Endometritis: Symptoms and Management

Introduction

The uterus plays a vital role in menstruation, fertility, and pregnancy. During pregnancy, the uterus expands and contracts during labor. The uterus consists of three layers:

• Perimetrium - Perimetrium is the protective outermost layer.

• Myometrium - Myometrium is the muscular middle layer that expands according to the growing baby during pregnancy and contracts during labor to facilitate the baby's delivery.

• Endometrium - Endometrium is the uterine lining that sheds monthly (menstruation) unless pregnancy occurs.

However, certain diseases can cause painful symptoms in the uterus that need treatment. A lot of women are affected by these conditions, with varying degrees of prevalence.

What Is Endometritis?

Endometritis is an inflammatory condition of the endometrium caused by infection, often bacterial (aerobic and anaerobic) in nature. There are two main types of endometritis:

• Acute Endometritis - Acute endometritis refers to a sudden and severe inflammation of the endometrium. It is caused by a bacterial infection, commonly associated with childbirth (vaginal or cesarean), miscarriage, or certain medical procedures such as an intrauterine device (IUD) insertion or dilation and curettage (D and C).

• Chronic Endometritis - Chronic endometritis is a long-lasting inflammation of the endometrium that persists for an extended period (more than six months). It can be caused by persistent or recurrent infections, sexually transmitted infections (STIs), or certain underlying conditions such as endometriosis (a condition where fragments of the uterine lining grow in locations outside of the uterus).

What Are the Symptoms of Endometritis?

Endometritis symptoms can vary from person to person, but common manifestations include:

• Discomfort or persistent cramp-like pain in the lower abdomen or pelvis.

• Unusual or heavy vaginal bleeding.

• Bleeding accompanied by foul-smelling discharge.

• Changes in the color, consistency, or odor of vaginal discharge.

• Swelling in the area of the lower abdomen.

• Elevated body temperature.

• Discomfort while urinating or a frequent urge to urinate.

• Constipation or discomfort with bowel movements.

• Discomfort or pain experienced during sexual activity.

How Is Endometritis Diagnosed?

Endometritis is diagnosed following a physical examination and additional tests, which are mentioned below:

• Medical History - The doctor will get information like the symptoms, the duration of pain, the onset of pain, and any history of recent pregnancies or procedures involving the uterus.

• Physical Examination - A pelvic examination is done to check if there are any signs of infection or inflammation of the uterus, cervix, and surrounding structures.

• Vaginal Discharge Examination - Samples of vaginal discharge or cervical mucus may be collected for analysis of color, consistency, and odor. Vaginal cultures are also done to help identify the presence of infectious agents like bacteria or sexually transmitted infections (STIs).

• Blood Tests - It is done to assess overall health, check for signs of infection (such as elevated white blood cell count) and detect specific markers of inflammation (such as elevated erythrocyte sedimentation rate (ESR).

• Imaging Tests - Imaging tests such as transvaginal ultrasound or pelvic scan may be used to evaluate the condition, assess the lining of the uterus for inflammation or thickening, and evaluate the surrounding structures.

• Endometrial Biopsy - A small tissue sample from the endometrium may be obtained for examination under a microscope. This can help confirm the presence of inflammation and determine the specific cause of endometritis.

How Is Endometritis Treated?

Treatment measures aim at providing symptomatic relief and treating the underlying cause of endometritis. Depending on the severity of endometritis, the treatment measures may vary.

The treatment measures done are as follows:

• Medications - Medications are given to treat the infection and inflammation of the endometrium.

  • Antibiotics such as Ampicillin, Gentamicin, or Doxycycline may be prescribed at first for endometritis to target the underlying infection. The specific choice of antibiotics depends on the severity of the infection, the suspected bacteria involved, and if there are any relevant antibiotic resistance patterns present.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like, Ibuprofen may be recommended to alleviate pain and reduce inflammation.

  • Antipyretic medications such as Acetaminophen can help reduce fever associated with endometritis.

• Rest and Hydration - Sufficient rest and maintaining good hydration are important for the body's healing process.

• Hospitalization - In severe cases or when there's resistance to initial treatment, intravenous (IV) antibiotics may be administered initially, followed by oral antibiotics. Hospitalization may also be necessary if endometritis occurs soon after childbirth (vaginal or cesarean).

• Follow-up Care - Regular follow-up visits are essential to monitor progress, ensure the infection has cleared, and prevent complications.

What Are the Complications of Untreated Endometritis?

Timely diagnosis and treatment of endometritis usually allow good recovery for individuals. However, if left untreated, endometritis could cause severe complications, some of which are as follows:

• Pelvic Inflammatory Disease (PID) - Endometritis is a common cause of pelvic inflammatory disease, which refers to the infection and inflammation of the female reproductive organs, including the uterus, fallopian tubes, and ovaries. This condition can result in chronic pelvic pain, ectopic pregnancy (pregnancy outside the uterus), and an increased risk of tubal damage and infertility.

• Abscess Formation - In certain cases, the infection can progress and lead to the development of abscesses, which are localized pockets of pus. These abscesses can form within the uterus or in the surrounding pelvic tissues. Abscesses may require surgical intervention for drainage and treatment.

• Septicemia - If the infection spreads beyond the uterus and pelvic area, it can enter the bloodstream, causing septicemia or sepsis. Sepsis is a life-threatening condition characterized by a systemic inflammatory response to infection. It can lead to organ dysfunction, septic shock, and, in severe cases, even death.

• Pregnancy Complications - Endometritis during pregnancy can increase the risk of complications such as preterm labor, preterm birth, premature rupture of membranes, and postpartum infection. Recurrent or untreated endometriosis may also cause infertility.

Can Endometritis Be Prevented?

Endometritis is not a condition that can be prevented completely. However, certain preventive measures can be implemented to reduce the risk of developing endometritis. Some of the measures include:

• Antibiotic prophylaxis before cesarean or other invasive procedures involving the uterus (such as dilation and curettage and intrauterine device placement).

• Get screened routinely for sexually transmitted diseases and practice safe sex.

• Practice good hygiene measures following childbirth or invasive vaginal procedures.

Conclusion

It is important to complete the full course of antibiotics even if symptoms improve, as premature discontinuation of treatment can lead to recurrence or complications. If endometritis occurs due to sexually transmitted diseases, it is important for the sexual partner to be screened and treated for the same. While endometritis is a condition that requires prompt medical attention and appropriate treatment, with timely intervention and proper care, the prognosis for endometritis is generally favorable.