What is Endometritis: Causes, Symptoms, Treatment, Risk Factors, Complications

Endometritis is more common than one would think. This inflammatory condition affects the lining of the uterus and is usually caused by an infection. While endometritis is not a common life-threatening condition, but it is necessary to get it treated at the earliest. Endometritis goes away when treated with antibiotics. If left untreated, though, infections may lead to further complications with the reproductive system, cause fertility issues, and can also lead to other health problems. Here’s everything you need to know about the causes, symptoms, and treatment of endometritis.

What is Endometritis?

Endometritis is a condition that causes inflammation of the uterine lining and is usually caused by an infection.(1) The disease is not typically fatal, but if left untreated, it can lead to many types of complications with your reproductive system and affect your fertility, and also cause other health problems.(2, 3)

To lower the risks of complications, it is necessary that you get the condition treated at the earliest.

What Are The Causes of Endometritis?

Infections are the most common cause of endometritis. Some of the infections that are known to cause endometritis include:

  • Tuberculosis
  • Sexually transmitted diseases (STDs) or infections such as gonorrhea and chlamydia
  • Infections caused by the mixture of normal vaginal bacteria

All women have a natural mix of bacteria present in the vagina. Endometritis can also be caused when this natural mix of bacteria gets altered due to a life event or a stressful incident in your life.

What are the Risk Factors for Endometritis?

You are considered to be at a high risk of getting an infection that can lead to endometritis after you go through childbirth or after a miscarriage. The risk is exceptionally high if you have a cesarean delivery or prolonged labor.(4, 5) You are also at a high risk of getting endometritis after having undergone a medical procedure that involves entering through the cervix to reach the uterus.(6) This opens up a pathway for various bacteria to entire. Such types of medical procedures that increase the risk of developing endometritis are:

  • Process of dilation and curettage
  • Hysteroscopy
  • Placement of an intrauterine device (IUD)(7)

Endometritis can also occur along with other conditions of the reproductive system or in the pelvic area, such as cervicitis, which is an inflammatory condition of the cervix. These other accompanying conditions may or may not cause symptoms.

Symptoms of Endometritis

The common symptoms of endometritis include:(8)

  • Abnormal vaginal discharge
  • Abnormal vaginal bleeding
  • Abdominal swelling
  • Fever
  • Discomfort while having a bowel movement
  • A general feeling of being unwell
  • Pain in the pelvis region
  • Lower abdominal pain
  • Pain in the rectal region

Diagnosing Endometritis

Your doctor will begin by conducting a pelvic exam and a complete physical examination. They will examine your cervix, uterus, and your abdomen to check for symptoms of abnormal discharge and tenderness.(9) There are some frequent diagnostic tests used to diagnose endometritis, such as:

  • Taking samples from the cervix to check for bacteria that can cause a potential infection, such as gonococcus and chlamydia.(10)
  • A laparoscopy procedure to allow your doctor to look closely at the insides of your pelvis or abdomen.
  • Removing a small amount of tissue from the uterine lining to conduct a biopsy. This is known as an endometrial biopsy.(11)
  • Looking at the vaginal discharge under a microscope.

In some cases, a blood test may also need to be done to measure the count of white blood cells and erythrocyte sedimentation rate (ESR). Endometritis is known to increase the count of both white blood cells and erythrocyte sedimentation rate in the blood.

Treating Endometritis

The treatment of endometritis is a course of antibiotics. If the cause of your condition is a sexually transmitted infection, then your partner will also need to be treated. It is essential that you finish the course of the medication as prescribed by your doctor.

Severe or complicated cases of endometritis may need to be treated with intravenous fluids, and you may need to be hospitalized for the time being. This is more likely to be the case if you got endometritis right after childbirth.

Are There Any Complications of Endometritis?

If endometritis is not treated with antibiotics, then it can lead to severe illness and many possible complications. These may include:

  • Infertility
  • Septicemia, a condition marked by the presence of bacteria in the bloodstream
  • Pelvic peritonitis, a term used to refer to generalized pelvic infection
  • Collection of pus or abscesses in the uterus or the pelvis
  • Septic shock, a possibly fatal condition characterized by overwhelming blood infection that causes very low blood pressure
  • Septicemia can also lead to sepsis, which is a severe infection that tends to worsen very rapidly. It can also cause septic shock, which is a fatal medical emergency. Both of these complications require immediate medical assistance and treatment in a hospital.

