Symptoms of metroendometritis and methods of treating uterine disease

Endometrial diseases

18.04.2018

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9.4 thousand

6 min.

Chronic metroendometritis is an inflammatory disease that can be considered a combination of endometritis and myometritis. In practice, this means that inflammation affects both muscle tissue and the mucous membrane of the uterine wall.

Chronic metroendometritis is a common disease caused by infection. If treated incorrectly, it can cause infertility or chronic miscarriage. To combat it, medications and folk remedies are used.

• 1. Reasons
• 2. Symptoms
• 3. Echo signs
• 4. Treatment

Chronic metroendometritis rarely develops as an independent disease. Most often it is a logical continuation of the acute form of this pathology.

The prevalence of the disease has not been sufficiently studied. It has been established that this type of inflammatory process often develops after childbirth (in at least 5-8% of women; if the birth was pathological, the figure increases to 20%).

But chronic metroendometritis also begins for other reasons, for example, after surgery.

Sometimes inflammation develops due to sutures or suppuration of unremoved tissue remains in the uterine cavity, if the installation of an intrauterine device is unsuccessful.

There are two main forms of metroendometritis - infectious and aseptic. The difference between them lies in the causative agents of the disease. In most cases, these are opportunistic microflora (staphylococcus, E. coli), anaerobic bacteria - peptococci.

The infection does not always occur during childbirth or during the installation of an intrauterine device. Sometimes it is transferred by the circulatory system from any sources of chronic inflammation, including in the ENT organs. We should not exclude genital infections and various mechanical injuries in the pelvic area. Frequent douching and venous congestion are also causes of the disease.

Acute metroendometritis begins suddenly, with a rise in temperature to +38...+39 degrees, sharp or nagging pain in the lower abdomen, signs of general intoxication of the body. There is vaginal discharge, and sometimes blood or pus is visible in it.

With chronic metroendometritis, significant changes occur inside the uterus itself. The number of receptors sensitive to the action of sex hormones is reduced. Sclerotic processes are observed in the blood vessels of the small pelvis, and adhesions may form.

The acute phase of the disease in the patient lasts for 8-10 days, sometimes while taking antibiotics - even with virtually no fever.

When the disease occurs in an erased form, they speak of subacute metroendometritis. It is distinguished by unclear symptoms, and with an unfavorable course it also becomes chronic.

The subacute form is characterized by the following symptoms:

• vaginal discharge, which has a different appearance - sometimes it contains grayish mucus or blood (in the chronic form, purulent discharge does not occur as often as in the acute form, but they cannot be excluded);
• nagging pain, which is localized mainly in the area above the pubis;
• menstrual irregularities - sometimes bleeding can occur between menstruation, the timing is constantly confused, there are long delays;
• increase in size of the uterus.

Complications of the disease include infertility and miscarriages. Sometimes it develops against the background of pathologies such as cysts and inflammation of the appendages, adhesions in the pelvic organs.

To make an accurate diagnosis, you need to do an ultrasound of the pelvic organs. Sonographic signs of metroendometritis are determined by the size of the uterus, its position, and the condition of the endometrium and myometrium.

Normal indicators for the organ, that is, for its longitudinal, transverse and anteroposterior dimensions, range from 45-50, 45-50 and 40-45 mm, respectively. In women who have given birth, they are always a little larger. Echosigns of metroendometritis are an enlarged uterus.

In rare cases, there is also a decrease in the organ compared to the norm.

The condition of the endometrium plays an important diagnostic role. The main indicator is its thickness. With metroendometritis, thickening of the endometrium occurs due to the fact that inflammation disrupts the regenerative processes in the mucous membrane. In this case, normal tissues are replaced by connective ones.

The inflammatory process in the disease begins from the basal layer of the endometrium, and due to its lack of a clear anatomical boundary with the myometrium, the infection quickly spreads to muscle tissue.

Treatment of chronic metroendometritis is carried out at home. In the acute phase, rest and bed rest are prescribed. It is recommended to apply an ice pack to the lower abdomen.

It should not be left directly on the skin. Place a towel under the bubble (an ordinary rubber heating pad).

These compresses will help relieve swelling that occurs during an exacerbation and remove the inflammatory process.

Since the disease is usually caused by a bacterial infection, it is recommended to take antimicrobial medications. It is important to identify the pathogen and test its resistance to various types of such drugs. But practice shows that antibiotics from the group of semi-synthetic penicillins (Ampicillin) can successfully influence most pathogenic microbes.

Cephalosporins are used in combination with Metronidazole. Both systemic medications of this type and vaginal suppositories are prescribed. Following the results of treatment, an analysis must be done to check how successfully the infection was managed.

A drug such as Duphaston helps improve the condition of the endometrium. It can only be taken as prescribed by a doctor.

This is hormonal therapy, since Duphaston is an analogue of progesterone, which naturally must be produced in the ovaries in order to prepare the body for conceiving and bearing a child. This drug allows you to normalize the thickness of the endometrial layer.

To eliminate pain, antispasmodics are used, including No-Shpa or Drotaverine.

In case of severe symptoms of poisoning, sorbents are prescribed, which help to quickly remove harmful substances from the body. These are drugs such as activated carbon, Enterosgel, and other similar drugs.

At home, antiseptic douching solutions are sometimes used. But a more effective remedy is intrauterine lavage. It is done exclusively in a clinical setting.

If we are talking about women after childbirth, then often several such procedures are supposed to be carried out in the maternity hospital. Lavage is drip irrigation of the uterus using antiseptic solutions.

