What is endometritis, what are its symptoms and treatment methods. Treatment of chronic endometritis - how does the pathology manifest? How does chronic endometritis manifest?

Endometritis is an inflammation of the inner lining of the uterus - the endometrium. This disease is a serious medical and social problem. It is endometritis that is often the culprit of miscarriage and unsuccessful attempts.

Table of contents:

Causes

The uterus is located in the pelvis. The main purpose of this organ is to carry the fetus during pregnancy.

The wall of the uterus consists of 3 layers:

1. The outer layer is serous (perimetry);
2. Middle - muscular (myometrium);
3. Internal - mucous (endometrium).

The endometrium is a hormonally sensitive tissue. During the premenstrual period, this layer thickens, the number of glands increases, and the blood supply to the tissue increases. All these changes are preparation for the implantation of a fertilized egg. If pregnancy does not occur, the surface layer of the endometrium sloughs off and is removed with menstruation. After menstruation, the endometrium is restored due to the deep layer.

Causes of acute endometritis

The entry of microorganisms into the uterus provokes inflammation of the endometrium. Since the mucous and muscular layers of the uterus are in very close contact, the inflammatory process often also affects the myometrium - metroendometritis develops.

Causes of acute endometritis:

• Curettage of the uterine cavity;
• Abortion (especially criminal abortion is often the cause of endometritis);
• Childbirth, both natural and by caesarean section;
• Probing of the uterine cavity;
• Installation of a fallopian device;
• Carrying out hysterosalpingography;
• Hysteroscopy.

There are nonspecific and specific endometritis. The development of nonspecific endometritis is caused by Klebsiella, Proteus, etc. Specific endometritis is provoked by mycobacteria, viruses, and fungi.

Note:Many women confuse endometritis with. These are essentially two different diseases. Endometritis is an inflammatory process localized in the endometrium. Endometriosis is not inflammatory disease, which is characterized by the growth of endometrial tissue beyond its boundaries.

Causes of chronic endometritis

The cause of chronic endometritis is untreated or undertreated acute endometritis. The inflammatory process triggers morphological and functional changes in the inner wall of the uterus, which determines the features of the clinical picture. The incidence of chronic endometritis is approximately 14%.

The following types of chronic endometritis are distinguished:

1. Atrophically th - characterized by atrophy of the glands, proliferation of fibrous tissue;
2. Cystic- characterized by the formation of cysts in the endometrium;
3. Hypertrophic- characterized by proliferation of the endometrium.

Symptoms of endometritis

The severity of the clinical picture of the disease depends on the duration of its existence. Thus, acute endometritis occurs rapidly with bright clinical picture. The chronic form of the disease often has few symptoms.

Symptoms of acute endometritis

The first symptoms of endometritis occur several days after abortion, childbirth, or intrauterine manipulation. The disease begins with an increase in temperature, up to 38-39 degrees, the woman feels weakness and chills. Serous-purulent or even bloody discharge from the vagina appears. A woman is being tortured. The listed symptoms are not specific and can be observed in other inflammatory diseases. Endometritis can be suspected if any intrauterine manipulations were performed shortly before the onset of symptoms.

Symptoms of the disease usually last up to ten days. After which there are several possible outcomes:

• Complete cure with successful therapy;
• Transition to a chronic form - in the absence or insufficiently effective treatment;
• The formation of complications - in the absence of timely treatment.

Symptoms of chronic endometritis

As already mentioned, the symptoms of chronic endometritis are vague. A woman may have a long-term elevated temperature. Marked uterine bleeding occurring during the intermenstrual period. In addition, there is constant serous-purulent discharge from the vagina. Women are worried about periodic, less often constant, pain.

Complications

Complications of endometritis occur in the absence of treatment or its delay. Most complications are associated with infection extending beyond the boundaries of the uterus.

Possible complications:

Diagnostics

If you have the above symptoms, you should consult a gynecologist. The doctor will listen to complaints and clarify the intrauterine manipulations performed. To confirm the diagnosis of endometritis, you will need to conduct some research. By palpating the lower abdomen, the doctor can determine the enlargement and tenderness of the uterus. During internal gynecological examination the doctor can determine the pathological nature of the discharge by its color, consistency, smell, and quantity. A selected smear from the cervical canal will subsequently undergo bacteriological examination.

In addition, the doctor may examine the uterus. During the study, thickening of the endometrium, blood and purulent clots in the uterine cavity, remnants of placental tissue, and changes in the echogenicity of the myometrium are determined. In the chronic form of the disease, adhesions in the uterus can also be detected.

Treatment of endometritis

First of all, treatment begins with the prescription of etiotropic drugs: antibacterial, antiviral drugs. Antibiotics are selected taking into account the causative agent of the infection; these can be penicillins, cephalosporins, macrolides, tetracyclines. often prescribed together with antifungal drugs (fluconazole, nystatin, etc.). The dosage of the medication and the duration of treatment are determined by the severity of endometritis. If necessary, the patient is given infusion, as well as desensitizing and restorative therapy.

