Endometritis

Endometritis is an inflammation of the lining of the uterus (endometrium), usually caused by an infection. It can occur after childbirth, miscarriage, or certain medical procedures. Common symptoms include pelvic pain, abnormal vaginal bleeding, and fever. Prompt treatment with antibiotics is usually effective in resolving the condition and preventing complications.

What is Endometritis?

Endometritis is a condition where the inner lining of the uterus, called the endometrium, becomes inflamed. This inflammation is most often caused by an infection. It can be acute, meaning it appears suddenly and severely, or chronic, meaning it lasts longer with milder symptoms. Endometritis is different from endometriosis, which is a condition where uterine-like tissue grows outside the uterus.

The uterus is a pear-shaped organ in a woman's pelvis where a baby grows during pregnancy. The endometrium is the tissue that lines the inside of the uterus. Each month, this lining thickens in preparation for a possible pregnancy and then sheds during menstruation if pregnancy does not occur. When the endometrium becomes inflamed, it can lead to various uncomfortable symptoms. This inflammation is almost always due to an infection that has reached the uterine lining. The infection can be caused by different types of bacteria. Endometritis is a common infection, especially after certain events like childbirth or gynecological procedures. It is important to treat it promptly to prevent more serious health problems. With the right treatment, most people recover fully.

Symptoms

Symptoms of endometritis can vary but often include pain in the lower abdomen or pelvis, abnormal vaginal bleeding or discharge, and fever. You might also feel generally unwell or experience discomfort during bowel movements or urination. These symptoms can appear suddenly or develop gradually over time.

The most common symptom of endometritis is pain or tenderness in the lower abdomen or pelvis. This pain can range from mild cramping to severe discomfort. It might feel like a constant ache or come and go. Many people with endometritis experience changes in their vaginal discharge. This discharge may be heavier than usual, have an unusual color (such as yellow or brown), or have a foul smell. Abnormal vaginal bleeding, such as bleeding between periods or heavier menstrual bleeding, is also a common sign. Other symptoms can include a fever, which might be low-grade or higher, and a general feeling of being unwell, often described as malaise. Some individuals may also have pain during sexual intercourse, painful bowel movements, or a burning sensation when they urinate.

Causes & risk factors

Endometritis is typically caused by an infection that enters the uterus. This often happens after events like childbirth, miscarriage, or medical procedures involving the uterus. Certain sexually transmitted infections (STIs) can also lead to endometritis, increasing your risk.

The most common cause of endometritis is an infection from bacteria that normally live in the vagina or bowel. These bacteria can travel up into the uterus, especially when the cervix, the opening to the uterus, is more open than usual. Several situations can increase your risk of developing endometritis. Childbirth is a significant risk factor, particularly after a C-section (cesarean delivery). Other procedures that involve the uterus, such as a D&C (dilation and curettage) for a miscarriage or abortion, hysteroscopy (a procedure to look inside the uterus), or the insertion of an IUD (intrauterine device), can also introduce bacteria and increase risk. Sexually transmitted infections (STIs) like chlamydia and gonorrhea are also common causes of endometritis. These infections can spread from the cervix into the uterus. Other risk factors include prolonged labor, premature rupture of membranes during pregnancy, and having multiple vaginal exams during labor.

How it's diagnosed

Diagnosing endometritis usually involves a physical exam, where your doctor will check for tenderness in your pelvis and any abnormal discharge. They may also take samples for laboratory tests, such as vaginal or cervical cultures, to identify the specific bacteria causing the infection. In some cases, a tissue sample from the uterine lining may be taken.

When you see your doctor with symptoms of endometritis, they will typically start with a physical examination. This includes a pelvic exam, where they will gently check your abdomen and pelvis for pain or tenderness. They will also look for any abnormal vaginal discharge. To confirm the diagnosis and identify the type of infection, your doctor will likely take samples for laboratory tests. This might involve a swab of your vagina or cervix to perform cultures, which can detect bacteria like those causing STIs. Blood tests, such as a complete blood count (CBC), may also be done to check for signs of infection, like an elevated white blood cell count. In some situations, especially if the diagnosis is unclear or if chronic endometritis is suspected, your doctor might recommend an endometrial biopsy. During this procedure, a small tissue sample is taken from the lining of your uterus and examined under a microscope. This can help confirm inflammation and identify the presence of infection.

Treatment options

The primary treatment for endometritis is antibiotics, which are prescribed to kill the bacteria causing the infection. The specific type of antibiotic and how long you need to take it will depend on the severity of your infection and the type of bacteria identified. In severe cases, you might need to receive antibiotics intravenously in a hospital.