If standard conservative treatment methods do not give the desired result and septic complications are noted, then the patient needs hospitalization, since surgical intervention is necessary, including removal of the affected tissue.

Treatment of chronic metroendometritis with folk remedies is allowed:

Raw materials	Recipe	Application
Cinquefoil and chamomile inflorescences	1. Take dry raw materials in equal proportions. 2. Select 1 tbsp. l. mixtures. 3. Pour in 2 cups of boiling water. 4. Cool and filter	Use for douching once a day. The product has anti-inflammatory properties and the ability to stop internal bleeding
Chamomile and linden inflorescences	1. Mix chamomile (3 parts) and linden (2 parts). 2. Select 4 tbsp. l. dry crushed raw materials. 3. Pour a glass of boiling water. 4. Infuse the product for a couple of hours. 5. Strain	Used for intravaginal irrigation
Oak bark, chamomile flowers, nettle leaves, knotweed	1. Take oak bark (1 part), chamomile flowers and nettle leaves (3 parts each), knotweed grass (5 parts). 2. Grind and mix. 3. Pour 2 tbsp into a thermos. l. mixtures. 4. Pour 1 liter of boiling water. 5. Leave for several hours. 5. Strain	The infusion is used both for douching and for making vaginal tampons.
Rosemary, yarrow, sage and oak bark	1. Take raw materials in equal proportions. 2. Select 2 tbsp. l. for 1 liter of boiling water. 3. Leave for several hours	Used for douching. This product is a strong antiseptic
Willow bark and linden blossom	1. Mix willow bark (3 parts) and linden blossom (2 parts). 2. Take 4 tsp. facilities. 3. Brew in a glass of boiling water. 4. Leave for an hour	You can douche with the solution up to 2 times a day

It is recommended to first consult with your doctor regarding any traditional medicine.

Source: https://fraumed.net/uterus/endometrium/metroendometrit.html

Metroendometritis: symptoms, diagnosis and treatment

Metroendometritis is an infectious gynecological disease accompanied by inflammation of the muscular layer (myometrium) and mucous membrane (endometrium) of the uterus. The disease develops against the background of infection entering the uterine cavity from the fallopian tubes, vagina or cervical canal.

There are no general statistics on the incidence of metroendometritis. But according to the observation of gynecologists in the postpartum period, the number of women with this disease ranges from 3 to 8%, and with complicated childbirth it increases to 20%.

If metroendometritis is not treated in a timely manner, it can lead to a purulent-septic process, and subsequently to uterine infertility.

That is why the pathology is on a par with other serious gynecological diseases.

Description of the disease

After the infection enters the uterine cavity, inflammation of the mucous membrane begins to develop - endometritis. Over time, the damaged mucosa loses its ability to retain pathogenic microorganisms, and they begin to penetrate deeper. As a result, the infection enters the muscular layer of the uterus, causing an inflammatory disease such as metritis. At this stage, the clinical manifestations of metroendometritis become pronounced.

In a healthy woman, the uterus is reliably protected by such physiological barriers as the endometrium, uterine glands, and cervical canal. Therefore, the risk of infection entering the cavity is minimized.

The development of pathology is possible with mechanical damage to the mucous membrane and with malfunctions of the immune system.

This is why metroendometritis often develops after childbirth, abortion or gynecological surgery.

In addition, self-medication may help the infection penetrate deeper. An independent attempt to get rid of the disease only leads to relief of symptoms, but not to the destruction of the source of infection.

The inflammatory process in metroendometritis can be acute, subacute and chronic. In the first case, the clinical manifestations of the disease are quite vivid and appear within 3–5 days from the moment of infection. The subacute form has a more blurred clinical picture, it is more difficult to diagnose and most often it indicates the presence of a chronic process.

The chronic form develops when treatment of metroendometritis was not carried out in a timely manner. Symptoms in this case are practically absent, except for moments of exacerbation of the disease.

Causes of metroendometritis

The only reason for the development of metroendometritis in the uterine cavity is infection. In medicine, the disease is usually divided into 2 types: specific and nonspecific.

In the first case, inflammation is provoked by pathogenic microorganisms such as gonococci and Trichomonas. And in the second case, the infection develops due to streptococcus, staphylococcus, E. coli and a number of other microorganisms.

But there are also negative factors that at some point can contribute to the development of the disease. These include:

1. Various injuries after diagnostic procedures. Even a small wound in the uterine cavity can become an excellent place for bacteria to multiply.
2. Consequences of abortion. During this procedure, the mucous membrane is removed, in place of which an open wound surface is formed. And through damaged vessels, microorganisms easily penetrate into the muscular layer of the uterus. In addition, accumulated blood in the absence of a mucous layer becomes an ideal place for bacteria to multiply.
3. Insertion of the intrauterine device into the cavity. Microorganisms are able to penetrate through its threads.
4. Promiscuous sexual intercourse.
5. Failure to comply with personal hygiene rules, especially during the postpartum period.
6. Surgical operations in the uterine cavity.
7. Polyps not removed in a timely manner. They retain uterine secretions, thereby creating a favorable environment for the proliferation of microorganisms.

Risk factors in the postpartum period include complicated, protracted labor, weak labor, uterine bleeding and remnants of placental tissue in the uterine cavity. The development of metroendometritis can be facilitated by menstruation, bacterial vaginosis, colpitis, endocervicitis and venous congestion in the pelvic organs.

Clinical manifestations of the disease

Symptoms of metroendometritis directly depend on the cause of its occurrence. But there are a number of common clinical manifestations. These include:

• disruptions of the menstrual cycle;
• aching pain in the lower abdomen;
• symptoms of body intoxication (nausea, vomiting).

