Symptoms of endometritis and basic methods of treating the disease

Endometritis is an inflammatory process in the inner mucous layer of the uterus - the endometrium. It can occur acutely or chronically, which leaves an imprint on the symptoms. Accompanied by pain, discharge, and menstrual irregularities. Of primary importance for the diagnosis of acute endometritis are the data of a gynecological examination and the results of vaginal smears; the chronic form of the disease is confirmed by ultrasound and hysteroscopy data. Treatment includes antibacterial, anti-inflammatory therapy, and physical rehabilitation.

Endometritis is often combined with inflammation of the muscular layer of the uterus - endomyometritis. The endometrium is the inner functional lining of the uterus, changing its structure throughout the menstrual cycle.

Each cycle it grows and matures anew, preparing for the attachment of a fertilized egg, and is rejected if pregnancy does not occur. Normally, the uterine cavity, lined with endometrium, is reliably protected from infection.

But under certain conditions, infectious pathogens easily enter the uterus and cause an inflammatory reaction of its inner layer - endometritis. According to the nature of the course, acute and chronic forms of endometritis are distinguished.

Endometritis

Endometritis can be caused by various pathogens: bacteria, viruses, fungi, parasites, mixed flora. Depending on the nature of origin, specific and nonspecific endometritis are distinguished:

1. Specific ones include infectious (viral, chlamydial, bacterial, protozoal, fungal) and parasitic endometritis. They can be caused by pathogens such as herpes simplex viruses, cytomegaloviruses, chlamydia, mycobacterium tuberculosis, toxoplasma, mycoplasma, candida, radiant fungi, gonococci, etc.
2. With the nonspecific nature of endometritis, pathogenic flora in the uterus is not detected. A nonspecific form of endometritis can be caused by bacterial vaginosis, HIV infection, the presence of an intrauterine device, or taking hormonal contraceptives.

In the development of endometritis, the state of the immune, endocrine, and nervous systems is important, often aggravating the course of the disease. The onset of acute endometritis is often preceded by:

Incomplete removal of the remnants of the fertilized egg, placenta, accumulation of liquid blood and clots favors the development of infection and acute inflammatory process of the inner surface of the uterus.

This is due to hormonal and immune changes in the pregnant woman’s body, a decrease in overall immunity and resistance to infections.

Chronic endometritis

The chronic form of endometritis is often a consequence of untreated acute endometritis that occurs after childbirth, abortion, intrauterine manipulation, due to the presence of foreign bodies in the uterus.

In 80-90% of cases, chronic endometritis occurs among women of the reproductive period and tends to increase, which is explained by the widespread use of intrauterine contraception, the increase in the number of abortions, intrauterine diagnostic and therapeutic procedures.

Chronic endometritis is one of the most common causes of infertility, miscarriages, failed attempts at in vitro fertilization, complicated pregnancies, childbirth and the postpartum period.

To identify the infectious agent in chronic endometritis, highly accurate immunocytochemical diagnostics are used. The chronic form of endometritis often has a mild clinical course without pronounced signs of microbial infection. There is thickening of the uterine mucosa, serous plaque, hemorrhages, fibrous adhesions, leading to disruption of the normal functioning of the endometrium.

Risk factors

In the occurrence of endometritis, a special role is played by the reduction of barrier defense mechanisms that prevent the penetration of infection into the internal genital organs. This may be caused by the following factors:

• Mother's birth injuries. Ruptures of the perineum, vagina, and cervix during childbirth contribute to the penetration of infection into the genital tract and its ascent into the uterine cavity.
• Mechanical, chemical, thermal factors damaging the vaginal mucosa. Poor genital hygiene, frequent douching, use of vaginal spermicides, etc. lead to changes in the normal microflora of the vagina and its protective properties.
• Menstruation, childbirth, abortion. The release of blood leads to the washing out of the secretions of the cervical canal, alkalization of the acidic environment of the vagina and a decrease in its bactericidal properties. Under these conditions, pathogenic microorganisms freely penetrate from the external environment and actively multiply on the wound surface of the uterus.
• Intrauterine contraceptives. Intrauterine devices located in the uterine cavity for a long time become a potential source of inflammation, facilitating the penetration of infection through the ascending route through the IUD threads. If endometritis occurs, then removal of the IUD is necessary.
• Using vaginal tampons. By absorbing bloody discharge, tampons provide an optimal environment for the development of infection. Tampons should be changed every 4-6 hours and should not be used at night, before or after menstruation, or in hot climates. Violating the rules for using tampons can lead to the development of toxic shock syndrome.
• Common factors: chronic stress, overwork and poor hygiene. These factors weaken the body and make it susceptible to infection.

Acute endometritis usually develops 3-4 days after infection and is manifested by fever, pain in the lower abdomen, discharge from the genital tract with an unpleasant odor, painful urination, increased heart rate, and chills.

Acute endometritis has a particularly severe and rapid course in patients with intrauterine devices. Therefore, the first signs of acute endometritis are a reason for an immediate consultation with a gynecologist.

A gynecological examination reveals a moderately enlarged and painful uterus, sanguineous or serous-purulent discharge. The acute stage lasts from a week to ten days and, with effective therapy, ends in cure, otherwise – transition to chronic endometritis.

Chronic endometritis

The severity of chronic endometritis is determined by the depth and duration of structural changes in the endometrium.

The main manifestations of chronic endometritis are menstrual irregularities (scanty or heavy periods), uterine bleeding, pathological serous-purulent or bloody discharge, aching pain in the lower abdomen, painful sexual intercourse. A two-hand gynecological examination reveals a slight thickening and enlargement of the uterus in size.