For chronic endometritis, antibiotics are also prescribed. It is optimal to choose a medicine after determining the sensitivity of the infectious agent to a specific group of antibiotics. A course of hormonal therapy is often prescribed. In case of adhesive disease, surgical treatment is required to remove adhesions.

What is uterine endometritis in simple terms? What types of endometritis are there?

Endometritis of the uterus, in simple language, is inflammation in the internal mucous layer. Very often you can find this disease together with the inflammatory process of the muscles of the uterus. According to the International Classification of Diseases, 10th revision (ICD-10), endometritis has code N71, which means inflammatory disease of the uterus.

What does endometritis mean? The ICD code deciphers this disease as a simple inflammatory disease, nothing more.

The endometrium is the inner mucous layer of the uterus. It protects the uterine cavity from infections. Throughout the cycle, the endometrium changes its structure. Each month it grows and matures anew, preparing for the attachment of a fertilized egg. If pregnancy does not occur, the endometrium is rejected.

If the uterus is covered with an internal mucous layer, then pathogens have practically no opportunity to get inside. But in certain situations and reduced immunity, the endometrium can become inflamed. Inflamed endometrium will bring mass discomfort. It is almost impossible to determine this disease specifically. early stages. Endometritis can only be recognized after undergoing a complete examination of the reproductive system.

The endometrium becomes most vulnerable during menstruation. At this moment, it is easiest for infectious agents to enter the uterus. Sometimes infections spread from the endometrium to fallopian tubes.

Most often, the disease occurs due to infectious agents that enter the lower parts of the reproductive system. What does endometritis mean? A forum from a women's site interprets it as a disease of the reproductive system.

Types of endometritis

Like any disease, endometritis is divided into several main types. Each species is characterized in its own way and has its own distinctive features. The diagnosis of endometritis of any kind is quite difficult. Depending on the nature of the infectious agent, endometritis is divided into:

• nonspecific;
• specific.

Nonspecific endometritis occurs due to non-standard reasons. On medical forums about endometritis, there are several ways in which a nonspecific form can appear. It could be vaginosis or HIV. With the second, everything is very clear. With low immunity, it is easy for pathogens to penetrate the uterus and begin their development. With vaginosis, an ideal microflora appears for all infections. The pathogen, getting inside, begins to actively move towards the endometrium. But there are also reasons that may seem to have no effect on the appearance of endometritis. These include the use of intrauterine contraceptives and radiation therapy. Intrauterine contraception includes IUDs. They are installed to prevent pregnancy. Modern spirals do not in any way affect the condition of a woman’s genital organs. The only way endometritis occurs is through the rejection of the coils. Still, the spiral is a foreign body that can cause the appearance of favorable microflora for the development of diseases. As for radiation therapy, everything is simple. A woman who is exposed to radiation becomes vulnerable to any infections. When irradiated, human orgasm cells may die and mucous membranes become weaker. The weaker the endometrium, the easier it is to catch the disease. In this way, inflammation forms, that is, endometritis. No matter how you get the infection, the essence of the disease will not change.

As soon as bacteria and fungi enter the mucous membranes, they begin to actively multiply. Subsequently, inflammation appears.

According to the course of the disease, they are distinguished:

• spicy;
• chronic.

Acute endometritis is a very dangerous look diseases. At its core, it is an infection of the inner mucous membrane of the uterus. The basal layer of the endometrium is mainly affected. If this type of disease is not detected in time, the inflammation process will begin to spread throughout lymphatic vessels. This can lead to general inflammation of the reproductive system.

Chr. endometritis (ICD 10 code N71.1) occurs due to systematic manifestations of the disease. When infections or harmful microorganisms constantly enter the uterine mucosa, it begins to constantly become inflamed. As a rule, women do not pay attention and begin to take conventional anti-inflammatory drugs, which in turn slightly heal the inflammation. Such drugs do not eradicate the source of the disease. With systematic inflammation of the endometrium, the disease becomes chronic. Chr. endometritis (ICD-10 N71.1) manifests itself in disruption of menstrual cycles and reproductive function. More than half of sick women experience either too heavy periods, or vice versa. complete absence. Also, almost all women experience discomfort during sexual intercourse, after which slight bleeding may be observed. In ICD-10, chronic endometritis is coded N71.1. Chronic endometritis is the most dangerous of all types. There are cases when it occurs against the background of the appearance of diseases that are sexually transmitted. This particular type of endometritis, judging by reviews, can lead to spontaneous abortions in the early stages. Systematic inflammation can lead to infertility. If you are diagnosed with endometritis, you need to rush to the hospital urgently! In the clinic, endometritis will be cured quickly and effectively, and without adverse reactions.