During a gynecological examination, the doctor identifies changes in the size and shape of the uterus. Depending on the degree of inflammation, tenderness may be present on palpation.

The main symptoms of acute metroendometritis are severe pain in the pubic area, a sharp increase in temperature and the appearance of purulent discharge with a characteristic unpleasant odor. The acute form of the disease most often develops 3–5 days after intrauterine intervention (abortion, childbirth, installation of an IUD).

Symptoms of chronic metroendometritis include uterine bleeding, severe pain when pressing in the uterus and its significant increase in size. According to the observations of gynecologists, any disturbance of reproductive function in a woman can be considered an indirect clinical manifestation of the disease. For example, inability to conceive and miscarriages.

In the chronic form of the disease, menstrual dysfunctions such as anovulatory cycle and menorrhagia are often observed. Accompanying chronic metroendometritis can be cysts, intrauterine synechiae, adhesions in the pelvic organs and chronic adnexitis.

Diagnostic methods

In order to diagnose metroendometritis, the gynecologist first examines the uterus and vagina. Then the doctor writes out directions for laboratory and instrumental diagnostics:

1. Blood test to detect leukocytes and ESR (erythrocyte sedimentation rate). Their increased number directly indicates an inflammatory process in the body.
2. Ultrasound (ultrasound examination).
3. Bacterial culture of secretions. It allows not only to identify the causative agent of the infection, but also to determine which antibiotic will be most effective in treatment.
4. Examination of a vaginal smear helps to assess the severity of the inflammatory process and microbial composition.
5. Transvaginal ultrasound. Using this method, you can understand the condition of not only the uterus, but also the rest of the pelvic organs.

Additional research methods may be needed if concomitant diseases are identified in the patient. If the diagnosis of metroedometritis is difficult, the doctor resorts to laparoscopy.

Treatment options

Women with suspected metroendometritis are subject to urgent hospitalization. Lack of timely treatment can provoke uterine bleeding and, as a result, death.

The basis of drug therapy in this case is antibacterial drugs. Before starting treatment, a sensitivity test of the pathogen to the antibiotic is carried out.

If such a procedure cannot be carried out, then the doctor prescribes broad-spectrum drugs. One of the most common antibiotics for metroendometritis is penicillin.

If the drug is intolerable, at the discretion of the gynecologist, it is replaced with macrolides, tetracyclines or third-generation cephalosporins.

In any case, the doctor prescribes medications individually for each patient, sometimes this can be a whole group of medications. The course of treatment lasts on average 10-14 days. To remove toxins and purulent accumulations, the uterine cavity is washed with antiseptics. Additionally, to strengthen the immune system, a vitamin complex is prescribed.

Nonsteroidal anti-inflammatory drugs (ibuprofen, indomethacin) help stop the inflammatory process in the uterine cavity. They not only relieve pain, but also reduce tissue swelling. After the inflammatory process has subsided, the patient is prescribed physiotherapeutic procedures. These include electrophoresis, phonophoresis, paraffin and laser therapy.

Remember, resumption of sexual activity is possible no earlier than one menstrual cycle after the end of treatment. Such precaution is necessary for complete restoration of the endometrium, otherwise the risk of re-infection is very high.

Prognosis and prevention

Prevention of metroendometritis consists of several simple rules. The main ones include the following points:

• No messy connections.
• Compliance with the rules of intimate hygiene, especially during the menstrual cycle.
• Timely visit to the gynecologist for a preventive examination.
• A competent approach to the choice of contraceptives.
• Treat any pathologies of the pelvic organs in a timely manner.
• After the installation of an intrauterine device and during the postpartum period, visits to the doctor should be regular.
• If any of the above symptoms occur, you should immediately contact a gynecologist.

If treatment is started in a timely manner, then the chance of a complete recovery without consequences is quite high. Lack of therapy contributes to the transition of metroendometritis to a chronic form.

The inflammatory process will progress further, covering not only the uterus, but also neighboring organs. In this case, abscesses, thrombosis and complete infertility are practically unavoidable.

That is why you should not delay visiting a gynecologist and hope that metroendometritis will go away on its own.

Source: https://zdorovaya-ya.ru/zabolevaniya/metroendometrit/simptomyi-i-lechenie-metroendometrita.html

Metroendometritis

Metroendometritis is an inflammation of the muscular and mucous membrane of the uterine wall, combining signs of myometritis and endometritis. The clinical picture of acute metroendometritis is determined by hyperthermia, intoxication, pain in the lower abdomen, and purulent leucorrhoea. Chronic metroendometritis is accompanied by serous discharge from the genital tract, menstrual dysfunction and intermenstrual bleeding. Pathology is diagnosed based on the results of a gynecological examination, echography, and bacteriological culture of the discharge. Treatment of the acute form - antibiotic therapy, detoxification, adequate pain relief; For chronic metroendometritis, physiotherapy and hormonal therapy are indicated.

Metroendometritis is a combined inflammatory process in the uterus, covering the basal layer of the endometrium and the adjacent myometrium. In this case, endometritis, as a rule, precedes the development of metritis.

The general population frequency of various forms of metroendometritis has not been determined, but it is known that in the postpartum period this infectious complication develops in 3-8% of postpartum women, and during pathological childbirth its frequency increases to 20%.

Delayed diagnosis and irrational treatment of metroendometritis can lead to the development of generalized purulent-septic complications, and in the long term - uterine infertility. The seriousness of the prognosis puts metroendometritis among the most important problems of modern obstetrics and gynecology.