Structural changes in the endometrium during chronic endometritis can cause the formation and growth of polyps and cysts. Chronic endometritis causes infertility in 10% of cases and miscarriage in 60% of cases. The muscular layer of the uterus is often involved in the inflammatory process - myoendometritis occurs.

The endometrium is an important functional layer of the uterus, responsible for ensuring the normal course of pregnancy.

Inflammatory diseases of the endometrium - endometritis - lead to a complicated course of pregnancy: threat of miscarriage, placental insufficiency, postpartum hemorrhage.

Long-term consequences of endometritis include adhesions inside the uterus (intrauterine synechiae), sclerosis of the uterine cavity, disrupted menstrual cycle, endometrial polyps and cysts.

With endometritis, the ovaries and tubes may be involved in the inflammatory process, peritonitis, adhesions of the intestines and pelvic organs (adhesive disease) may develop.

Adhesive disease manifests itself as pain and often leads to infertility.

Diagnosis of acute endometritis is based on collecting a medical history, patient complaints, symptoms, gynecological examination, clinical blood test and bacterioscopic examination of smears. Women with an acute form of endometritis are treated inpatiently, since there is a potential danger of developing severe septic complications (parametritis, pelvioperitonitis, peritonitis).

When diagnosing the chronic form of endometritis, in addition to clarifying the clinical symptoms and history of the disease, a special role belongs to curettage of the uterine mucosa performed for diagnostic purposes.

Histological examination of the altered endometrium allows us to confirm the diagnosis of chronic endometritis.

Important diagnostic methods are ultrasound (ultrasound) and endoscopic (hysteroscopy) studies, which reveal structural changes in the endometrium.

In the acute phase of endometritis, patients are prescribed hospital treatment with bed rest, mental and physical rest, an easily digestible nutritious diet, and a drinking regime. The basis of drug treatment for acute endometritis is:

• Antibacterial therapy. It is selected taking into account the sensitivity of the pathogen (amoxicillin, ampicillin, clindamycin, gentamicin, kanamycin, lincomycin, etc.). For mixed microbial flora, a combination of several antibiotics is indicated. Due to the frequent addition of anaerobic pathogens, metronidazole is included in the treatment regimen for acute endometritis.
• Pathogenetic therapy. In order to relieve intoxication, intravenous administration of saline and protein solutions up to 2-2.5 liters per day is indicated. It is advisable to include multivitamins, antihistamines, immunomodulators, probiotics, and antifungals in the treatment regimen for acute endometritis.
• Treatment with physical factors. For analgesic, anti-inflammatory and hemostatic purposes, apply cold to the abdominal area (2 hours - cold, 30 minutes - break). When acute symptoms subside, physiotherapy and hirudotherapy (medical leeches) are prescribed.

Therapy for chronic endometritis

In the treatment of chronic endometritis, modern gynecology uses an integrated approach, including antimicrobial, immunomodulatory, restorative, and physiotherapeutic treatment. Treatment is carried out in stages.

The first step is the elimination of infectious agents, followed by a course aimed at restoring the endometrium. Broad-spectrum antibiotics (sparfloxacin, doxycycline, etc.) are usually used.

The recovery course is based on a combination of hormonal (estradiol plus progesterone) and metabolic therapy (calf blood hemoderative, inosine, ascorbic acid, vitamin E).

An important place in the treatment of chronic endometritis is given to physiotherapy: UHF, electrophoresis of copper, zinc, lidase, iodine, pulsed ultrasound therapy, magnetic therapy.

Physiotherapeutic treatment reduces inflammatory swelling of the endometrium, activates blood circulation, and stimulates immunological reactions.

For patients with chronic endometritis, resort therapy (mud therapy, hydrotherapy) is indicated.

The effectiveness of treatment of chronic endometritis is assessed according to the following criteria:

• restoration of the morphological structure of the endometrium (according to ultrasound results)
• restoration of the menstrual cycle.
• elimination of infection
• disappearance of pathological symptoms (pain, bleeding)
• restoration of reproductive function

To avoid the occurrence of endometritis, it is necessary to prevent abortions, observe hygiene measures, especially during the menstrual period, prevent postpartum and post-abortion infections, use barrier contraception (condoms) to prevent sexually transmitted infections. Timely detection of asymptomatic infections and their treatment in most cases gives a favorable prognosis for subsequent pregnancies and childbirth.

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

“Endometritis - what is it? Types, main symptoms and treatment regimens”

The inner surface of the uterus is covered with a mucous layer - the endometrium. Depending on the phase of the menstrual cycle, it changes its thickness and consistency: during menstruation it is thin, by the time of ovulation it has a thickness of 0.9 - 10 mm, and by the time of the next menstruation it reaches 1.2 - 1.4 mm. One of the common pathologies of the endometrial structure is called endometritis.

Most often it occurs in girls and young women, but it can also appear in old age. Medical terminology is sometimes complex and patients want it explained to them in an understandable language - what is uterine endometritis? This disease is an infectious inflammation of the endometrium, which sometimes affects not only the mucous, but also the muscular layer of the organ of the reproductive system.

