Endometritis is an inflammation of the lining of the uterus. It is usually caused by an ascending infection from the vagina.
What is endometritis?
In endometritis, the lining of the uterus (endometrium) becomes inflamed. The pathogens rise from the vagina and enter the uterus through the cervix. Inflammation of the endometrium is often accompanied by inflammation of the uterine muscles. This combined inflammation is also called endomyometritis. During the course of the disease, menstrual irregularities and spotting may occur. If it spreads to the uterine muscles, severe pain also occurs. Normally, endometritis takes a good course. However, it can also lead to infertility.
Causes
Endometritis is almost always caused by an ascending infection from the vagina. Most often, this infection is caused by pathogens such as staphylococcus, chlamydia, and streptococcus. Normally, the internal cervix is a barrier to pathogens and germs. However, menstruation, curettage, probing, or childbirth can cause holes in this barrier through which pathogens can enter the uterus. In this case, the pathogens first settle on the so-called zona functionalis. This layer of the endometrium is shed cyclically during menstrual bleeding. Pathogens that adhere to the zona functionalis are accordingly excreted with the bleeding. Thus, self-healing of the endometrium is initiated during menstrual bleeding. However, if the infection reaches the zona basalis, the pathogens remain in the uterus during and after menstruation. The disease persists. The myometrium is mainly involved in purulent endometritis. Outside the puerperium, however, myometritis rarely occurs. Only in very rare cases is the endometrium infected by descending infection from the ovaries (salpingitis). In old age, due to decreasing estrogen levels, the mucous membranes and thus also the mucous membrane of the uterus become thinner and thinner. This can also be a cause of uterine inflammation.
Symptoms, complaints and signs
Most women do not notice the vaginitis that precedes uterine inflammation at all. The cervicitis that follows, the inflammation of the cervix, also often goes unnoticed. There may be mild symptoms such as discharge or unpleasant odor in the intimate area. The vagina may hurt, burn, itch or be red. The symptoms of actual endometritis are also rather non-specific. There is often abdominal pain. The uterus is also painful with pressure. As the mucosa changes due to the inflammatory processes, menstrual irregularities may occur. Menstrual bleeding may be increased or last longer. Spotting and intermenstrual bleeding may occur between normal menstrual periods. When endometritis spreads to the fallopian tubes, the previously rather moderate fever increases. Patients experience severe pain and feel very ill.
Diagnosis
Diagnosis always begins with a detailed medical history. Among other things, it is clarified whether a procedure was performed on the uterus in the near past that could have favored the penetration of pathogens. Such a favorable intervention is, for example, the insertion of an IUD. This is followed by a detailed physical examination. First, the doctor palpates the abdomen and lower abdomen. In the case of endometritis, painful pressure is felt here. In the case of a severe inflammation, a defensive tension may develop. The patient’s abdomen is then hard as a board. With the colposcope, the doctor can examine the mucous membranes of the vagina and the cervix. He also takes a sample of the vaginal secretion and performs a smear test on the cervix. The vaginal secretion and the smear are then examined for pathogens in a laboratory. In this way, the diagnosis can be confirmed. If there are changes in the mucosal cells, additional tissue samples may need to be taken to rule out cancer. If endometritis has spread to the ovaries, elevated levels of inflammation will be found in the blood work.
Complications
Inflammation of the mucous membrane of the uterus usually progresses without the occurrence of further complications if treated properly.In some cases, however, secondary symptoms and accompanying symptoms cannot be ruled out. One of the symptoms is pyometra. In pyometra, pus accumulates in the uterus. Women of older age are more frequently affected by this. This is due to the fact that the cervix is narrower in old age than in younger years and is therefore more easily inflamed. Furthermore, endometritis occurs in a few cases together with a muscle layer inflammation of the uterine tissue, a so-called myometritis. A serious complication is the spread of the inflammation to surrounding tissue. For example, endometritis may spread to an inflammation via the fallopian tube to the ovary. In the worst case, a so-called adnexitis can lead to infertility. A very serious complication is the spread of the infection to the abdominal cavity. This can be fatal. If the causative pathogens of the infection enter the bloodstream of the organism, sepsis, also called blood poisoning, cannot be ruled out. This can have a fatal outcome.
When should you go to the doctor?
Women who notice increased whitish discharge, abdominal pain, and other signs of endometritis should consult a gynecologist. Although endometritis does not always require medical treatment, complaints in the genital area generally require clarification by a physician. If complications occur – such as burning pain or heavy discharge – a doctor must be consulted on the same day. Women with IUDs or after childbirth are particularly susceptible to uterine inflammation. Endometritis is also more common during monthly menstruation. Tumor diseases as well as benign tumor formations at the cervix are further risk factors. If you belong to one of these groups, it is best to consult a doctor regularly. If signs of uterine inflammation become apparent, this must be clarified immediately. Complaints in the area of the fallopian tubes and ovaries indicate that the inflammation has already spread further. In this case, a physician should also be consulted immediately, who can clarify the symptoms and, if necessary, treat them directly. If in doubt, go directly to the nearest hospital.