Metroendometritis

Taking into account causally significant factors, two etiological forms of metroendometritis are distinguished - infectious and aseptic. Most cases of the disease are caused by opportunistic flora or aerobic-anaerobic complexes, which often act synergistically.

The most relevant pathogens, according to microbiological studies, are staphylococcus, streptococcus, Proteus, Escherichia coli and Pseudomonas aeruginosa, anaerobic bacteria (bacteroides, peptostreptococci, peptococci).

In many patients with metroendometritis, polymicrobial associations are cultured: Staphylococcus aureus in combination with hemolytic streptococcus, Escherichia coli or enterobacteria. Along with nonspecific microflora, gonococci, mycoplasmas, Koch's bacilli, and diphtheria bacillus can be found in crops.

In most cases, infection occurs in an ascending manner: from the vagina and cervical canal to the uterine cavity.

This is facilitated by various gynecological manipulations - dilation of the cervical canal, abortion, childbirth, installation of an IUD, hysteroscopy, hysterosalpingography, RDV.

The source of downward spread of infection can be the fallopian tubes, contact - an inflammatory-changed appendix, hematogenous introduction of pathogens - distant purulent foci in the ENT organs.

The development of metroendometritis of infectious etiology is favored by conditions that facilitate the penetration of pathogens into the uterus: menstruation, uterine bleeding, venous congestion in the pelvic cavity, nonspecific and specific colpitis and endocervicitis.

Risk factors for puerperal (postpartum) metroendometritis are weakness of labor, a long anhydrous period, retention of the remnants of placental tissue in the uterus, and postpartum hemorrhage.

The origin of aseptic metroendometritis is closely related to injuries and bruises of the uterus, exposure to physical and chemical factors (cryotherapy, endometrial ablation, douching). Infectious inflammation in these cases occurs secondarily.

The infectious process in metroendometritis begins in the basal layer of the endometrium. The absence of a clear anatomical boundary between it and the myometrium causes the rapid spread of infection to the muscular layer.

The endometrium thickens, loosens, becomes swollen and hyperemic, and becomes covered with purulent plaque. Leukocyte infiltration, degeneration and desquamation of the glandular epithelium are visualized microscopically. The myometrium is also swollen, infiltrated with lymphocytes and segmented neutrophils.

In severe cases, there is involvement of the serous lining of the uterus in inflammatory changes, leading to the development of perimetritis.

In chronic metroendometritis, edema and hyperemia are less pronounced; lymphocytes and plasma cells predominate in the inflammatory infiltrate. The myometrium is thickened due to the proliferation of connective tissue.

Due to sclerotic processes in the vessels and fibrous transformations of the stroma, the endometrium acquires uneven thickness, areas of hyperplasia and polypous growths appear on it.

Signs of acute inflammation usually appear 3-4 days after artificial termination of pregnancy, childbirth, or therapeutic and diagnostic manipulations on the uterus.

The condition quickly worsens: body temperature reaches 38.0-39.0°C, chilling, severe malaise, tachycardia, and intoxication syndrome appear.

There are painful sensations in the lower abdomen and sacrum; upon palpation, the uterus is enlarged and painful. Characterized by abundant cloudy leucorrhoea - serous-purulent, purulent, sometimes with a putrid odor.

The presence of obstacles to the outflow of purulent secretions from the uterine cavity (submucous fibroids, uterine polyps, cicatricial changes in the cervix, etc.) can cause the occurrence of pyometra.

In this case, the patient’s condition worsens and cramping pain appears in the lower abdomen.

In case of postpartum metroendometritis, against the background of delayed lochia due to poor contraction of the uterus, its inflection, or blockage of the cervical canal by blood clots, lochiometra may develop.

Acute metroendometritis lasts on average from 5-7 to 8-10 days. Erased forms (for example, against the background of antibiotic therapy) occur with low-grade fever.

The most prognostically unfavorable complications are considered to be uterine gangrene and sepsis.

Chronic metroendometritis

It may be a continuation of the acute form if its treatment is incorrect or not intensive enough, or it may immediately arise as a primary chronic disease.

In chronic metroendometritis, vaginal discharge is serous, light, sometimes with a purulent admixture. Periodically, nagging pain may occur above the pubis, in the lumbar region and sacrum.

On palpation, the uterus is painless, compacted and slightly enlarged.

Pathomorphological changes in the endometrium determine the predominance of menstrual dysfunction in the clinical picture of chronic metroendometritis: menorrhagia, metrorrhagia, anovulatory cycles.

This form of metroendometritis is often accompanied by Nabothian cysts, chronic adnexitis, adhesions in the pelvis, chronic pelvic pain, and intrauterine synechiae.

These pathological conditions, in turn, cause impaired reproductive function (spontaneous termination of pregnancy, habitual miscarriages, infertility).

Acute metroendometritis in a patient who turned to a gynecologist with characteristic complaints is suggested by the connection of the disease with recent childbirth, intrauterine therapeutic and diagnostic interventions, and STDs.

Examination on a chair helps to create an objective picture of the disease: discharge of purulent leucorrhoea from the cervical canal, pain and enlargement of the uterus (or its subinvolution). A general blood test reveals acute inflammatory changes: leukocytosis, shift of the leukocyte formula to the left, acceleration of ESR.

Chronic metroendometritis is indicated by thin leucorrhoea, an enlarged uterus of dense consistency, and various disorders of menstrual function.

Ultrasound of the pelvic organs visualizes a thickened myometrium and a hyperplastic endometrium with a heterogeneous echostructure.

Histological analysis of scrapings of the uterine mucosa obtained as a result of diagnostic curettage allows us to identify changes characteristic of chronic metroendometritis.