Causes of the disease:

1. Mechanical damage to the uterus, during which an infection was introduced. As a rule, these are childbirth, abortions, miscarriages, careless instrumental examination in a gynecological chair. As a result of all these actions, a wound appears inside the uterus or on the surface of the cervix, which becomes infected. After some time, the infection rises and the endometrium is involved in the inflammatory process.
2. Physiological reasons that are usually associated with menstruation. There is a reflux of old menstrual blood into the body of the uterus. Most often this happens due to sexual intercourse during menstruation or regular use of intravaginal tampons. As a result, old menstrual blood begins to rot in the uterine cavity, which leads to an infection that affects the endometrium.

Since endometritis is an inflammatory process, it is important to accurately determine the cause of its occurrence in order to determine the correct treatment tactics.

Gynecologists divide endometrial inflammation into two groups: acute and chronic endometritis. They have different symptoms, clinical pictures and varying degrees of the body's response to treatment.

Symptoms and treatment of acute endometritis

An acute inflammatory process in the endometrium begins after surgical manipulations of the uterus, or after the birth of a child. Therefore, the most common is acute postpartum endometritis, which occurs in approximately half of women after cesarean section. This is due to blood clots that remain in the uterus after surgery. The patient has the following symptoms:

• High temperature (not lower than 38 degrees)
• Acute pain in the lower third of the abdomen
• Pain when urinating. They occur in advanced cases of acute endometritis, when the urethra is involved in the inflammatory process.
• Discharge from the genital tract accompanied by an unpleasant odor
• The appearance of chills

Acute endometritis often occurs after careless installation of an intrauterine device, during which an infection was introduced into the uterine cavity.

Treatment of the disease

To avoid risk, gynecologists prefer to refer the patient to a hospital for treatment. Acute endometritis has very severe symptoms and its treatment requires constant medical supervision. Otherwise, the disease can become a serious threat to the life and health of a woman.

In the hospital, a sensitivity test to a particular type of antibiotic is carried out, and then antibacterial therapy is prescribed, consisting of those drugs to which the body will give the greatest response.

In especially severe cases, the gynecologist prescribes treatment with several antibiotics at once. To support the body, droppers with glucose and water-salt solutions (Glucosolan, Acesol, Disol, etc.) are prescribed.

If the patient suffers from thrush from time to time, then antifungal drugs (Nystatin or Flucostat) are prescribed simultaneously with antibiotics. Moreover, their use is justified even if there are no signs of thrush yet. With intensive antibacterial therapy, antifungal agents should be taken for preventive purposes rather than for therapeutic purposes.

The standard treatment regimen often includes immunostimulating and vitamin preparations, which are selected individually by the doctor. Physiotherapy procedures are also prescribed in the form of douching with antibacterial and antiseptic herbal medicines.

Signs of chronic endometritis, treatment regimens

The disease is a consequence of incompletely cured acute endometritis. The clinical picture is often unclear. Because of this, women do not realize the seriousness of the situation and do not consult a doctor for a long time. The signs of chronic endometritis differ from the acute form of this disease:

• Intermenstrual scanty bleeding
• Changes in the nature of menstruation themselves: they become longer, and in some cases more abundant.
• Gray-yellow thick discharge with an unpleasant odor
• Constant mild pain in the lower third of the abdomen, not associated with the onset of menstruation or ovulation.
• The constant presence of fluid in the retrouterine space on ultrasound
• The contours of the endometrium on ultrasound are blurred and indistinct
• Slight increase in the size of the uterine body

The most important danger of the chronic form of the disease is that it can cause miscarriage in early pregnancy.

Features of treatment

Treatment of chronic endometritis can be carried out both in a hospital setting and on an outpatient basis. The doctor prescribes antibiotics, which may include Amoxicycline, Gentamicin, Lincomycin. In addition, anti-inflammatory drugs such as Ibuklin, Ibuprofen are prescribed.

The course of antibiotics can be long, take place in several stages and consist of not one, but several drugs.

Only after the examination results show that the inflammatory process in the uterine cavity has been eliminated can we begin to restore the damaged internal mucous layer - the endometrium.

Particular attention is paid to immunostimulating therapy. The doctor can prescribe not only vitamin complexes, but also drugs such as Interferon, Orvirem, Cycloferon, Kogacel.

• Strengthening the immune system in this case is necessary for the body to engage in the fight against the infectious and inflammatory process.

Endometritis and pregnancy

The fertilized egg must implant into one of the walls of the uterus in order to successfully continue its development. Connected by the vascular network to the mother’s body, the embryo will receive all the necessary substances for life. An inflamed endometrium can become a serious obstacle to the implantation process, as it will regularly peel off.

As a result, doctors will be faced with a difficult choice: either carry out serious antibacterial therapy at a short stage of pregnancy, or wait for a miscarriage and treat the woman after it.

Usually, if an ultrasound diagnoses a detachment of the ovum, the patient is prescribed hormonal support and a miscarriage is avoided.

But with an inflamed endometrium, taking hormones will not be able to stop the detachment that has begun, because the reason for embryo rejection is not the lack of one or another hormone, but the presence of an inflammatory process.

Therefore, endometritis and pregnancy are incompatible with each other, and it is better to treat the disease before you start planning a child.

Source: https://zdorova-krasiva.com/endometrit/

Endometritis: causes, symptoms, diagnosis and treatment in Moscow

Endometritis is an inflammatory process in the tissues lining the inner cavity of the uterus. The cause of the disease is the penetration of various infectious pathogens into the uterine cavity - fungi, bacteria and viruses. Endometritis often occurs against the background of a general decrease in immunity.

At the beginning, the pathological process affects only the endometrium, but due to the special structure of the tissues, the inflammatory process quickly goes deeper and affects muscle tissue.