What types of endometritis are the most dangerous? It is difficult to answer this question. But doctors advise paying special attention to the chronic form. It is quite difficult to cure. Chronic endometritis is more likely to heal over a certain period of time. With this type of disease, it is strictly forbidden to overcool! Any violation of the mucous membrane will lead to exacerbation of endometritis. Women who have treated endometritis all their lives give rather mixed reviews about this type of disease.

Endometritis is treated comprehensively in clinics. In general, this disease is not particularly dangerous. With the right approach, treatment will go quickly, and the disease itself will not bring much discomfort. The main rule for inflammation of the genital organs is to consult a doctor in time and start treatment!

In order to understand the essence of endometritis, it is necessary to reveal the reasons for its occurrence.

Causes of uterine endometritis

The causes of endometritis in women are very controversial. The main one is the contact of pathogenic bacteria and microorganisms with the inner mucous membrane of the uterus. This is especially true for women with low immunity. There have been cases when microbes entered the endometrium through damage. The causes of uterine endometritis are so commonplace that 80% of women around the world are at risk.

The endometrium can be damaged by:

• careless use of a syringe;
• improper use of a hysteroscope by a gynecologist;
• abortion;
• X-ray or ultrasound hysterosalpingography;
• carrying out a uterine probing procedure.

You need to insert the syringe into the uterine cavity very carefully. At the same time, we cannot forget about hygiene. You need to wear medical disposable gloves to avoid introducing bacteria to the mucous membranes. It is also necessary to carefully inspect the syringe device to see if there are any sharp points on it. If the syringe is smooth, then you can begin the procedure.

A hysteroscope is used to examine the uterus or look for diseases. The treating gynecologist should administer it carefully and rather slowly. This is to avoid damaging the inner mucous membrane.

Often after an abortion, a woman's uterus is scraped out. This is probably the main risk factor for endometritis. When performing an abortion, metal forceps are used, which can easily snag the endometrium. Important to remember! After an abortion, it is necessary to carefully observe the rules of hygiene. As a rule, even with an abortion in the early stages and hygiene, inflammation may appear. This is due to the fact that the uterine cavity is still subject to mechanical violations of its integrity.

You can also name the main risk factors for postpartum endometritis. This could be a rupture of the vaginal cavity, or a bacteria that has entered the uterus through the blood.

When identifying diseases of the fallopian tubes and the uterus itself, the method of hysterosalpingography is used in medicine. Its essence is that the doctor introduces special substances into the uterine cavity using a cannula and takes a picture. The image will show how the substances react with the uterine space. In this way, the disease can be identified. Substances that are administered can irritate the mucous membrane and thus cause inflammation.

Probing is a minimal intervention. But it is important to remember that it is the probe that can easily introduce microbes into the uterine cavity, so when carrying out this procedure you must follow the rules of antiseptics!

Ways infections enter the uterine cavity

As has already turned out, the causes of endometritis are closely related to mechanical disorders of the uterine cavity. It remains to be understood how infectious agents penetrate the damaged endometrium and cause inflammation.

There are three main ways:

• hematogenous;
• lymphogenous;
• ascending.

The hematogenous method involves infection through the blood. Once they enter the circulatory system, viruses and fungi begin to spread quite quickly throughout the body. As for the uterine cavity, it is very easy to get an infection there. For example, while performing an abortion, the gynecologist hooked the endometrium with forceps. This did not bring any pain, and even after curettage, the woman would hardly have been able to feel it. It turned out to be a small wound. Minimum deviation from general rules hygiene will lead to the internal mucous membrane becoming inflamed. If you do not immediately consult a doctor, the occurrence of endometritis is inevitable. The causes of endometritis after childbirth are precisely hematogenous in nature.

It is even easier for infection to penetrate through lymph than through blood. That is, it is enough for the pathogen to penetrate the uterine cavity and settle on the mucous membrane. Then it's a matter of time. Minimal hypothermia or poor personal hygiene can lead to endometritis.

The ascending method of infection is the most common. It is caused by the fact that the infection moves to the endometrium from the cervix or through the vagina. The vagina is the most accessible place for infection. You can even get it from a non-sterile swab.

Why endometritis occurs can be answered simply. It occurs due to any little thing that is unnatural for the environment of the uterus.

Causes that lead to the development of endometritis

Endometritis can occur without obvious disorders of the uterine cavity. For its development, it is enough for the infection to get inside and a favorable environment for its development.

Causes of infection:

• avitaminosis;
• failure to comply with intimate hygiene rules;
• chronic infections;
• installation of a spiral;
• improper cesarean delivery;
• abortions;
• sexual contact with a carrier of infections;
• sexual intercourse during menstruation.

