The Endometritis is an inflammation of the lining of the uterus. It is usually caused by an infection ascending from the vagina.
What is endometritis?
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With endometritis, the lining of the uterus (endometrium) becomes inflamed. The pathogens rise from the vagina and reach the uterus via the cervix. Inflammation of the endometrium is often associated with inflammation of the uterine muscles. This combined inflammation is also known as endomyometritis.
In the course of the disease, menstrual cycle disorders and spotting can occur. If it spreads to the uterine muscles, severe pain also occurs. Endometritis usually goes well. But it can also lead to infertility.
causes
A uterine infection is almost always caused by an infection ascending from the vagina. These infections are usually caused by pathogens such as staphylococci, chlamydia and streptococci. Usually the inner cervix is a barrier for pathogens and germs. However, due to menstruation, curettage, probing or childbirth, this barrier can have holes through which the pathogens can penetrate the uterus.
The pathogens initially settle on the so-called zona functionalis. This layer of the endometrium is shed cyclically during menstrual bleeding. Pathogens that adhere to the zona functionalis are excreted with the bleeding. This initiates self-healing of the uterine lining during menstrual bleeding.
However, if the infection reaches the zona basalis, the pathogens remain in the uterus during and after menstruation. The disease persists. The myometrium is particularly involved in purulent endometritis. However, outside of the puerperium, myometritis rarely occurs.
Only in very rare cases is the lining of the uterus infected by a descending infection from the ovaries (salpingitis). In old age, due to the falling estrogen level, the mucous membranes and thus also the mucous membrane of the uterus become thinner and thinner. This can also be a cause of uterine inflammation.
Symptoms, ailments & signs
Most women do not even notice the vaginal inflammation that precedes the uterine infection. The following cervicitis, the inflammation of the cervix, often goes unnoticed. You may experience mild symptoms such as discharge or an unpleasant smell in the genital area.
The vagina may be painful, burning, itchy, or red. The symptoms of the actual endometritis are also rather unspecific. Abdominal pain is common. The uterus is also tender on pressure. Since the mucous membrane changes due to the inflammatory processes, menstrual disorders can occur.
Menstrual bleeding may be increased or last longer. Spotting and intermenstrual bleeding may occur between normal menstrual periods. As the endometritis spreads to the fallopian tubes, the previously moderate fever increases. The patients are in severe pain and feel very sick.
diagnosis
At the beginning of the diagnosis there is always a detailed anamnesis. Among other things, it will be clarified whether an operation has been carried out on the uterus in the near past, which could have favored the penetration of pathogens. One such beneficial intervention is, for example, the insertion of the coil.
This is followed by a detailed physical examination. The doctor first feels the abdomen and lower abdomen. In the case of endometritis, tenderness to pressure is evident here. If the inflammation is severe, immune tension can develop. The patient's stomach is then as hard as a board. The doctor can use the colposcope to examine the mucous membranes of the vagina and the cervix.
He also takes a sample of the vaginal secretions and does a smear on the cervix. The vaginal secretions and the smear are then examined for pathogens in a laboratory. In this way the diagnosis can be secured. If there is a change in the mucous membrane cells, additional tissue samples may have to be taken in order to rule out cancer. If the endometritis has spread to the ovaries, there are increased inflammation values in the blood count.
Complications
Inflammation of the lining of the uterus, with proper treatment, usually proceeds without the occurrence of further complications. In some cases, however, secondary symptoms and side effects cannot be ruled out. Among other things, the so-called pyometra should be mentioned here. In a pyometra, pus accumulates in the uterus.
This affects older women more often. This is because the cervix is narrower as you age than it is when you are young, so it is more likely to inflame. Endometritis still occurs in a few cases together with inflammation of the muscles in the uterine tissue, known as myometritis.
A serious complication is the spread of the inflammation to the surrounding tissue. Endometritis can spread to inflammation via the fallopian tubes to the ovary. In the worst case, so-called adnexitis can lead to infertility.
A very serious complication is the spread of the infection into the abdominal cavity. This can be fatal. If the causative agents of the infection get into the bloodstream of the organism, sepsis, also known as blood poisoning, cannot be ruled out. This can be fatal.
When should you go to the doctor?
Women who experience increased whitish discharge, abdominal pain, and other signs of endometritis should see a gynecologist. A uterine inflammation does not always have to be treated medically, but complaints in the genital area generally need to be clarified by a doctor. If complications arise - such as burning pain or heavy discharge - a doctor must be consulted on the same day. Women with an IUD or after giving birth are particularly prone to uterine infections.