Most often, women of reproductive age suffer from endometritis. If you suspect a disease, you should consult a gynecologist.

Types of endometritis

Endometritis is classified according to its form:

Symptoms, timing and treatment methods are different in each case. At the same time, chronic endometritis always develops against the background of an untreated or acute disease without obvious signs.

Causes of endometritis

The main cause of the inflammatory process is the entry of pathogenic viruses and bacteria into the uterine cavity, which, against the background of decreased immunity or disruption of the integrity of the endometrium, affect the mucous membrane of the uterine cavity.

Pathogenic microorganisms, infections and viruses can enter the uterus both ascending (through the cervical canal of the cervix) and descending (from the fallopian tubes, inflamed appendix, etc.).

The most common cause of inflammation in the endometrium is mechanical damage to the inner lining of the uterus, caused naturally or by surgical intervention. These include:

• abortions, including spontaneous ones;
• C-section;
• various gynecological manipulations in the uterine cavity;
• childbirth.

In all of these cases, the endometrium lining the uterine cavity peels off from it in large pieces, exposing large areas of unprotected walls of the organ. Bacteria and infections that fall on them, introduced through surgical instruments or naturally, find themselves in a favorable environment for their reproduction.  

The acute form of endometritis, which in addition to the classic picture of symptoms is accompanied by purulent vaginal discharge, is caused by sexually transmitted diseases, for example, gonorrhea or chlamydia.

Inflammation can also be caused by:

• tuberculosis microbacteria;
• coli;
• protozoal infection;
• diphtheria bacillus;
• mycoplasma;
• group B streptococci, etc.

There are also risks of endometritis during normal menstruation. Blood, which, together with endometrial cells, is removed from the uterine cavity, has a specific effect on the cervical canal.

It temporarily changes the acidic environment of the uterine mucosa to an alkaline one, and after this its protective functions are significantly reduced.

With improper hygiene, sexual intercourse and frequent use of tampons, the risk of bacteria entering the uterine cavity increases significantly.

For example, a tampon left in the vagina for more than 6 hours or overnight is a potential source of many bacteria, which multiply at high speed in a warm and humid environment.

Intrauterine devices can also be a source of infection; they are installed incorrectly or remain in the uterus for longer than necessary; they cause damage to the endometrium and can provoke an inflammatory process. 

Symptoms of endometritis

During endometritis, a woman may feel:

• nagging pain in the lower abdomen, radiating to the anus;
• general weakness;
• headache;
• depressed emotional state or sudden mood swings.

Objective signs of endometritis

Signs of acute endometritis include:

• increased body temperature, accompanied by chills and subsequent fever;
• nausea and vomiting;
• unusual vaginal discharge (with an unpleasant odor, mixed with pus, blood);
• soreness of the uterus on palpation, and its increased size.

With a chronic inflammatory process in the endometrium, the signs are less pronounced. The temperature may appear only occasionally for several days, but it is low and can be easily confused with other ailments.

Only a gynecologist can detect the disease through a survey, examination, laboratory and instrumental studies. Also, with endometritis, menstrual irregularities are often observed - the discharge changes in character, it can become scanty or, on the contrary, abundant.

The period of bloody discharge after the end of menstruation itself increases significantly. Throughout the entire cycle, mild nagging pain in the lower abdomen is observed.

With long-term chronic endometritis, secondary infertility may occur.

In the acute form, from the moment of infection of the endometrium by pathogenic bacteria and viruses to the clinical manifestations of the disease, it takes from 1.5 to 4 days. Endometritis caused by surgical interventions manifests itself most quickly. With chronic endometritis, the process can last for several months.

Diagnosis of endometritis

Diagnostic methods

When a patient contacts her, the gynecologist first examines the history of the disease, finds out the number of pregnancies and births, abortions and spontaneous miscarriages.

A gynecological examination is the next mandatory diagnostic point. During palpation, the doctor determines the size of the uterus, how different they are from the norm, and monitors the pain of the reaction to the manipulations performed. Also during the examination, the doctor assesses the nature of vaginal discharge.

Acute endometritis is characterized by sharply increased size of the uterus and severe pain. In chronic endometritis, the pain is mild, the uterus is slightly enlarged.

The type of bacteria that caused the inflammatory process can be determined by bacteriological examination of the vaginal microflora.

Chronic endometritis is much more difficult to determine, sometimes requiring repeated sampling of material for bacteriological culture.

Additional diagnostic methods

Ultrasound examination helps to diagnose endometritis and distinguish it from other gynecological diseases. An experienced diagnostician using an ultrasound machine can identify:

• endometrial thickness;
• the presence of adhesions;
• changes in tissue echogenicity;
• remnants of the placenta or fertilized egg;
• the presence of blood clots and pus.

During an ultrasound examination, it is possible to determine whether the inflammatory process has spread to other organs of the reproductive system, for example, to the ovaries.

Hysteroscopy is an endoscopic diagnostic method. During the procedure, a specialist carefully examines the mucous membrane of the uterine cavity. With endometritis, the inner lining of the uterus has a bright red color and a loose structure. It bleeds at the slightest touch to the walls of the uterus. The cavity may also contain blood clots.

During hysteroscopy, at the discretion of the specialist, a biopsy (removal of material for histological examination) can be performed.

Treatment of endometritis

Treatment methods for acute endometritis

Treatment of acute endometritis is always carried out in a hospital, since the patient requires bed rest and constant monitoring by medical personnel.