Vitamin deficiency is one of the main reasons for the penetration and development of bacteria. Reduced immunity makes the body very vulnerable and creates a favorable environment for the development of various diseases and inflammations.

In order for the uterine mucosa to be in perfect order, you need to constantly monitor hygiene. This is especially important during menstruation. It is during this period that the uterus becomes more accessible to bacteria. The risk factors for endometritis as a disease are so unlimited that the disease progresses in magnitude every year.

Abortion often leads to inflammation of the endometrium. This is due to the fact that when performing curettage, forceps can very easily damage the delicate lining of the uterus.

You can also get a basket of bacteria through unprotected sexual intercourse with a partner who is a carrier of the infection. If semen that is infected gets into the uterus, you need to immediately understand that it will not be possible to avoid inflammation!

Chronic endometritis - treatment before IVF: causes, symptoms

The causes, treatment, symptoms of which will be similar.

>Chronic endometritis occurs due to systematic inflammation of the endometrium. With constant infection, as well as reduced immunity, sooner or later endometritis will become chronic. This form often develops from postpartum endometritis.

The cause of acute endometritis can be any inflammation of the uterus. All kinds of pathogens that enter the uterus can easily cause acute endometritis. Endometritis is the cause of infertility in many women.

Postpartum endometritis can often be found. This is due to the fact that during the birth of a child, the walls of the uterus and vagina are subject to high pressure. This means that the paths are mechanically damaged and become vulnerable. Any infection can cause inflammation of such pathways and rise to the endometrium.

In 2 cases out of 100, endometritis becomes the cause of female infertility! But by considering the signs and symptoms of the disease, you can try to avoid its development.

Endometritis of the uterus. Symptoms and treatment in women. Reviews

It is quite difficult to detect endometritis in the early stages. The combination of symptoms and signs of this disease may lead you to the pharmacy for anti-inflammatory drugs, but not to the gynecologist or infectious disease specialist. Symptoms of endometritis in women after 30 years of age may become more intense.

When you come for an examination to a doctor, you need to be prepared that he will ask a number of questions to determine the advanced stage of the disease. The main list of questions consists of:

• When did the pain start?
• Have you ever been pregnant?

By answering these questions truthfully, the patient helps the doctor determine the extent of the disease, on which the treatment of endometritis will depend. All signs of this disease can be divided into 2 main blocks: indirect and symptoms.

Indirect signs of endometritis

Indirect signs can be seen on ultrasound; they are also called echographic. Sonographic signs of endometritis on ultrasound can be seen with 100% accuracy. An experienced doctor receives the second block of indirect signs when interviewing a patient. Echo signs are determined by the following criteria:

• Increase in the size of the uterus;
• Presence or absence of adhesions.

If, during an ultrasound procedure, the doctor notices an increase in the size of the uterus in the first days of the cycle, this may indicate the presence of a disease. From any type of inflammation, the cavity itself begins to gradually increase. The enlarged uterus begins to put pressure on the organs of the urinary system. Hence the pain and constant desire to go to the toilet.

Endometrial thickness – important indicator physical health women. The endometrium can be divided into two layers: functional and basal. The first one is rejected every month, and later regenerated. Throughout the cycle, the thickness of the endometrium gradually increases. It is thinnest in the first 7 days of the cycle, and its thickness varies from 3 to 7 millimeters. In the following days it grows and by the end reaches 13 millimeters. If this does not happen, then the doctor may suspect an inflammatory process.

The presence of adhesions on the uterus may also indicate the presence of the disease. Adhesions can damage the integrity of the endometrial structure, thereby causing inflammation. On the other hand, with severe inflammation internal cavity connecting adhesions may appear in the uterus.

It is quite difficult to determine a specific disease based on these signs. At this stage, the doctor may suspect symptoms of sluggish endometritis. Reviews about this type of disease can be confused with any other. Sluggish endometritis does not bother the patient. This type of endometritis is also found in cats. At first it is in a sluggish stage, but later flows into other stages. The animal may experience blood in its discharge, hair loss, and decreased appetite.

Endometritis of the uterus - symptoms, treatment

Besides clinical symptoms, which are determined in the hospital, there are a number of sensations that can lead to examination.

So, endometritis of the uterus in women can manifest itself in this way:

• severe, constant pain during menstruation;
• pain in the sacral spine;
• itching in the perineal area;
• pain in the pelvic area;
• constant violations menstrual cycle;
• sexual dysfunction;
• anorgasmia;
• temperature increase on a constant basis;
• frequent urination.

At first glance, these symptoms can be confused with any other disease of the pelvic organs. But, as a rule, with endometritis, these symptoms occur together. During menstruation, a woman may experience aching and nagging pain. They are similar to the pain of a cold in the pelvic organs, but more severe.