Treatment of acute metroendometritis should be started as early as possible and carried out in full. Rest, bed rest, and application of a heating pad with ice to the lower abdomen are recommended.

In order to influence the widest possible range of microbial pathogens, semi-synthetic penicillins (ampicillin, carbenicillin), cephalosporins in combination with metronidazole are prescribed.

After receiving the results of microbiological analysis, antibiotic therapy is adjusted.

In case of severe intoxication syndrome, an infusion of colloid and crystalloid solutions is prescribed. The complex of general drug therapy includes desensitizing, painkillers, uterotonics, antispasmodics, vitamins, and immunomodulators.

If septic complications develop, surgical intervention may be required - supravaginal amputation of the uterus or hysterectomy (removal of the uterus along with the cervix).

In chronic metroendometritis, along with intramuscular antimicrobial therapy, targeted administration of antibiotics into the uterine mucosa is practiced.

Therapeutic douching, physiotherapeutic treatment (UHF therapy, laser therapy, intracavitary electrophoresis, paraffin therapy, mud therapy, etc.), therapeutic baths (hydrogen sulfide, radon) are used.

Correction of ovarian hypofunction is carried out by prescribing hormonal drugs (COCs). In the case of the formation of intrauterine adhesions, their separation is carried out under hysteroscopic control.

The course and prognosis of metroendometritis depend on the virulence of the pathogens and the resistance of the patient’s body. The outcome of acute endometritis can be either recovery or chronicity of the disease.

The resulting septic complications threaten not only further reproductive plans, but also life.

The consequences of chronic metroendometritis inevitably affect reproductive function, causing ectopic pregnancy, miscarriages, premature birth, abnormalities in the location of the placenta, weakness of labor, postpartum hemorrhage, etc.

Prevention and timely treatment of inflammatory diseases of the genitals, refusal of abortions, rational management of childbirth, maintaining sterility during intrauterine interventions, gynecological examinations and ultrasound control will help to avoid metroendometritis and its attendant complications.

Source: https://www.KrasotaiMedicina.ru/diseases/zabolevanija_gynaecology/metroendometritis

Metroendometritis - causes, symptoms and treatment of uterine inflammation

Metroendometritis is a female disease that is characterized by an inflammatory process that affects the mucous membrane (endometrium) and the layer of muscle tissue (myometrium) of the uterus.

Inflammation is most often infectious in nature (the cause of infection can be streptococcal, staphylococcal, tuberculosis or E. coli entering the uterus), but sometimes it can occur after childbirth, pregnancy that ends in miscarriage, abortion or the installation of an IUD that prevents conception.

Etiology and types of disease

As already mentioned, metroendometritis occurs against the background of infectious damage to the uterus by pathogenic microorganisms, which cause the development of infectious processes on its mucous membrane (endometrium). Doctors distinguish two groups of pathogenic bacteria that can cause the development of the disease:

• specific (chlamydia, gonococcal bacilli, herpes infection);
• nonspecific (intestinal or streptococcal bacilli, Klebsibela).

According to this classification, metroendometritis is usually divided into specific and, accordingly, nonspecific; the difference between the two subtypes of this disease lies in the symptoms and approaches to treatment (the effectiveness of antibacterial therapy directly depends on the correctly identified pathogen).

It is worth understanding that inflammation begins to develop not only against the background of infectious damage to the body by pathogenic bacteria or viruses, but also due to a decrease in the activity (or complete absence) of the mechanisms of protection of the uterine cavity, which occurs as a result of the “desquamation” of the epithelial tissue of the fallopian tubes during menstruation, imbalance of vaginal microflora, the appearance of specific immunoglobulins in the genital tract, and so on.

The routes by which microorganisms enter the uterus can also be different. If you believe the statistics, the most common cause of the development of acute metroendometritis is infection entering the uterine cavity through the ascending (from the lower genital organs) or hematogenous (through the blood) route, and chronic - lymphogenous.

Risk factors

Predisposing factors for the development of the disease include the presence of intrauterine devices, pregnancy (during pregnancy, the activity of the immune system decreases), frequent probing and diagnostic curettage of the uterine cavity, and abortion.

Postpartum metroendometritis often occurs due to non-compliance with the rules of personal hygiene of the genital organs or early onset of sexual activity, which is prohibited until the uterine mucosa is completely healed (1-3 months, depending on how pregnancy and childbirth went).

Main symptoms of the disease

Chronic metroendometritis

Clinical manifestations of the disease depend on the nature of the inflammatory process and the cause of its development.

At the very beginning of the disease, women with suspected metroendometritis (regardless of the nature of its course) complain of dull, aching pain localized in the lower abdomen, an apathetic state (lack of appetite, drowsiness), disruptions in the menstrual cycle (too heavy or, conversely, short menstruation, “spotting” spotting in the middle of the menstrual cycle), symptoms of infectious intoxication of the body (vomiting, nausea). Subsequently, during a gynecological examination of the vagina, the doctor notes an enlargement of the uterus, a change in its shape (in the absence of adequate treatment, it becomes spherical) and pain on palpation.

Acute metroendometritis, as a rule, develops 3–4 days after intrauterine interventions (termination of pregnancy, childbirth, installation of an IUD). It is characterized by a sharp increase in body temperature, pain in the pubic area, which can radiate to the sacrum, and the appearance of purulent bloody discharge from the vagina with a putrid odor.

As for the symptoms that accompany chronic metroendometritis, these include uterine bleeding, a noticeable enlargement of the uterus and severe pain when pressing on this area.

