy impossible in many cases.

The symptoms of chronic lesion of the endometrium are as follows:

  • The appearance of chronic uterine bleeding;
  • Their time period is expanding - both before menstruation and after;
  • There are serous and purulent minor discharge, almost constantly;
  • There are "tedious" pain in the lower abdomen;
  • In the end, the usual become miscarriages and infertility.

As a rule, general well-being with chronic endometritis does not suffer, or is only slightly affected. This "blurring" of the picture can make it difficult to make a correct diagnosis.

Diagnosis of Endometritis

With a typical course, the diagnosis of an acute, sub-acute process does not present significant difficulties. The main "reference points" of diagnosis are the following "milestones":

  • Anamnesis data: “there was something”: cold during curettage, violent sex during menstruation, and so on;
  • Survey data: increase in the size of the uterus, its displacement;
  • The result of a gynecological examination: a change in the nature of the mucous membrane;
  • Taking and analyzing microbial flora from the uterus;
  • More accurate diagnosis by PCR , sampling from the cervical canal;
  • Ultrasound of the pelvic organs, with the definition of other processes. After all, acute endometritis can simulate another pathology, for example, acute intestinal obstruction, appendicitis or ectopic pregnancy;
  • In a hospital, laparoscopy is done with inspection and revision of the pelvic organs, endometrial biopsy is performed.

Treatment of acute endometritis

Treatment of acute endometritis

Treatment of endometritis in women, as well as all processes, must have their exact goals. In the acute case, they are:

  1. Release of the uterus and genital tract from a possible cause - pathogenic microorganisms using antibacterial therapy;
  2. Preventing the acute process from becoming chronic;
  3. Mandatory preservation of the possibility of becoming pregnant and carrying out the child.

To achieve these goals, a set of measures is used - from bed rest and diet to intravenous and local administration of antibacterial drugs.

When treating acute endometritis, myotropic antispasmodics are prescribed to relax the uterus - this improves the outflow and the possibility of local administration of drugs.

If necessary, appointed detoxification, immunomodulatory therapy.

Treatment of chronic endometritis

Treatment of chronic endometritis includes the same activities, but on an outpatient basis, subject to the drug regimen and visits to antenatal clinics.

Antibiotics and hormonal drugs can be used for signs of exacerbation of endometritis, including in response to physiotherapy. Treatment of folk remedies is strictly prohibited.

If there are indications for surgical treatment, then most often with endometritis is required to remove the intrauterine contraceptive, which became the cause of infection. Sometimes you need to clean the uterus from the remnants of the ovum.

Endometritis and pregnancy

As mentioned above, an acute, and even more chronic, process in the mucous membrane of the uterus significantly increases the risk of habitual miscarriage and the occurrence of infertility. With endometritis, you can get pregnant, but nothing good will come of it.

Most likely, the fetal egg will simply not be able to attach to the inflamed and unprepared section of the mucous membrane, covered with pus, microbes, and constantly bleeding. The case will end in miscarriage, which will further aggravate the situation.

Therefore, you first need to cure this disease, and then plan a pregnancy, if you want to make and give birth to a healthy baby.

A few words about inflammation of the uterine lining after childbirth. It was said above that postpartum endometritis can occur independently, as a complication after pregnancy and childbirth.

In order to avoid this process, it is better to give birth spontaneously, without a cesarean section. Contribute to the development of this process, poor discharge of the placenta, accumulation of blood in the uterus, prolonged labor, significant blood loss during childbirth. But the main conditions for the development of this form of endometritis are chronic inflammatory diseases of the female genital organs that are not cured before delivery.

Complications of Endometritis

The complications of endometritis include the penetration of inflammation into the deeper and deeper layers of the uterus, including muscles (myometritis), and all the membranes of the uterus.

Then the infection can go to the abdominal cavity with the development of peritonitis. Long-term effects include the pronounced development of adhesions, which is the cause of infertility.

For the timely prevention of the development of any complications of endometritis, you must follow the rules of personal hygiene, visit a gynecologist in time, observe sexual hygiene and avoid hypothermia. Then neither endometritis, nor any other inflammatory diseases of the reproductive system will be terrible to you.


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