Itching in the perineal area manifests itself precisely due to the fact that inflammation from its source has begun to spread to other areas. The sacral spine begins to ache due to an increase in general body temperature and a decrease in immunity. The pain can be either nagging or sharp at certain intervals. Endometritis is a common disease in cats. Symptoms of endometritis in cats are similar to those in humans. On different forums, the symptoms of endometritis are described differently.

One of the most distinctive features endometritis is a decrease in libido. This is due to the fact that the inflamed endometrium gives a signal to the brain that the disease is developing in the uterus. The female body is ready to be fertilized throughout its entire existence in reproductive age. Reviews about the symptoms and treatment of endometritis in this form are ambiguous. This is due to the fact that the brain sends back signals that the egg cannot be fertilized as inflammation occurs in the uterus. Thus, a woman's overall libido decreases. Many young ladies have repeatedly noticed that with endometritis they do not experience orgasm.

Vaginal discharge as the first sign of endometritis

Vaginal discharge is normal in Everyday life. As a rule, discharge begins in the second half of the cycle, when the egg is ready for fertilization. After this, their abundance decreases and preparation for menstruation begins. But the nature of the discharge can say a lot about the absence or presence of diseases. Vaginal discharge is not always clinical signs of endometritis in women

The following discharges are typical for endometritis:

• thick;
• with a yellowish tint;
• with admixtures of blood.

Since the mucous membrane is inflamed, there is more discharge. In this case they perform protective function. During inflammatory process they are yellowish in color, sometimes mixed with pus. Pus appears with acute endometritis or when infection occurs due to a fungus.

The situation is worse if at any time during the cycle there is discharge mixed with blood. No, it’s not a lot like during menstruation. On average, you can notice about 1 drop. But this is quite enough! Before blood appears in the discharge, there is usually a strong tug in the lower abdomen, so a woman may think about the onset of premature menstruation. Blood in the discharge often indicates that endometritis has passed from a standard state to a chronic one. If this phenomenon occurs more than once, then you need to urgently go for examination to a doctor!

Chronic endometritis. Symptoms Treatment

Symptoms of chronic endometritis may be absent for a long time. The disease can rarely be identified at first. Symptoms will be similar to other diseases of the pelvic organs. Sometimes women feel some changes in the body, but do not attach much importance to it. Many people consult a doctor already at the stages when the pain becomes constant and disturbing. Often doctors can detect chronic endometritis in a woman already at the stage when the person cannot conceive.

Signs of chronic endometritis

The main signs of chronic endometritis in women include:

• Menstrual irregularities;
• Blood content in secretions;
• Frequent pain in the lumbar region;
• The content of pus in the discharge during menstruation.

Bloody discharge before and after menstruation may be various types. On women's forums, the symptoms of chronic endometritis are described exclusively by bloody discharge. For some they will be abundant, for others they will be only slightly smearing. Both options are nothing more than a deviation from the norm. They mean that both the mucous membrane layer and the muscular part of the uterus are involved in the process. The process of mucosal restoration slows down, which leads to prolonged menstruation, and sometimes to blood clotting disorders due to changes in the properties of platelets. Patients who complained of frequent bleeding not associated with menstruation were often diagnosed with chronic endometritis. Periodic nagging and aching pain in the lower abdomen. They can vary in intensity from very weak to significant. The pain usually becomes more severe in the premenstrual period. Sometimes they radiate to the perineum, lumbar region, rectum and are accompanied by a feeling of fullness, heaviness, and heat. May intensify when palpating the abdomen and gynecological examination. Mucopurulent vaginal discharge with an unpleasant odor during the period between menstruation. This is due to a weakening of the protective secretory properties of the epithelial cells of the vagina and cervix. TO general symptoms may include: apathy, depression, fatigue.

Indirect signs of chronic endometritis on ultrasound

Indirect signs can be seen on ultrasound; they are also called echographic. Echo signs are determined by the following criteria:

• Increase in the size of the uterus;
• Determination of endometrial thickness;
• Presence of growths on the uterus

It is impossible to recognize the echographic signs of chronic endometritis on your own!

Signs of chronic endometritis of various forms

Chronic endometritis comes in two main forms. Both forms can lead to infertility.

• Active;
• Latent.

The active form is chronic inflammation of the uterine mucosa or, in other words, catarrhal endometritis. It is located in the muscular cavity of the uterus, which in turn fits tightly to the endometrium itself. If a diagnosis of chronic endometritis is made in catarrhal form, then circulation in the affected tissues is immediately disrupted. Blood begins to circulate slowly through the vessels, and blood clots may form in this area. At the very beginning, the disease does not go beyond the endometrium, but if treatment is not started in time, it smoothly spreads to neighboring organs. Symptoms of exacerbation of chronic endometritis can be observed precisely with this form of the disease.