Without waiting for bacteriological tests, broad-spectrum antibiotics are prescribed. At this stage, it is necessary to eliminate the inflammatory process, preventing the spread of infection into the thickness of the uterine wall and to other organs.

Antibiotics are administered intravenously or intramuscularly for 7-10 days. 

Also prescribed for endometritis are:

• painkillers and antipyretics;
• topical antibacterial drugs, for example, vaginal suppositories;
• uterine contractants;
• vitamins.

• To prevent bleeding and to reduce severe pain, cold is applied to the lower abdomen.
• The task of specialists during the treatment of endometritis is to prevent its transformation into a chronic form and prevent the occurrence of possible complications.
• After the acute process has been eliminated, physiotherapeutic procedures are prescribed that improve blood flow in the uterus and prevent the appearance of adhesions.

Treatment of chronic endometritis

Treatment of chronic inflammation of the endometrium is a longer process, but the stages of treatment are similar - antibacterial therapy is required, after which hormonal drugs are prescribed. They are necessary to restore endometrial function and normalize the menstrual cycle.

An important stage in treatment is the elimination of the consequences of a chronic disease - adhesions in the uterine cavity, blockage and deformation of the fallopian tubes, etc. 

Physiotherapeutic procedures are mandatory as part of the treatment of chronic inflammation of the endometrium. These include:

• electrophoresis;
• pulsed ultrasonic waves;
• UHF, etc.

Source: https://www.polyclin.ru/endometrit/

Chronic endometritis: symptoms, signs, treatment methods / Mama66.ru

Endometritis is a disease that is provoked by difficult childbirth and abortion, miscarriages, and various gynecological interventions. Up to 90% of cases are diagnosed in women of childbearing age.

Its prevalence is continuously growing due to the use of intrauterine contraception, an increase in the number of abortions, and intrauterine medical manipulations.

Chronic endometritis is most often the result of an untreated acute form of the disease.

This pathology often leads to infertility, miscarriages, unsuccessful attempts at artificial insemination, complicated pregnancy, childbirth and the postpartum period. Currently, endometritis is successfully treated. Doctors prescribe complex therapy, including the use of medications and folk remedies, as well as physiotherapy.

What is chronic endometritis?

Chronic endometritis is an inflammatory process in the uterine mucosa. The injured membrane is more susceptible to the disease, so artificial and natural termination of pregnancy, intensive obstetric care, and diagnostic curettage of the uterine cavity often lead to its development.

In the initial stages, inflammation is pronounced, symptoms increase quickly, and the disease may be accompanied by a bacterial, viral, fungal, parasitic or other type of infection. Most often, several types of microorganisms are present.

The acute form becomes chronic if treatment is not started in a timely manner, as well as non-compliance with doctor’s recommendations and reduced immunity. Symptoms become more subdued, but the disease responds less well to treatment.

Against the background of a sluggish process, an exacerbation may occur when the symptoms of chronic endometritis are similar to the acute form. Advanced cases of endometritis lead to the spread of inflammation to the muscular layer of the uterus and the development of myoendometritis.

Causes, risk groups

Endometrial tissue has two layers. The functional layer, or outer layer, sheds at the end of menstruation. Basal - responsible for the formation of the first. The main cause of endometritis is damage to the structure of the layers and penetration of infection.

Most often, injuries occur for the following reasons: 

• insertion of a probe into the uterine cavity;
• improperly performed douching procedures;
• uterine curettage procedure;
• hysteroscopic examinations;
• hysterosalpingographic examinations.

Depending on the causes and pathogens, endometritis can be specific or nonspecific. The first option is associated with the development in the uterine cavity of pathogens of chlamydia, herpes simplex virus, cytomegalovirus, HIV infection, gonorrhea, tuberculosis, mycoplasmosis, candidiasis, toxoplasmosis, sarcoidosis, etc.

A chronic nonspecific variant of endometritis develops due to the use of an intrauterine device, irradiation of the pelvic area, the use of hormonal contraceptives, and disruption of the vaginal microflora. During diagnosis, specific microorganisms are not identified.

Women are most at risk of developing endometritis:

• have had an abortion or miscarriage;
• undergone hysteroscopic and hysterosalpingographic procedures;
• undergone biopsy and curettage procedures;
• using an intrauterine device;
• suffered postpartum infectious complications;
• having chronic cervicitis (inflammation of the cervix);
• having bacterial vaginosis and/or candidiasis;
• survivors of sexually transmitted diseases (chlamydia, gonorrhea, mycoplasmosis, etc.);
• carriers of genital herpes or cytomegalovirus;
• having submucosal uterine fibroids or polyps.

But even with such a large list of risk groups, in every third woman the cause of chronic endometritis is unknown.

Symptoms and diagnosis

Depending on the depth and duration of existence of structural disorders of the endometrium, mild, moderate and severe forms of the disease are distinguished. Each of them will be characterized by more or less pronounced symptoms.

The main signs of chronic endometritis: 

• disrupted menstrual cycle (scarcity or profuse discharge);
• bleeding from the uterus;
• purulent discharge;
• aching pain in the lower abdomen;
• pain during sexual intercourse.

Chronic endometritis is a disease whose symptoms are not always fully present. In each clinical case, 1-2 leading signs are determined, the rest are weakly expressed or are not observed all the time.

Diagnosis begins with a doctor’s interview and an examination in a gynecological chair, during which the presence of compaction and enlargement of the uterus is determined. Due to structural abnormalities in the endometrium, polyps and cysts sometimes grow. The disease causes infertility in every 10 women, and causes miscarriage in every second woman.