In addition, when talking about chronic metroendometritis, doctors say that an indirect symptom of its manifestation is considered to be disruption of the woman’s reproductive system (pregnancy failures at different stages, suspicion of infertility), so it is recommended to treat this disease at the first signs of its appearance.

Diagnostic methods

Diagnosis of metroendometritis

Before starting treatment for a disease, doctors diagnose it, which is generally not difficult.

The diagnosis is made on the basis of a gynecological examination of the uterus and vagina, ultrasound examination and clinical blood tests to determine the causative agent of the infection.

In cases where the symptoms of metroendometritis are not clear and the doctor suspects the development of another disease accompanied by similar symptoms, the woman undergoes diagnostic curettage of the uterine cavity and a biopsy of endometrial tissue.

How to treat?

Patients with suspected metroendometritis are subject to urgent hospitalization (especially if the inflammation is acute and occurs after pregnancy), because the lack of adequate treatment for one of the symptoms of the disease, such as uterine bleeding, can be fatal.

Doctors prescribe bed rest for patients, applying cold compresses to the lower abdomen and diet.

If an inflammatory process occurs after a pregnancy ending in miscarriage, doctors must prescribe the woman intrauterine lavage - washing the uterine cavity with an antiseptic solution in order to remove blood clots that cause inflammation, stop the proliferation of pathogenic microorganisms, and stimulate the contractile activity of the myometrium.

Basic principles of drug therapy

Considering that metroendometritis is an infectious disease, its treatment begins with taking antimicrobial drugs - broad-spectrum antibiotics and sulfonamides, and drugs that relieve pain (for this purpose, doctors prescribe the use of vaginal suppositories, which contain anesthetic components). If uterine bleeding occurs, ascorbic acid or the drug “Vikasol” is prescribed.

Treatment of chronic metroendometritis consists of physiotherapeutic procedures: light therapy, mud therapy, electrophoresis, visits to therapeutic sanatoriums.

Is therapy possible with folk remedies?

Self-medication of this disease is extremely dangerous, since the lack of antibacterial and hemostatic (for uterine bleeding) therapy can lead to the development of serious complications, but sometimes (during periods of subsidence of the inflammatory process) doctors recommend that patients douche with solutions of chamomile, nettle, linden blossom or sage (plant have a bacteriostatic, anti-inflammatory and hemostatic effect).

The prognosis for treating the disease in most cases is favorable, but it is necessary to start therapy as early as possible, because otherwise the inflammatory process can spread to surrounding organs, which threatens the development of sepsis, or severely disrupt the contractile activity of the uterus.

Source: https://SimptoMer.ru/bolezni/zhenskie-zabolevaniya/508-metroendometrit-simptomy

Treatment of metroendometritis - signs, causes, diagnosis

With metroendometritis, the inflammatory process involves the myometrium and endometrium of the uterus. During the postpartum period, infectious complications are observed in 3–8% of women who give birth. With pathological childbirth, the frequency of metroendometritis increases to 20%. Advanced disease provokes generalized purulent-septic complications and uterine infertility.

Based on etiology, there are aseptic and infectious forms of metroendometritis. The disease is caused by opportunistic flora or aerobic-anaerobic complexes.

The most relevant pathogens include: Proteus, streptococcus, Escherichia coli, staphylococcus, Pseudomonas aeruginosa, anaerobic bacteria.

Metroendometritis is provoked by polymicrobial associations: hemolytic streptococcus in combination with aureus, enterobacteria or Escherichia coli. Together with nonspecific microflora, gonococci, diphtheria bacillus, Koch's bacilli and mycoplasma are found in the crops.

Infection occurs in an ascending manner: bacteria enter the uterine cavity from the vagina and cervical canal.

This occurs due to the installation of an IUD, abortion, RDV, dilation of the cervical canal, hysteroscopy, childbirth and hysterosalpingography.

The sources of descending infection include the fallopian tubes, and the source of contact infection is the inflamed appendix. Hematogenous infection is provoked by purulent areas that are located in the ENT organs.

Metroendometritis of infectious etiology progresses faster during menstruation, uterine bleeding, venous congestion in the pelvic area, nonspecific and specific colpitis and endocervicitis. If the fertilized egg is not completely removed, post-abortion metroendometritis may occur.

In these situations, infectious inflammation is observed secondarily.

Infectious processes in metroendometritis begin in the basal layer of the endometrium. There is no clear anatomical boundary between the endometrium and myometrium, so the infection quickly spreads to muscle tissue.

Then the endometrium becomes swollen and hyperemic. It loosens and thickens, becoming covered with a purulent coating. Under the microscope, infiltration of leukocytes, degeneration and desquamation of the glandular epithelium are visible.

The serous membrane of the uterus becomes inflamed in severe cases and provokes perimetritis.

Chronic metroendometritis differs from acute metroendometritis by less edema and hyperemia, and the infiltrate mainly consists of plasma cells and lymphocytes. Connective tissues grow, due to which the myometrium thickens.

Sclerotic processes in the vessels and fibrous transformation of the stroma make the endometrium uneven, hyperplasia and polyp growth appear on it. Due to dystrophic changes in the glands, the secretory transformation of the endometrium is disrupted.

This leads to anovulation and cycle disruptions.

Signs of metroendometritis

Acute metroendometritis

Manifestations of an acute inflammatory process are observed 3–4 days after abortion, childbirth and various medical manipulations in the uterine area.

The patient’s health worsens: the temperature rises to 38–39°C and chills, intoxication syndrome, malaise, and tachycardia occur.

There is pain in the sacrum and lower abdomen, enlargement and tenderness of the uterus during palpation. Symptoms of the disease include cloudy serous-purulent leucorrhoea with putrefactive odors.