The latent form can occur due to various infections. It could be bacteria, fungi, etc. If the disease manifests itself before pregnancy and childbirth, then it poses a real threat to pregnancy and conception. It is the latent form of chronic endometritis that can lead to infertility.

This is because this form of the disease is difficult to recognize. Endometritis may not make itself felt for many months. But the slightest irritation is enough for a woman to see a doctor. If chronic endometritis appears in a woman already during pregnancy, then there is a real threat of miscarriage or even death of the fetus. Symptoms of chronic endometritis in women who are pregnant are most pronounced. In 80% of cases, chronic endometritis occurs in a latent form, and it is almost impossible to detect it on your own.

If you do not consult a specialist in time, small cysts may form in the uterine cavity. Sometimes you may notice heavy bleeding during menstruation. If it doesn’t look at all like your usual discharge, then you need to go to the hospital immediately!

Morphological signs of chronic endometritis suggest the appearance of formations in the uterine cavity.

With sluggish endometritis, adhesions may form. Need to know! A woman will be able to get pregnant in this form, but problems may arise with pregnancy.

The following morphological variants of chronic endometritis are distinguished:

• Atrophic;
• Cystic;
• Hypertrophic.

In the first option, muscle tissue is gradually replaced by connective tissue. This means that the endometrium ceases to perform its functions. This will lead to infertility in the future. To avoid this, you need to start treatment with special devices.

The cystic variant, as a rule, appears from the introduction of fungal and bacterial infections. Small cysts begin to grow on the endometrium and subsequently move into the uterine cavity. If cysts on the endometrium are not seen in time, it begins to thicken and women have a reduced chance of pregnancy. Signs of inflammation of chronic endometritis are very easy to detect. At a minimum this is sharp increase body temperature.

The hypertrophic variant of chronic endometritis is one of the most complex. In this case, the endometrial walls gradually become very dense and close the uterine cavity. Firstly, it prevents a woman from getting pregnant. Even if conception has occurred, it is almost impossible to carry a child in such a cavity. In addition to the fact that the cavity itself becomes small, the woman also constantly feels nagging pain. It is with this option that a constant desire to go to the toilet begins.

Signs of chronic endometritis during hysteroscopy

Hysteroscopy is used to examine the uterus when various diseases. Chronic endometritis is no exception. Using a hyteroscope, you can see signs of the disease such as:

• endometrial thickening;
• presence of adhesions.

As a rule, using a hyteroscope, you can check the uterus exclusively in the second period of the cycle. At this time, the endometrium has a maximum width, the density of which should not exceed 15 millimeters. If the endometrium is larger, then a repeat examination is necessary.

If the study does not give a positive answer to chronic endometritis, then it is worth checking for the acute form of the disease.

Acute endometritis. Symptoms

Acute endometritis rarely occurs from viruses or bacteria. Usually its occurrence is associated with surgical intervention into the uterine cavity. This could be abortion, childbirth, installation of an IUD, or other operations.

The main symptom of acute endometritis in women is a sharp increase in body temperature. At the time of exacerbation of the disease, it rises to 38.5-39 °C.

Indirect signs of acute endometritis

Saw indirect signs endometritis, one cannot say 100 percent that this is the same disease. But it is worth paying attention to the following:

• Sharp pain in the lower abdomen;
• High temperature that does not subside;
• Nausea, vomiting;
• General weakness.

These signs may indicate half or even more diseases of the genital organs. The thing is that after surgery in the uterine cavity, the endometrium is damaged the most. And the slightest pathogen is enough to cause symptoms of acute endometritis after 2-3 days. It is worth paying attention to such a sign as heat. Usually, after manipulation of the uterus, the body temperature in the female body rises to 37. This indicates that some kind of inflammation has appeared inside. This temperature can last for about 7 days. If during this period it has not risen higher, then there is nothing to worry about.

Symptoms of acute endometritis

The main symptoms of acute endometritis are:

• Purulent vaginal discharge;
• Constant cramps in the lower abdomen;
• Lack of appetite;
• Bloody discharge with an unpleasant odor.

Particular attention should be paid to such a symptom as discharge. If they suddenly begin to become unpleasant purulent smell, and they also contain blood impurities, then you need to quickly consult a doctor.

Similar symptoms may occur with endometritis after caesarean section.

Endometritis after cesarean section. Symptoms and treatment

Endometritis after cesarean section can manifest itself in three forms. With each form, a woman can notice various symptoms and signs. Forms of acute endometritis after cesarean section:

• latent;
• open;
• erased.

Symptoms of endometritis after cesarean section in latent form

The latent form is the most unpredictable. Immediately after a cesarean section, a woman does not feel any signs of inflammation. Accordingly, the woman in labor has no idea what to expect.

Signs of endometritis after cesarean section in latent form:

• increase in temperature on day 7;
• lethargy;
• lack of appetite;
• increase in the number of discharges.