To confirm or refute the diagnosis, the gynecologist prescribes a number of additional examinations: 

• ultrasound examination of the uterus and its appendages;
• hysteroscopic examination;
• curettage of the uterine cavity followed by histological analysis of the materials.

If these procedures confirm the presence of chronic endometritis, a number of studies are carried out to determine the infectious agents that cause inflammation: 

• Sowing materials from the uterine cavity. This procedure not only identifies pathogens, but also determines the most effective type of antibiotics.
• Blood collection for analysis to detect antibodies (ELISA) to various infectious pathogens. The procedure determines the presence or absence of viruses (herpes, cytomegalovirus).
• Polymerase chain reaction study in material obtained from the uterine cavity. Bacteria and viruses that caused the disease are identified.
• Flora smear. Determines the inflammatory process in the cervix and vagina.

Additionally, a hormonal blood test may be prescribed, especially if infertility was previously diagnosed.

Treatment

Once the diagnosis has been made, chronic endometritis can be cured using an integrated approach. It consists of antimicrobial, metabolic, antioxidant, immunomodulatory therapy and physiotherapy.

With effective therapeutic measures, the ultrasound picture of the endometrium is restored, the activity of pathogenic microflora is eliminated or reduced, the morphological structure of the tissue and fertility are restored, pain in the lower abdomen disappears, and the menstrual cycle is normalized.

Drug treatment consists of two stages: 

1. Elimination of infection. Antibiotics are used for this: Ceftazidime, Ceftriaxone, Cedex, Doxycyline, etc. The dose and duration of administration depend on the degree of the disease and diagnostic results. For purulent endometritis, antibiotics are prescribed together with Metronidazole. If the causative agent of the infection is a virus, then treatment is carried out with antiviral drugs and immunomodulators (Acyclovir, Viferon, Interferon, etc.). In parallel, anti-inflammatory and painkillers (Ibuprofen, Nurofen, Diclofenac, Spazmolgon, aspirin, No-shpa, etc.) can be prescribed.
2. Restoration of endometrial tissue. This stage combines the use of hormonal (Divigel, Utrozhestan) and metabolic agents (Actovegin, Chofitol, Inosine, vitamins C and E, Methionine, Wobenzym, glutamic acid). If there is uterine bleeding, then Oxytocin or a solution of aminocaproic acid is used. To restore the menstrual cycle, oral hormonal contraceptives are used for 3–5 months.

Some medications can be injected directly into the uterine tissue for active action in the lesion and a high therapeutic effect.

Chronic endometritis, as a disease associated with a disorder of tissue structure, can be cured with the help of physiotherapy.

They reduce inflammation and swelling of tissue, activate blood circulation, and stimulate immunological reactions. A course of electrophoresis, UHF, pulsed ultrasound therapy, or magnetic therapy may be prescribed.

Procedures with therapeutic mud and water in a sanatorium are also shown.

General preparation scheme for all fees:

• 2 tbsp. l. pour half a liter of boiling water over the herbal mixture, leave in a thermos for 10-12 hours, strain. 1 tbsp. l. Dilute the infusion with half a liter of water and take orally throughout the day.
• On the second day, increase the concentration of the drink by adding 2 tbsp to half a liter of water. l. infusion.
• If there are no allergic or other unpleasant reactions to taking the drink, then from the third day you can drink it without diluting (in the same volume).
• After bowel movements, once a day you need to do a microenema into the rectum (50 ml of infusion). It is most effective to use a freshly prepared product.

The mixture of herbs can be prepared according to the following recipes (all components in the same volume): 

• birch leaves, chamomile and meadowsweet flowers, mint, thyme, celandine and geranium herbs, licorice and elecampane roots;
• leaves of fireweed and raspberry, knotweed, St. John's wort, wormwood and horsetail, rose hips and coriander, immortelle flowers;
• roots of bergenia, angelica and dandelion, knotweed grass and thyme, calendula flowers and coltsfoot leaves.

But before you start treating endometritis with folk remedies, you need to consult a doctor and learn more about the contraindications of certain components. An ideal and safe collection can be prepared by a herbalist.

Chronic endometritis in pregnant women

Chronic endometritis and pregnancy are a common combination, since women of childbearing age are susceptible to the disease. This diagnosis is dangerous during pregnancy, as it can lead to miscarriage or miscarriage. Therefore, the first thing to do is consult a doctor and strictly adhere to the treatment plan he has developed, including antibiotics.

In order to reduce the risk of miscarriage, you need to follow a number of rules: 

1. The best option is to treat the disease at the stage of pregnancy planning, eliminate it completely or at least reduce the symptoms. Inflammation of the uterine cavity is accompanied by an infection that can easily be transmitted to the unborn child. And since the fetus does not have its own resistance to infection, the risk of its death is high.
2. With chronic endometritis, pregnancy occurs, but its course is accompanied by many problems. It is important to be under constant medical supervision. At the first complications, he will give a referral for inpatient treatment (preservation of pregnancy).
3. During pregnancy, you should not neglect recommendations for taking vitamins and dietary supplements, limiting physical and emotional stress.
4. The sluggish form requires the use of hormonal drugs and antiplatelet agents, eubiotics (Lactobacterin, Bifidin, Biovestin, Acylact, etc.). Therapy that restores the endometrium is carried out in the first trimester.
5. Also, to eliminate the infection, you need to take broad-spectrum antibiotics prescribed by your doctor. The harm from these drugs is less than from infection.
6. Often, medications are prescribed that increase the amount of estrogen in the body (Estradiol, Estrofem, etc.).
7. Physiotherapeutic treatment (UHF, electrophoresis, magnetic therapy) has a positive effect on the health of a pregnant woman.

