Endometritis: Symptoms, Causes, Treatment

What are the symptoms of endometritis?

Endometritis is an inflammation of the inner lining of the uterus (the endometrium). It can be caused by infection or other factors and can present with a variety of symptoms. Common symptoms of endometritis include:

1. Fever: A high fever can be one of the first signs of infection.
2. Abdominal pain: Pain or cramping in the lower abdomen or pelvic area.
3. Abnormal vaginal bleeding: This can include heavy menstrual bleeding, bleeding between periods, or bleeding after menopause.
4. Abnormal vaginal discharge: The discharge may have an unusual color (often yellow or green) or an unpleasant odor.
5. Painful intercourse: Discomfort or pain during sexual activity.
6. General malaise: Feeling unwell, fatigued, or having flu-like symptoms.
7. Painful urination: Discomfort or burning sensation while urinating.

If you suspect you have endometritis or are experiencing any of these symptoms, it is important to seek medical attention for proper diagnosis and treatment.

What are the causes of endometritis?

Endometritis is typically caused by an infection, often bacterial, that affects the lining of the uterus (endometrium). Several factors can increase the risk of developing endometritis, including:

1. Childbirth: Endometritis can occur after childbirth, particularly if there were complications during delivery, such as prolonged labor or the presence of meconium in the amniotic fluid.
2. Cesarean section: Women who undergo cesarean sections have a higher risk of developing endometritis compared to those who deliver vaginally.
3. Medical procedures involving the uterus: Endometritis can also result from medical procedures such as dilation and curettage (D&C), hysteroscopy, or placement of an intrauterine device (IUD).
4. Sexually transmitted infections (STIs): Certain sexually transmitted infections, such as chlamydia and gonorrhea, can lead to endometritis if left untreated.
5. Pelvic inflammatory disease (PID): Endometritis may be a complication of PID, which is an infection of the female reproductive organs, including the uterus, fallopian tubes, and ovaries.
6. Bacterial imbalance: Disruption of the normal balance of bacteria in the vagina (dysbiosis) can predispose women to endometritis.
7. Immune system suppression: Conditions or medications that weaken the immune system can increase the risk of developing endometritis.

Prompt diagnosis and treatment of infections, particularly after childbirth or certain medical procedures, can help prevent the development of endometritis.

How is the diagnosis of endometritis made?

The diagnosis of endometritis is typically made through a combination of physical examination, medical history, and laboratory tests. Here are the common methods used to diagnose endometritis:

1. Physical Examination: A pelvic exam is performed to assess the cervix, uterus, and adnexa (ovaries and fallopian tubes) for tenderness, swelling, or masses.
2. Medical History: A thorough medical history is taken to identify any symptoms, such as abnormal vaginal discharge, pelvic pain, or heavy bleeding.
3. Endometrial Sampling: A sample of the endometrium (the lining of the uterus) is obtained through a procedure called endometrial biopsy. This involves inserting a thin tube through the cervix into the uterus and gently scraping off a small sample of tissue.
4. Cytology: A Pap test or Pap smear is performed to examine the cells on the cervix for abnormal cell changes or cancer.
5. Pelvic Ultrasound: An ultrasound examination may be done to evaluate the size and shape of the uterus, ovaries, and fallopian tubes.
6. Laparoscopy: A laparoscopic examination may be performed to visually inspect the pelvic cavity and take tissue samples from the fallopian tubes and uterus.
7. Blood Tests: Blood tests may be ordered to check for signs of infection, such as elevated white blood cell count or C-reactive protein (CRP).
8. Endocervical Curettage: This is a procedure in which a specialized instrument called a curette is inserted through the cervix into the uterus to collect a sample of tissue and fluid.
9. Hysteroscopy: This is a procedure in which a flexible tube with a camera on the end is inserted through the cervix into the uterus to visualize the uterine cavity and take tissue samples.

The diagnosis of endometritis is confirmed by identifying inflammation or infection in the endometrium, such as:

• Presence of inflammatory cells or bacteria in the endometrial tissue sample
• Elevated levels of inflammatory markers in blood tests
• Visible signs of inflammation on ultrasound or laparoscopic examination

It’s important to note that endometritis can be challenging to diagnose, especially if symptoms are mild or nonspecific. A healthcare provider may need to perform multiple tests and examinations to confirm the diagnosis.

What is the treatment for endometritis?

The treatment for endometritis depends on the underlying cause, severity, and location of the infection. Here are some common treatments for endometritis:

1. Antibiotics: Antibiotics are usually the first line of treatment for bacterial endometritis. The choice of antibiotic depends on the bacteria causing the infection and may include:
   • Metronidazole (Flagyl) for anaerobic bacteria
   • Cephalexin (Keflex) or cefotetan (Cefotan) for gram-negative bacteria
   • Doxycycline (Vibramycin) or azithromycin (Z-Pak) for Chlamydia or Mycoplasma
2. Antivirals: For viral causes of endometritis, antiviral medications such as valacyclovir (Valtrex) or acyclovir (Zovirax) may be prescribed.
3. Hormonal therapy: Hormonal medications such as progestins (e.g., medroxyprogesterone acetate, Depo-Provera) or estrogen-progestin combinations (e.g., Yasmin) may be used to treat endometrial hyperplasia or polyps.
4. Surgery: Surgery may be necessary if the endometritis is caused by a foreign body, such as an IUD, or if there is a suspected tubal perforation. Procedures may include:
   • IUD removal: Removing the IUD to treat bacterial or inflammatory conditions
   • Laparoscopic surgery: Performing laparoscopic surgery to drain abscesses or remove adhesions
   • Hysteroscopy: Using a hysteroscope to remove polyps or fibroids
5. Cryotherapy: Cryotherapy involves freezing the affected area with liquid nitrogen to destroy abnormal cells.
6. Radiofrequency ablation: Radiofrequency ablation uses heat energy to destroy abnormal cells.
7. Hysterectomy: In severe cases of endometritis, a hysterectomy may be necessary to remove the uterus.

Additional treatments that may be used in conjunction with antibiotics include:

1. Pain management: Medications such as ibuprofen or acetaminophen can help manage pain and discomfort.
2. Heat therapy: Applying heat to the lower abdomen may help reduce cramping and discomfort.
3. Rest: Getting plenty of rest and avoiding strenuous activities can help alleviate symptoms.
4. Follow-up care: Regular follow-up appointments with a healthcare provider are important to monitor progress and adjust treatment as needed.

It’s essential to note that treatment may vary depending on individual circumstances and the underlying cause of endometritis. A healthcare provider will work with the patient to develop a personalized treatment plan.