Signs of inflammation in latent form are quite ambiguous, rather reminiscent of a common cold. It is worth paying attention to the quantity and quality of discharge. In this form, they may resemble a thick, translucent mass with purulent residue.

As a rule, pus must be present in them. This is due to the fact that the damaged endometrium cannot heal on its own and the wound begins to slowly fester.

Signs of acute endometritis in open form

Acute endometritis in open form appears almost immediately after cesarean section. Its symptoms are noticeable even to the woman in labor already 1-3 days after the operation. This form of acute inflammation is the easiest to recognize and therefore the easiest to eliminate.

Symptoms open form acute endometritis:

• a sharp increase in body temperature;
• severe cutting pain in groin area;
• nausea, vomiting;
• the appearance of brown blood clots in the discharge.

You need to immediately pay attention to the nature of the discharge and the sharp increase in temperature. A woman’s condition can worsen literally hourly. As soon as the temperature reaches 39 degrees, the woman in labor may begin to feel sick, and with this, cutting pains appear in the groin area. After the pain, vaginal discharge may begin, which has the smell of dried blood. As a rule, small brown clots are present in these secretions.

Symptoms of acute endometritis in erased form

The erased form is the most ambiguous. It may appear more than 7 days after the operation. Its symptoms include the 2 previous forms. The worst thing is that a sharp deterioration in the patient’s condition is observed when she is no longer under the supervision of doctors.

Symptoms:

the temperature rise is no higher than 37.5 degrees, followed by a decline;

increase in the number of discharges;

nagging, intermittent pain in the lower abdomen.

This form of endometritis is insidious in that it has wave-like symptoms. Symptoms and treatment of endometritis after cesarean section in this form cannot be clearly named! After a sharp deterioration in the general condition of the woman in labor, its normalization is observed. A woman will never recognize her illness on her own. This form is not characterized by an increase in temperature to critical values, there is no chills, no drops of blood are released from the vagina, no pus comes out. In general, the woman’s condition is quite normal. A month after cesarean section, endometritis can take an acute form.

A woman diagnosed with postpartum endometritis may have similar symptoms.

Symptoms of postpartum endometritis

Postpartum endometritis occurs in 80% of women giving birth. It is characterized internal inflammation endometrium after mechanical damage. As a rule, during childbirth, bacteria can enter the uterine cavity. It is enough for them to settle on the wall of the uterus, and inflammation cannot be avoided. This is due to the fact that before childbirth the endometrium becomes quite thin, so it becomes easily inflamed. Postpartum endometritis manifests itself in 4 forms:

• light;
• moderate;
• heavy.

The signs and symptoms that characterize postpartum endometritis depend on the nature of its manifestation: compensated, decompensated, subcompensated.

Signs of mild postpartum endometritis

IN mild form endometritis occurs almost unnoticed by the mother in labor. A couple of days after giving birth, a woman’s temperature begins to rise, but not higher than 38 degrees. As soon as a woman begins to feel general weakness, the lower abdomen begins to pull. Many women in labor do not attach importance to this, since this is a normal condition after childbirth. If measures are not taken, then after a couple of weeks, discharge begins to appear, which contains clots of pus. This will be a clear sign of postpartum endometritis.

Signs of moderate form of postpartum endometritis

5-7 days after giving birth, a woman may experience intestinal upset, as well as a large amount of gas. In addition, the temperature gradually rises to 38 degrees or more. Standard symptoms include:

• general weakness;
• headache;
• lack of appetite;
• nagging pain in the lower back;
• discharge mixed with pus.

Purulent discharge almost always appears with the onset of postpartum endometritis. In this form they appear approximately 5 days after birth. Has a nasty rotten smell. Symptoms and treatment of endometritis after childbirth can only be indicated by the attending physician, depending on the complexity of the disease.

Symptoms of postpartum endometritis in severe form

A severe form of endometritis occurs approximately 7 days after birth. These signs of endometritis after childbirth are the most unpleasant of all. This endometritis is characterized by the fact that it often becomes chronic. A woman may not even immediately understand that she has inflammation.

It all starts with the woman’s body temperature gradually rising to 39 degrees. After this, the lower abdomen begins to feel like it is bursting. The lower back begins to burn. Clots of blood and pus appear in the discharge, and they have an unpleasant, rotten smell. The condition further worsens, but may improve dramatically. This is the whole trick of a severe form of endometritis.

Endometritis can only be diagnosed by visiting a doctor.

Diagnosis of endometritis in women

Diagnosing a disease such as endometritis is quite difficult. Therefore, its definition includes a number of stages, each of which is an integral component of the overall picture.