Once endometritis is diagnosed, your doctor will prescribe antibiotics. It is very important to take the full course of antibiotics exactly as prescribed, even if your symptoms improve quickly. Stopping treatment early can lead to the infection returning or becoming harder to treat. If the endometritis is caused by a sexually transmitted infection, your sexual partners may also need treatment to prevent reinfection. Your doctor will provide guidance on this. It is also important to avoid sexual activity until the infection has cleared. For more severe infections, or if you are unable to take oral antibiotics, you might need to be admitted to the hospital. In the hospital, antibiotics can be given directly into your vein (intravenously). Sometimes, if there are retained tissue fragments in the uterus after childbirth or miscarriage, a procedure may be needed to remove them in addition to antibiotic treatment.

Recovery & outlook

With prompt and appropriate antibiotic treatment, the outlook for endometritis is generally very good, and most people make a full recovery. Symptoms usually begin to improve within a few days of starting medication. If left untreated, however, endometritis can lead to more serious complications, including infertility or widespread infection.

Most people with endometritis respond well to antibiotics. You should start to feel better within 2 to 3 days of beginning your medication. It is crucial to complete the entire course of antibiotics, even if you feel better, to ensure the infection is fully cleared and to prevent it from coming back. If endometritis is not treated, the infection can spread. This can lead to more serious conditions such as pelvic inflammatory disease (PID), which can affect other reproductive organs. Untreated infection can also cause a collection of pus (abscess) in the pelvis or, in rare cases, a life-threatening widespread infection called sepsis. Long-term complications, though uncommon with proper treatment, can include chronic pelvic pain or infertility. This is why early diagnosis and treatment are so important. Following your doctor's instructions and attending follow-up appointments can help ensure a complete recovery and prevent future problems.

When to see a doctor

You should see a doctor if you experience symptoms that could indicate endometritis, such as new or worsening pelvic pain, unusual vaginal bleeding or discharge, or a fever. Early medical attention is important because prompt treatment can prevent the infection from spreading and reduce the risk of serious complications.

It is important to contact your doctor if you notice any of the key symptoms of endometritis. These include persistent lower abdominal or pelvic pain, especially if it is new or getting worse. You should also seek medical advice if you have abnormal vaginal bleeding, such as bleeding between periods, or a vaginal discharge that is foul-smelling, unusually heavy, or discolored. Fever, particularly if it is accompanied by pelvic pain, is another sign that warrants a doctor's visit. If you have recently had a baby, a miscarriage, an abortion, or a gynecological procedure and develop these symptoms, it is especially important to get checked. Do not delay seeking medical care if you suspect endometritis. Untreated infections can spread and lead to more severe health issues, including infertility. Your doctor can accurately diagnose your condition and prescribe the necessary treatment to help you recover.

Frequently asked questions

Can endometritis affect my ability to get pregnant?

Yes, if left untreated, endometritis can potentially affect your ability to get pregnant. The inflammation and infection can cause scarring or damage to the uterine lining, which may make it harder for a fertilized egg to implant. Prompt treatment with antibiotics significantly reduces this risk.

Is endometritis contagious?

Endometritis itself is not contagious. However, if the endometritis is caused by a sexually transmitted infection (STI) like chlamydia or gonorrhea, then the underlying STI can be passed to sexual partners. In such cases, your partner may also need treatment.

How long does it take to recover from endometritis?

With appropriate antibiotic treatment, most people start to feel better within 2 to 3 days. It is crucial to complete the entire course of antibiotics, which typically lasts for several days to two weeks, to ensure the infection is fully cleared and to prevent recurrence.

Can endometritis come back after treatment?

Endometritis can recur, especially if the initial treatment was not completed, if the underlying cause (like an STI) was not fully addressed, or if you are re-exposed to risk factors. It's important to follow your doctor's instructions and attend follow-up appointments to minimize this risk.

What is the difference between endometritis and endometriosis?

Endometritis is an inflammation or infection of the uterine lining (endometrium). Endometriosis, on the other hand, is a condition where tissue similar to the uterine lining grows outside the uterus, such as on the ovaries, fallopian tubes, or other pelvic organs. They are distinct conditions with different causes and treatments.

Are there ways to prevent endometritis?

Yes, there are preventive measures. If you are having a C-section or certain gynecological procedures, your doctor may give you preventive antibiotics. Practicing safe sex can help prevent STIs, which are a common cause of endometritis. Prompt treatment of any vaginal or cervical infections can also reduce your risk.

Sources

• MedlinePlus — Endometritis
• Mayo Clinic — Endometritis
• Cochrane Library — Endometritis