Treatment and therapy
As a rule, endometritis must be treated as an inpatient. Broad-spectrum antibiotics such as ciprofloxacin, doxycycline, or metronidazole are used for treatment. Anticonvulsant and analgesic medications such as butylscopolamine are used to relieve pain. Anti-inflammatory drugs such as ibuprofen, diclofenac or phenylbutazone additionally fight the inflammation. If pus forms in the uterine cavity, it must be aspirated with a so-called Fehling’s tube. During the entire treatment, the patient must remain on bed rest. If the uterine infection has occurred after insertion of an IUD, the contraceptive device must be removed immediately. After the therapy with antibiotics is completed, the doctor performs a uterine scraping. During this procedure, possible infected mucosal remnants are removed. This is to prevent further inflammation. If the uterus does not regress properly after the scraping, a contraceptive is administered. This ensures that the uterine muscles contract. After any uterine inflammation, a tumor of the uterus must also be ruled out. For this purpose, the scraped tissue is examined pathologically.
Outlook and prognosis
The prognosis of endometritis is favorable with prompt and good medical treatment. Antibiotics are prescribed immediately after diagnosis, leading to a rapid regression of symptoms. The body’s defenses are built up within a few days and the pathogens slowly die. Subsequently, they are transported out of the organism and healing occurs. Normally, the patient is healthy and symptom-free within a few weeks. The prognosis deteriorates as soon as the inflammation has already spread to neighboring organs. If the abdominal cavity or the intestine are affected, there is a risk of further complications and a deterioration in the patient’s state of health. In severe cases, the intestine may rupture and the patient’s life may be in danger. These patients require an emergency physician so that medical care can be initiated as quickly as possible.Timely treatment of endometritis is therefore crucial for the course of the disease and the prognosis. If medical treatment is not given, the risk of spreading increases. People who have a strong immune system, do not have any other diseases and follow a healthy lifestyle can achieve self-healing. However, this is not recommended because the risk of deterioration of health is too high. Endometritis may recur in the course of life. The prognosis is then also favorable.
Prevention
Endometritis cannot always be prevented. The best way to prevent the inflammation is to avoid inflammation of the vagina. An intact vaginal environment is the best protection against pathogens. To preserve the vaginal flora, the intimate area should only be washed with water and not with soap or shower gel. Most intimate lotions are also not suitable for care, as they have too high a pH value. In addition, women should pay attention to good sexual hygiene. In particular, switching directly from anal to vaginal intercourse carries a high risk of infection. The use of tampons during menstruation can also promote infections of the vagina and thus also inflammation of the uterus.
Aftercare
In most cases of endometritis, the affected person has only very limited options for aftercare. The focus is therefore also on the rapid and early treatment of this disease to prevent further complications and avoid other complaints. In general, early treatment always has a positive effect on the further course of endometritis. The treatment itself is carried out with the help of antibiotics. The affected person should always take these according to the doctor’s instructions. When taking antibiotics, alcohol should also not be drunk, as this can significantly reduce their effect. Furthermore, the symptoms can also be alleviated with the help of painkillers. However, a doctor should also be consulted in this case, painkillers should not be taken for a long period of time. Since endometritis can also lead to a tumor in the uterus, regular examinations should be performed to prevent the tumor from spreading. Since endometritis can also lead to psychological discomfort or depression, help and support from one’s family and friends is also very important in this case.
What you can do yourself
Uteritis is very often preceded by vaginitis (vaginitis). The pathogens rise from the vagina via the cervix into the uterus. This can be caused by inadequate intimate hygiene. Regular cleaning of the external genitals with warm water and a mild cleanser can therefore prevent vaginitis. However, excessive intimate hygiene, especially using aggressive cleaning substances, is counterproductive. In addition, typical pathogens such as chlamydia, gonococci or streptococci are transmitted much more frequently during heterosexual intercourse. Women should therefore always insist on using a condom when having sexual intercourse with men. This precaution is particularly important when partners change frequently. There is also an increased risk of infection during menstruation and especially during the so-called postpartum period, i.e. the first eight weeks after the birth of a child. During this time, the cervix is slightly open, which is why pathogens can penetrate the uterus more easily. The same applies after surgical procedures such as scraping out the uterus, as the cervical canal must be widened during the procedure. During such phases, it is essential to ensure appropriate intimate hygiene and to refrain from unprotected sexual intercourse.