Chronic endometritis is another complication, which causes chronic inflammation of the endometrium. In this condition, while a pathogen is present in the body, but it only produces a low-grade infection. In most cases, this does not cause any symptoms, or the symptoms may even be misdiagnosed, due to which the right treatment cannot be started. Chronic endometritis is known to be a major cause of infertility.(12)

Can Endometritis Be Prevented?

The risk of endometritis from childbirth can be decreased by ensuring that your gynecologist or doctor is using completely sterile equipment and methods during delivery or cesarean surgery. Your doctor is also likely to prescribe antibiotics after birth as a precaution, especially during a cesarean delivery or before the operation begins.

You can also lower the risk of getting endometritis from sexually transmitted infections by practicing safe sex and using condoms. Other tips that can help include:

  • Getting a routine screening done for suspecting sexually transmitted diseases, not just for yourself, but also for your partner
  • Completing the prescribed treatment for a sexually transmitted infection

Conclusion

The outlook for anyone who has got endometritis and has gotten it treated properly is usually very good. Endometritis is treatable with the correct course of antibiotics, and people typically do not experience any problems in the long run. However, if the condition is left untreated, then issues with reproduction as well as severe infections may occur. This can even lead to infertility or septic shock, which is a life-threatening condition that needs immediate medical treatment.

If you are experiencing the symptoms of endometritis, then you should consult your doctor at the earliest. Remember that it is essential to complete the treatment course of antibiotics to prevent any severe complications from developing in the future.

References:

  1. Eckert, L.O., Hawes, S.E., Wölner-Hanssen, P.K., Kiviat, N.B., Wasserheit, J.N., Paavonen, J.A., Eschenbach, D.A. and Holmes, K.K., 2002. Endometritis: the clinical-pathologic syndrome. American journal of obstetrics and gynecology, 186(4), pp.690-695.
  2. Gilbert, R.O., Shin, S.T., Guard, C.L., Erb, H.N. and Frajblat, M., 2005. Prevalence of endometritis and its effects on reproductive performance of dairy cows. Theriogenology, 64(9), pp.1879-1888.
  3. Czernobilsky, B., 1978. Endometritis and infertility. Fertility and sterility, 30(2), pp.119-130.
  4. Watts, D.H., Krohn, M.A., Hillier, S.L. and Eschenbach, D.A., 1990. Bacterial vaginosis as a risk factor for post-cesarean endometritis. Obstetrics and gynecology, 75(1), pp.52-58.
  5. Olsen, M.A., Butler, A.M., Willers, D.M., Gross, G.A., Devkota, P. and Fraser, V.J., 2010. Risk factors for endometritis after low transverse cesarean delivery. Infection Control & Hospital Epidemiology, 31(1), pp.69-77.
  6. Kim, I.H. and Kang, H.G., 2003. Risk factors for postpartum endometritis and the effect of endometritis on reproductive performance in dairy cows in Korea. Journal of Reproduction and Development, 49(6), pp.485-491.
  7. Sheppard, B.L., 1987. Endometrial morphological changes in IUD users: a review. Contraception, 36(1), pp.1-10.
  8. Peipert, J.F., Ness, R.B., Blume, J., Soper, D.E., Holley, R., Randall, H., Sweet, R.L., Sondheimer, S.J., Hendrix, S.L., Amortegui, A. and Trucco, G., 2001. Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease. American journal of obstetrics and gynecology, 184(5), pp.856-864.
  9. Polisseni, F., Bambirra, E.A. and Camargos, A.F., 2003. Detection of chronic endometritis by diagnostic hysteroscopy in asymptomatic infertile patients. Gynecologic and obstetric investigation, 55(4), pp.205-210.
  10. Hillier, S.L., Kiviat, N.B., Hawes, S.E., Hasselquist, M.B., Hanssen, P.W., Eschenbach, D.A. and Holmes, K.K., 1996. Role of bacterial vaginosis–associated microorganisms in endometritis. American journal of obstetrics and gynecology, 175(2), pp.435-441.
  11. Noyes, R.W., Hertig, A.T. and Rock, J., 1950. Dating the endometrial biopsy. Obstetrical & Gynecological Survey, 5(4), pp.561-564.
  12. Park, H.J., Kim, Y.S., Yoon, T.K. and Lee, W.S., 2016. Chronic endometritis and infertility. Clinical and Experimental Reproductive Medicine, 43(4), p.185.

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