Acute metroendometritis lasts from 5 to 10 days. In severe cases, inflammation spreads to the serous covering of the abdominal cavity or the pelvic peritoneum. The most severe complications are sepsis and uterine gangrene.

Chronic metroendometritis

The disease occurs primarily or as a continuation of acute metroendometritis with incompetent treatment. The pathology is accompanied by serous, light-colored vaginal discharge mixed with pus and persistent pain.

Chronic metroendometritis causes menstrual dysfunction due to pathomorphological changes in the endometrium. Menstrual dysfunction is expressed in menorrhagia, metrorrhagia, and anovulatory cycles.

This form of metroendometritis is accompanied by nabothian cysts, chronic adnexitis, adhesions in the pelvis, chronic pelvic pain, and intrauterine synechiae.

As a result, reproductive function is impaired.

Diagnosis of metroendometritis

At the DaliMed clinic, metroendometritis is diagnosed by examining the patient in a chair, ultrasound of the pelvic organs, tests, bacteriological studies, smear microscopy and PCR diagnostics. Scrapings of the uterine mucosa are subjected to histological analysis.

A general blood test determines acute inflammatory changes. Ultrasound diagnostics detect thickening of the myometrium and hyperplastic endometrium, which has a heterogeneous echostructure.

Treatment of metroendometritis

In case of acute metroendometritis, you need to apply a container of ice to the lower abdomen, observing bed rest. The doctor prescribes penicillin to the patient, as well as cephalosporin and metronidazole. Based on the results of microbiological analysis, the specialist makes adjustments to antibiotic therapy.

Infusion of crystalloid and colloid solutions is indicated for intoxication syndrome. Drug therapy is supplemented with desensitizing, analgesic, uterotonic agents, antispasmodics, vitamins, and immunomodulators.

Acute metroendometritis is eliminated by intrauterine lavage - drip irrigation of the uterus. If parts of the fetal egg or remains of the placenta are retained in the cavity of this organ, they are removed by curettage or vacuum aspiration.

In case of septic complications, supravaginal amputation of the uterus is performed.

Chronic metroendometritis is treated by injecting antibiotics directly into the uterine mucosa. Douching, medicinal baths, and physiotherapeutic procedures are indicated.

The latter include UHF therapy, intracavitary electrophoresis, paraffin therapy, mud therapy and laser therapy. Ovarian hypofunction is corrected with the help of hormonal drugs.

Intrauterine adhesions are separated under hysteroscopic control.

Prevention and prognosis of metroendometritis

Acute endometritis can be completely cured, but sometimes it becomes chronic. Septic complications affect the body's fertility. Chronic metroendometritis provokes ectopic pregnancy, miscarriages, premature birth, postpartum hemorrhage, etc.

Metroenometritis prevents regular medical monitoring. Timely treatment of inflammatory diseases of the genitals, normal management of childbirth, refusal of abortions, sterile intrauterine interventions, ultrasound control and routine examinations by a gynecologist can prevent metroendometritis and its attendant complications.

Source: https://www.dali-med.ru/ginekologiya/metroendometrit/

Treatment of chronic and acute forms of metroendometritis

Chronic metroendometritis is an inflammatory process in the mucous and muscular lining of the uterus. At the first manifestation of symptoms, treatment should be prescribed. How to treat the disease depends on the infectious pathogen that has entered the uterine cavity.

What is metroendometritis

Metroendometritis is an inflammatory process in the muscular and endometrial layer of the uterus. Inflammation occurs when infectious pathogens enter the uterus or after mechanical stress. (childbirth, miscarriage, abortion or installation of contraceptive devices).

Causes

Of course, a woman’s reproductive organ has its own natural protection from various infectious pathogens. The vagina contains special acids, so most of the microorganisms die there.

The next protective level is the cervical secretion, which consists of immunoglobulins that protect the uterus from pathogenic microorganisms. And the third barrier that protects the organ is its mucous layer, which also destroys pathogenic bacteria.

Therefore, if the infection nevertheless got into the uterus, and metroendometritis began, then the reasons:

1. Weakening of the immune system.
2. Mechanical damage to the uterine wall.
3. Foreign bodies in the uterine cavity.

Infection may be due to the following factors:

• pelvic surgery;
• childbirth or cesarean section during which fragments of the placenta remain inside the uterus, the fetus remains without water for a long time, bleeding after childbirth);
• artificial termination of pregnancy, mechanical cleaning after a miscarriage, remnants of fertilized egg particles in the uterus;
• removal of the intrauterine device earlier or later;
• STI;
• bleeding;
• colpitis;
• blood stagnation in the pelvic organs;
• douching too often;
• injuries in the pelvic area (bruise);
• the presence of mycobacterium tuberculosis in the body;
• E. coli or diphtheria coli in the blood;
• streptococcal or staphylococcal infection.

All these factors can lead to the development of acute or chronic uterine metroendometritis.

Forms of diseases

Metroendometritis develops in acute and chronic forms. Each of them has its own symptoms and treatment. The acute form occurs with severe symptoms, but in some cases, it can become chronic.

Acute

Acute metroendometritis develops sharply. First, the temperature rises to 39-40 degrees, you feel weak and dizzy. No appetite, sleepy. This means that the body has become intoxicated. Constantly pulls and hurts in the lower abdomen.

Bloody or purulent discharge from the vagina with a characteristic odor appears. If the infection began after childbirth, then postpartum bleeding does not subside, but rather increases.

In the subacute form, the symptoms become less pronounced. The intensity of the discharge decreases and the pain decreases. The inflammatory process subsides, becoming chronic. Then, exacerbation of chronic metroendometritis may begin again.

