Endometritis: Symptoms, Risk Factors, and Effective Management

What is inflammation in the uterus?
Endometritis in Hindi means inflammation in the lining of the uterus or uterus (endometrium). Usually this inflammation in women's uterus is caused by an infection. Although it is not such a dangerous disease, it is important to treat it as soon as possible. This inflammation usually goes away when your doctor treats it using antibiotics.

Endometritis affects a woman's ability to get or stay pregnant. Inflammation of the uterus can cause scarring, which prevents the embryo from implanting and developing normally within the uterine wall. A study published in 2016 suggests that chronic endometritis may affect fertility in the following ways -

• By preventing a fertilized egg from implanting into the uterine lining
• By increasing the risk of recurrent miscarriage

However, the same study report also suggests that treatment with antibiotics may improve fertility and increase the chances of successful conception. A 2018 study looked at 95 women who had fertility problems. They found that more than half of these women had chronic endometritis and antibiotic therapy improved their symptoms by more than 80 percent. With successful treatment, pregnancy and delivery rates were also increased in these women. Fertility specialists sometimes suggest that women should be screened for endometritis and treated for it. If multiple cycles of in vitro fertilization (IVF) fail or there are repeated miscarriages, especially when the embryos are of good quality. If left untreated, these infections can lead to complications in the reproductive organs, fertility issues and other general health problems.

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The symptoms of inflammation of the uterus can usually be the following -

• Abdominal swelling
• Abnormal vaginal bleeding and discharge
• Constipation or pain while going to the bathroom
• Fever or chills
• Feeling unwell or extremely tired
• Pelvic pain, pain in the lower abdomen or rectal area

If you are ever experiencing pelvic pain or discomfort or have abnormal discharge or abnormal bleeding, you should see your doctor. Some pelvic infections can cause very serious complications, so it is important to start treatment early.

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Why and how does inflammation of the uterus occur?
Inflammation of the uterus is usually caused by infection. Some of the infections that can cause inflammation of the uterus are as follows -

• Sexually transmitted infections (STIs), such as chlamydia and gonorrhea. 
• Tuberculosis or TB
• Infections caused by a mix of normal vaginal bacteria

The cervix, which is the entrance to the uterus, usually prevents bacteria from entering the uterus. However, when the cervix is ​​open, such as during childbirth or surgery, bacteria can enter the womb. Normal bacteria are normally present in the vagina of women, but inflammation of the uterus occurs when this natural mix of bacteria changes after childbirth.

After a miscarriage or delivery, you are at risk of developing an infection that can cause inflammation of the uterus, especially after a long labor or cesarean delivery. You are more likely to develop endometritis after a medical procedure that requires the insertion of an instrument into the uterus through the cervix, as this procedure can provide a route for bacteria to enter the womb. Some medical procedures that may increase your risk of developing endometritis include:

• During hysteroscopy
• Dilation and curettage (uterine scraping) during placement of an intrauterine device (IUD)

Uterine inflammation can also occur when there are other conditions in the pelvic area, such as inflammation of the cervix, called “cervicitis.” These conditions may or may not cause any symptoms.

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Using sterile equipment and techniques during delivery or surgery can reduce your risk of developing endometritis. Your doctor may prescribe antibiotics as a precaution during a cesarean delivery or just before the surgery begins. If inflammation in the uterus is caused by an STI, the following measures can be taken to prevent inflammation in the uterus due to STI -

• Get regular screening and diagnose suspected STIs early
• Both you and your partner complete all the prescribed treatments for their STIs
• Follow safe sex practices such as using condoms.

When a woman is at risk of developing endometritis, such as before a scheduled pelvic procedure or surgery, the doctor may prescribe antibiotics to prevent it from occurring. You should take them as your doctor advises. If you are experiencing any symptoms of endometritis, talk to your doctor to prevent any serious complications from arising.

Your doctor will first do a physical and pelvic exam. She will also examine your abdomen, uterus and cervix for signs of tenderness and discharge. The following tests may also help diagnose inflammation in the uterus

• Cervical culture - A sample or culture from the cervix may be tested to look for infection-causing bacteria such as chlamydia and gonococcus (the bacteria that causes gonorrhea).
• Vaginal ultrasound - An ultrasound test uses sound waves to show pictures of the inside of your uterus (womb) and ovaries. A small tube is placed in your vagina. Pictures of your uterus and ovaries are seen on a TV-like screen.
• Wet mount - In a wet mount, discharge from the cervix can be collected and looked at under a microscope. This can help identify infection or other causes of inflammation.
• CT scan - A CT scan test is also called a CAT scan. This involves an X-ray machine using a computer to take pictures of your abdomen. You may be given a dye before the pictures are taken to help the doctor see the images better. If you are allergic to contrast dye, tell your doctor beforehand.
• Laparoscopy or hysteroscopy – Laparoscopy is done to look at the lining of your uterus. A small scope with a light and camera is placed through your vagina into the cervix. Liquid or gas may be passed through the scope to help with better viewing. A sample of tissue may also be taken from your womb during this test.
• Endometrial biopsy – A small amount of tissue is taken from the lining of the uterus for testing, which is called an endometrial biopsy.

Blood tests may also be done to measure your white blood cell (WBC) count and erythrocyte sedimentation rate (ESR). Endometritis will cause an increase in both your WBC count and your ESR.

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When doctors treat endometritis, they aim to remove infection and inflammation from the uterus. The following measures may be taken by the doctor to treat inflammation in the uterus -

1. Antibiotics - This medicine is given to fight or prevent infection caused by bacteria. Take them as you are given.
2. Evacuation - Evacuation is done to remove tissue left in your womb after birth or abortion.
3. Needle aspiration - This may be needed to drain an abscess that has formed in your abdomen. A needle may be placed inside through your abdomen or vagina and used to remove the pus.
4. Surgery - You may also undergo surgery to remove pus and infected tissue.

If your doctor finds that you have an STI, your sexual partner may also need to be treated. Finishing all the medicines prescribed by your doctor is essential for proper treatment. Learn from your doctor about your health condition and how it can be treated. Discuss treatment options with your doctor to decide what kind of treatment you want to receive.

The information provided above is for an educational purpose only. It is not medical advice for treating your individual conditions. Talk to your doctor, nurse or pharmacist to see if it is safe and effective for you.

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Usually, if a woman has inflammation in the uterus and gets it treated properly, then endometritis gets cured without any other complications and problems. If this infection is not treated with antibiotics, then you can experience many complications and even serious illness. Some such complications of inflammation in the uterus are given below -

• Infertility may occur.
• Pelvic peritonitis, a common infection, can lead to pelvic infections.
• Abscesses or pus can form in the pelvis or uterus.
• Septicemia (bacteria in the bloodstream) can lead to sepsis, a serious infection that can happen very quickly. It can also lead to septic shock (a type of blood infection that causes low blood pressure), which can be life-threatening. Both need to be treated in a hospital as quickly as possible.

Chronic endometritis is chronic inflammation of the endometrium. The pathogen remains present but causes mild infection and most women have no symptoms or may be mistaken for symptoms. However, chronic endometritis has been linked to infertility.

(Read more - Secondary female infertility - Causes, and Treatment)

In case of inflammation of the uterus, it is important to rest first and avoid excessive physical activity. Applying a hot water bottle to reduce inflammation can provide relief. Include anti-inflammatory foods, such as turmeric, ginger, and omega-3 fatty acids in your daily routine. Drink enough water and eat a fiber-rich diet so that the digestive system can function properly. In severe cases, it is important to consult a doctor, as they can make a correct diagnosis and recommend appropriate treatment or medications.