With chronic endometritis, bearing a child is possible, but it requires more effort than in healthy women. Therefore, it is important to treat it already at the planning stage.

If you cannot get rid of the sluggish process in one course, you need to discuss all possible complications during pregnancy with your doctor and be determined to unconditionally follow all his recommendations (including taking antibiotics, hospital treatment).

Chronic endometritis, although a common disease, is treatable. If you strictly follow your doctor's recommendations and have a lot of patience, you can get rid of the problem forever.

Do not neglect medical help, even if the symptoms do not cause much discomfort. A sluggish process can become aggravated, and is dangerous for its complications: from myoendometritis to sepsis.

Olga Khanova, doctor, especially for Mama66.ru

Interesting video about endometritis

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Source: https://mama66.ru/gynecology/lechenie-ehndometrita

Endometritis - treatment regimen and symptoms, therapy after childbirth

• Early detection of symptoms and initiation of treatment for endometritis is the key to preserving women’s health and the ability to bear a child in the future.
• The disease is characterized by inflammation of the inner lining of the uterus (endometrium), into which the egg is implanted during pregnancy.
• It can manifest itself in two forms - acute and chronic, the symptoms and therapy of each are slightly different.
• Ignoring the pathology leads to serious consequences, for example, the spread of infection to surrounding organs and infertility.
• Various methods are used to treat endometritis - prescribing antibacterial agents, physiotherapy, taking hormones.

What is chronic endometritis

1. Chronic endometritis is one of the forms of the disease, which is characterized by a long course with periods of exacerbation and subsidence.
2. It usually develops after an acute pathology, if the girl did not see a doctor or ignored his prescriptions, but it can immediately manifest itself in a chronic form.

3. Pathogenic microorganisms strengthen in the uterus, the structure of the mucous membrane is disrupted, and it cannot resist infection.
4. There are often no obvious clinical manifestations; a woman may experience minor abdominal pain or discomfort during sex, but most do not pay attention to such minor signs.

5. The chronic course of the pathology is more dangerous than acute endometritis, since the latter usually begins to be treated immediately, while therapy for the former is constantly postponed.

6. This leads to deep damage to the layers of the uterus; over time, inflammation covers not only the basal and functional endometrial globules, but also the myometrium (muscle tissue of the uterus), and then can spread to surrounding organs.

7. Due to the activity of pathogenic bacteria, the inner layer of the uterus is susceptible to structural transformation, the rhythm of physiological changes is disrupted - the growth and rejection of the functional ball, as a result, the menstrual cycle is disrupted.
8. In addition, the disease leads to thinning of the endometrium, which interferes with the implantation of a fertilized egg, so a common complaint from patients is the inability to become pregnant or bear a child.

Symptoms of acute and chronic inflammation

Signs of acute endometritis appear unexpectedly: body temperature rises sharply to high values ​​(40 degrees or more), sweating increases, the patient feels hot and shivering, and the general condition worsens significantly.

Patients complain of severe weakness, reluctance to eat, and drowsiness. Pain occurs in the lower abdomen, which is acute or, in the presence of a foreign body in the organ cavity, spasmodic in nature.

It can radiate to the lower back and sacrum. Large quantities of mucus mixed with pus and blood are released from the vagina, which has a very unpleasant odor.

  Leeches for endometritis - the use of hirudotherapy

In the case of postpartum or post-abortion endometritis, significant bleeding may occur.

I am concerned about aching painful sensations in the lower abdomen, radiating to the back, and discomfort during sexual intercourse and bowel movements. Patients often complain of quickly onset fatigue and an unstable emotional state.

Irregularities occur in the menstrual cycle, bloody discharge occurs between periods, and more than 50% of women cannot become pregnant.

Treatment of acute endometritis

Treatment of acute endometritis should be carried out only in a hospital setting. The patient is prescribed antibacterial agents, which are administered intravenously and intramuscularly; several medications from different groups are often used.

• To relieve unpleasant symptoms, detoxification therapy is carried out, antipyretic and anti-inflammatory drugs are given.
• In severe cases, surgical cleansing of the uterine cavity is performed (curettage of the functional endometrium).
• To strengthen the body and stimulate the immune system, the patient is recommended to eat more fruits and vegetables, and vitamin complexes are prescribed separately.

To avoid dysbiosis, probiotics are used. Treatment usually lasts from 5 to 10 days, but in some cases it can be longer.

Treatment regimens for chronic endometritis

1. The treatment regimen for chronic endometritis differs from the treatment methods for the acute form of the disease: the dosage and duration of medication are changed, and hormonal agents are prescribed.

2. In addition, physiotherapeutic treatments are widely used to help strengthen the body, enhance its defenses and restore damage to the uterine lining.

3. In the case of postpartum chronic endometritis, they resort to a procedure such as washing the uterine cavity with antiseptic solutions, but this can be done no earlier than 5 days after birth.

4. The method helps to quickly free the organ from pus and accelerate involution (return to prenatal size), which is disrupted due to inflammation.
5. Treatment of chronic endometritis is a long process that requires joint efforts of the doctor and the patient, since the inner lining of the organ is subject to significant changes, and it is quite difficult to return it to its original state.

Physiotherapy

The treatment regimen for chronic inflammation in the uterus necessarily includes physiotherapeutic procedures; they help normalize the activity of the reproductive system, stabilize the functioning of the ovaries and generally strengthen the body.