Endometritis is also more common during the monthly menstrual period. Tumor diseases and benign tumor formations on the cervix are further risk factors. If you belong to these groups, it is best to consult a doctor regularly. If there are any signs of uterine inflammation, this must be clarified immediately.
Discomfort in the fallopian tubes and ovaries indicate that the inflammation has already spread. In this case, a doctor must also be called in immediately, who can clarify the symptoms and, if necessary, treat them directly. If in doubt, go straight to the nearest hospital.
Doctors & therapists in your area
Treatment & Therapy
As a rule, endometritis must be treated as an inpatient. Broad spectrum antibiotics such as ciprofloxacin, doxycycline or metronidazole are used for treatment. Relaxing and pain relieving drugs such as butylscopolamine are used to relieve pain. Anti-inflammatory drugs such as ibuprofen, diclofenac or phenylbutazone also fight the inflammation.
If pus forms in the uterine cavity, it must be sucked out with a so-called Fehling's tube. The patient must remain in bed rest throughout the treatment. If the uterine inflammation occurred after inserting an IUD, the contraceptive must be removed immediately.
After the antibiotic therapy is over, the doctor will perform a scraping of the uterus. Any infected remains of the mucous membrane are removed. This is to prevent further inflammation. If the uterus doesn't recede properly after scraping, a contraction drug is given.
This ensures that the uterine muscles contract. After every uterine inflammation, a tumor of the uterus must also be excluded. For this, the scraped tissue is pathologically examined.
Outlook & forecast
The prognosis for endometritis is favorable with prompt and good medical treatment. Immediately after the diagnosis, antibiotics are prescribed, which lead to a rapid resolution of the symptoms. The immune system builds up within a few days and the pathogens slowly die off. Then they are transported out of the organism and healing occurs. Usually the patient is healthy and symptom-free within a few weeks.
The prognosis deteriorates as soon as the inflammation has spread to neighboring organs. If the abdomen or the intestines are affected, there is a risk of further complications and deterioration in the state of health. In severe cases, the intestine can break through and the patient's life is in danger.
These patients need an emergency doctor so that medical care can be initiated as quickly as possible. Timely treatment is therefore crucial for the course of the disease and the prognosis in endometritis.
Failure to seek medical treatment increases the risk of spread. People who have a strong immune system, do not have any other illnesses and follow a healthy lifestyle can achieve self-healing. However, this is not recommended as the risk of deterioration in health is too great. Endometritis can recur later in life. The prognosis is then also favorable.
prevention
Endometritis cannot always be prevented. The best way to prevent inflammation is to avoid inflammation of the vagina. An intact vaginal environment is the best protection against pathogens. To preserve the vaginal flora, the genital area should only be washed with water and not with soap or shower gel. Most intimate lotions are also unsuitable for care because they have a too high pH value.
In addition, women should pay attention to good sexual hygiene. The direct switch from anal to vaginal intercourse in particular carries a high risk of infection. Using tampons during menstruation can also lead to vaginal infections and thus inflammation of the uterus.
Aftercare
In most cases of endometritis, the patient has only very limited options for follow-up care. The focus is therefore also on the rapid and early treatment of this disease in order to prevent further complications and avoid other complaints.In general, early treatment always has a positive effect on the further course of the endometritis.
The treatment itself takes place with the help of antibiotics. The affected person should take this as directed by a doctor. When taking antibiotics, alcohol should not be drunk either, as this can significantly reduce their effect. The symptoms can also be alleviated with the help of painkillers.
However, a doctor should also be consulted here, painkillers should not be taken over a long period of time. Since endometritis can also lead to a tumor in the uterus, regular examinations should be performed to prevent the tumor from spreading. Since endometritis can also lead to psychological complaints or depression, the help and support of your own family and friends is very important.
You can do that yourself
A uterine infection is very often preceded by an inflammation of the vagina (vaginitits). The pathogens rise from the vagina through the cervix into the uterus. This can be caused by inadequate intimate hygiene.
Regular cleaning of the external genitals with warm water and a mild detergent can therefore prevent vaginitis. Excessive intimate hygiene, especially when using aggressive cleaning substances, is counterproductive.
In addition, typical pathogens such as chlamydia, gonococci or streptococci are transmitted much more frequently during heterosexual intercourse. Women should therefore always insist on the use of a condom when having sex with men. This precautionary measure is particularly important if the partner changes frequently.
There is also an increased risk of infection during menstruation and especially during the so-called puerperium, i.e. the first eight weeks after the birth of a child. During this time, the cervix is slightly open, which makes it easier for pathogens to enter the uterus. The same applies after surgical interventions such as scraping the uterus, as the cervical canal has to be widened during the operation. During such phases it is imperative to ensure adequate intimate hygiene and to avoid unprotected sexual intercourse.