Chronic metroendometritis

Metroendometritis can become chronic from acute. This is likely if the treatment of the pathology was incorrect or the cause of the inflammatory process has not been eliminated. The disease is asymptomatic, alternating with acute outbreaks and subsidence of inflammation.

Gradually, the internal endometrium of the uterus changes. There are fewer endings that respond to the influence of female hormones, sclerosis of the uterine vessels, cystic neoplasms and adhesions appear.

With chronic metroendometritis, pregnancy can occur, but it ends in miscarriage.

How to diagnose

To determine metroendometritis and the type of pathogenic pathogen, it is necessary to conduct a diagnosis. Methods for determining metroendometritis:

1. Ultrasound. First on the seventh day of the menstrual cycle, then on the twenty-first day. With metroendometritis, the uterus is dilated, the structure of the endometrium is uneven, the walls of the uterus are not symmetrical, and gas bubbles appear.
2. Hysteroscopy. It is carried out on the tenth day of the cycle. A change in the thickness of the endometrium is visible, polyps appear, the surface has areas of redness, and the endometrium bleeds. However, this is not a very informative method of research; changes in the mucous layer of the uterus are not always visible.
3. Histology. One of the most accurate studies for metroendometriosis. Done in the first half of the menstrual cycle. According to the analysis, plasma cells and lymphocytes, fibrosis, and sclerotic changes in the vessels are present.
4. Immunohistochemical analysis. Shows the degree of receptor sensitivity to estrogen and progesterone. Based on this criterion, the doctor determines the course of treatment.
5. Blood analysis. If there is an inflammatory process in the body, then the leukocytes in the blood are increased.

Symptoms

Metroendometritis goes through three stages:

1. Stage one. The infection reaches only the falling mucous layer and certain parts of the endometrium. Where the infectious focus is, the endometrium becomes inflamed and red. There are no infectious pathogens in the muscular layer of the uterus.
2. Stage two. The infection penetrates deeper, affecting the muscular layers of the uterus. Captures the myometrium and tissues located close to it.
3. Stage three infection is widespread in the mucous muscular layers of the uterus, as well as in the perimetry and parametrium. If the infection reaches the serous layer of the uterus, inflammation forms. Perimetritis is complicated by inflammatory processes in the serous layers of the abdominal organs, which are close to the uterus. The course of the disease is complicated by pelvoperitonitis. Sometimes, the infection can spread to the area of ​​the periuterine tissue. Then parmerite appears. Or both complications may develop at the same time. To prevent complications, you need to pay attention to the symptoms of the disease.

Chronic metroendometritis does not develop as clearly as the acute form of the disease. It often goes asymptomatically or the symptoms are vague. Main signs of pathology:

• bloody, purulent, mucous with a grayish tint;
• pain in the lower abdomen and sacrum;
• the genital organ enlarges, pain is felt when pressing with a finger;
• the cycle goes astray, is irregular, bleeding is too heavy;
• difficulties with conception, early termination of pregnancy.

Against the background of infectious infection, cystic formations, adhesions, inflammation in the ovaries and fallopian tubes, and chronic pelvic pain develop.

Treatment

Treatment of metroendometritis is prescribed after diagnosis and identification of the causative agent. Treatment of chronic metroendometritis:

• medicinal;
• physiotherapy;
• surgical.

Metroendometritis must be treated comprehensively, using both physiotherapy and antimicrobial agents. This gives a faster effect.

1. Antibiotics, antispasmodics, desensitizers, immunomodulators and vitamins are prescribed. Antimicrobial agents are introduced into the endometrial layer of the uterus through douching with antiseptics and antibiotics. To reduce the load on the liver, vaginal suppositories with antimicrobial and anti-inflammatory effects are used.
2. Physiotherapeutic. A course of UHF, electrophoresis and therapeutic baths is prescribed.
3. Surgical. If parts of the fertilized egg or sutures remain in the uterus, they are scraped out to stop further inflammation.

After completing the full course of treatment, preventive measures must be taken to prevent a new infection.

Metroendometritis during pregnancy and after childbirth

It is possible to become pregnant with metroendometritis, but the development of pregnancy stops. The fruit freezes. But it happens that the disease develops after pregnancy. Pregnancy complicated by metroendometritis does not proceed entirely well. Pathology provokes:

1. Premature birth.
2. Placental dysfunction.
3. Oxygen starvation and delay in fetal development.

A woman can give birth either independently or through a caesarean section. During childbirth, there may be hypotonic bleeding and other complications, so if a pregnant woman is sick with this disease, she should be especially observed by a doctor.

The development of postpartum metroendometritis begins on the fifth to eighth day after birth. With an emergency caesarean section, the risk of infection increases several times.

The woman feels pain when palpating the uterus, the uterus enlarges, the temperature rises, the heartbeat quickens, there is bloody discharge with a smell, and insomnia.

Prevention

To prevent infection, you need to undergo regular examinations with a gynecologist and ultrasound monitoring. Timely treatment of inflammatory diseases and protection from unwanted pregnancy are important. When installing spirals or other intrauterine intervention, it is important to completely maintain sterility so that infection does not enter the cavity of the reproductive organ.

Forecast

If chronic metroendometritis is not treated, infertility develops, miscarriages or ectopic pregnancies occur. Labor becomes more complicated, and uterine bleeding may begin after childbirth. With timely treatment, reproductive function is completely restored, and within a year a woman can become pregnant and give birth to a healthy child.

Source: https://MatkaMed.ru/endometrij/hronicheskij-metroendometrit