Important! You can resort to physiotherapy only during remission of the disease; in the acute period, such methods are contraindicated.

Regular procedures have a positive effect on the body:

• blood circulation and trophism in the layers of the endometrium improves;
• pain and discomfort are reduced;
• swelling of the uterine mucosa subsides;
• the supporting forces of the immune system are improved;
• The menstrual cycle returns to normal - it becomes regular, ovulatory, biphasic.

Physiotherapy also refers to preventive measures that help avoid complications such as infertility, stable miscarriage and the spread of infection.

Laser treatment

• Laser therapy involves irradiating the uterus with a light wave of a certain length.
• Under the influence of radiation, the mucous membrane is restored faster, blood circulation in it accelerates, and local immunity increases.
• In addition, the laser has a bactericidal effect, that is, it kills pathogenic microflora.

The course lasts about two weeks, its duration may vary depending on the results of treatment.

The procedures are carried out every other day, the duration of one should not exceed 7-10 minutes, taking into account the power of light emission.

Magnetotherapy

1. Magnetic therapy has a rapid healing effect, it eliminates uterine swelling and relieves inflammation.
2. In addition, the magnetic field affects the immune system, especially lymphocytes, stimulating them to activate protective functions.

3. The procedures are carried out over 10-20 days, during this period of time the endometrial structure usually has time to fully recover, the duration of one session ranges from 15-30 minutes.

Important! During magnetic therapy, the patient may complain of malaise or dizziness, but these phenomena are temporary and are associated with individual sensitivity, and therefore are not contraindications to treatment.

It is not recommended to prescribe magnetic field therapy to patients with certain diseases of the body:

• history of myocardial infarction;
• severe pathologies of the cardiovascular system, coronary heart disease;
• blood diseases with bleeding disorders;
• tuberculosis in the active stage.

The procedures are also contraindicated for people with pacemakers or metal implants, since they become damaged under the influence of a magnet.

UHF therapy

Under the influence of UHF therapy, blood vessels dilate, immune cells are released and enter the site of damage, as a result, pain decreases, and the mucous ball heals.

The effects are based on the entry of heat into the inflamed area, which is absorbed by lymph and blood, and then spreads throughout the diseased organ.

You can use UHF for 1-2 weeks, one procedure every day or every other day. The duration of the session is 10-15 minutes.

Important! Frequent use of UHF therapy for more than 2 weeks leads to excessive activation of fibroblasts, so adhesions may occur in the uterus, leading to further difficulties with pregnancy.

Interference therapy

The effect of interference therapy occurs due to irritation of receptors located in the walls of the uterus by medium-frequency current.

The tone of the organ increases, the myometrium begins to gradually contract, blood circulation increases, and pain is eliminated.

The duration of treatment takes more than two weeks, but the procedure itself lasts about 20 minutes. The method does not have any contraindications except for the acute period of pathology.

Treatment with electrophoresis

Electrophoresis allows small doses of medications to be introduced into the body by redirecting electrical particles. But due to delivery directly to the site of inflammation, they will be more effective than when taken orally or parenterally.

  Treatment of chronic endometritis - how the pathology manifests itself

Electrodes with different charges are attached to the patient’s body, some of them are positive, and some are negative. A hydrophilic pad (gauze folded in several layers) is placed between the skin and the electrode, onto which a medicinal solution is first poured.

In case of inflammation of the uterine mucosa, electrophoresis is prescribed with pads that are impregnated with iodine, copper or zinc, and novocaine is dripped onto them to relieve pain. The procedures are carried out for 2 weeks, no more than 20 minutes per day.

Antibiotics and antivirals

Antibiotics play a major role in the treatment of endometritis, since it is necessary to remove pathogenic flora in order to get rid of the disease.

In a chronic course, there are no obvious symptoms or threat to life, so there is little time to determine the sensitivity of bacteria to drugs - do an antibiogram.

Based on the results of the study, the doctor selects a specific medication to which the microorganisms responded best. Most often, cephalosporin antibiotics (Ceftriaxone) are prescribed in combination with Amoxicillin.

In the acute period, they are administered intravenously or intramuscularly, and in the remission stage, oral or local (vaginal suppositories) forms of drugs are used.

Sometimes endometritis develops not due to the penetration of pathogenic bacteria, but under the influence of viruses, such as herpes.

In such cases, antibacterial agents are used to prevent infection, and antiviral drugs are used for treatment - Acyclovir, Tromantadine.

Hormonal treatment

• Hormonal therapy for chronic endometritis involves selecting oral contraception for a woman.
• The drug will help stabilize the menstrual cycle, accelerate the regeneration of the uterine lining, and normalize the patient’s hormonal levels.
• For the effect to occur, oral contraceptives must be taken for at least 3 months, and the full course of treatment is six months.

Important! Hormonal medications will not only help get rid of the pathology, but will also prevent pregnancy until complete recovery.

Endometritis and pregnancy

Endometritis, especially in chronic form, leads to problems with pregnancy. Adhesions occur in the uterine cavity, the structure of the endometrium is disrupted, and it is difficult for the fertilized egg to find a place for implantation.

Even when pregnancy occurs, the likelihood of pregnancy is low, since the fertilized egg cannot reliably cling to the wall.

Pregnant women with endometritis have a significantly increased risk of spontaneous abortion or premature birth. In addition, the infection continues to spread and can reach the fetus, causing intrauterine infection and death.

Source: https://endometriy.com/endometrit/shema-lecheniya