Diagnosis of acute endometritis includes:

• determination of the clinical picture;
• interviewing the patient;
• gynecological examination of the uterine cavity;
• transvaginal ultrasound;
• laboratory research, as well as endometrial examination;
• hysteroscopy.

Depending on the symptoms, the patient may not undergo, for example, hysteroscopy. Each case of this disease is unique and requires a specific approach.

Determination of the clinical picture

The clinical picture is determined by the totality of symptoms that the patient feels. In this case, it is important to determine the following points:

• when and how often body temperature increased;
• does the patient have any discharge and what type is it;
• what type of pain does the woman experience?

First, the doctor feels the lower abdomen. This is done with the goal of understanding what type of pain a woman experiences. If the pain is sharp, then endometritis is presumably in an acute form. If the pain is dull and aching, then endometritis may already be present. chronic stage or in a mild form.

The next step is to check your body temperature. If it is between 37 and 38 degrees, then the patient will have to stay in the hospital. One measurement will be of little use. Body temperature is rather an average indicator. It is difficult to describe the picture from it. It simply confirms the diagnosis, but it is impossible even for a very experienced doctor to make it using temperature.

Particular attention is paid to the type of discharge of a woman. There can be many or few of them, the color varies from light yellow to brown. It is the color and content of pus or blood that will help make the correct diagnosis, and therefore the correct treatment in the future. Based on the nature of the discharge, an experienced doctor can diagnose postpartum endometritis.

Patient interview

The patient is interviewed in order to understand how she could have developed endometritis and how long she has had the disease.

The main list of questions consists of:

• When did the pain start?
• Is the pain constant?
• Do you often experience an increase in body temperature?
• Have you ever been pregnant?
• Were there any abortions? On what dates?
• How often do you change sexual partners?
• Length of the cycle, and at what age did menstruation begin?

Important ones are questions 4,5,6. Pregnancy is one of the companions of acute endometritis. More likely not even pregnancy, but childbirth. This is especially true for women who have had a caesarean section. This category is more susceptible to this disease than others. Diagnosis and treatment of the etiology of postpartum endometritis according to the classification is quite difficult.

Abortions often cause the endometrium of the uterus to become damaged, hence endometritis. This is especially true for late-term abortions, when the uterus is curetted. If the abortion occurred in the early stages and took the form of, for example, a vacuum abortion, then most likely the disease can be avoided. But if the abortion was late, or even worse, with complications, then you will have to be treated.

The frequency of changing sexual partners, as such, does not affect the development of endometritis. This question is asked to understand whether the disease could have formed due to infection. It is impossible to accurately determine whether this is true without donating blood.

Gynecological examination of the patient

An examination is carried out to understand whether the endometrium has thickened. To do this, the patient is placed on a chair and a speculum is inserted into the vagina. At this initial examination, the gynecologist can see whether there is any inflammation at all, and to what extent it is. This is done in order to prescribe tests for the woman.

Transvaginal ultrasound

After the gynecologist has conducted an initial examination and has seen even a slight thickening of the endometrium, he gives a referral for a transvaginal ultrasound. It is carried out using a special device, the tube of which is placed in the vagina and passes deeper into the uterus. It is with an ultrasound that the doctor can determine the extent of the disease. The device will show how enlarged the endometrium is, and the degree of inflammation will also be visible.

Laboratory research

After the ultrasound, the doctor writes a referral for the patient to undergo tests. Tests include:

• smear;
• blood donation.

In the smear, you can immediately detect impurities of pus or blood, which will indicate endometritis. Blood is donated in order to understand at what stage the inflammation is. The number of leukocytes and red blood cells is checked in the blood. Thus, it is possible to determine acute and postpartum types of endometritis.

When considering methods for diagnosing endometritis, special attention should be given to the differential diagnosis of postpartum endometritis, as well as the immunohistochemical diagnosis of chronic endometritis.

Differential diagnosis of postpartum endometritis is carried out exclusively in cases where endometritis is acquired sexually. This means that the doctor can determine the type of disease, but not the bacteria or microbe that caused it. Therefore, this method is also called differential diagnosis.

Immunohistochemical diagnosis of chronic endometritis is carried out exclusively in cases where endometritis is chronic. Diagnosis of endometritis and endometriosis is thus only possible with the help of the latest equipment. This method includes analyzes using special indicators. They show what stage the disease is at.

Diagnosis of endometritis in women in acute form

Acute endometritis is the easiest to diagnose. In order to understand that a woman is sick with it, it is enough to take a smear and determine the nature of the patient’s pain. As a rule, a smear will show the presence of blood clots or pus in the discharge. Also, to determine the diagnosis of acute endometritis, interviewing the patient will help. Echo signs of endometritis will not help determine the stage of the disease!

Acute endometritis endometritis is treated in any clinic; for this, the etiology of the disease is determined and only then complex treatment is prescribed. Diagnosis and treatment of the etiology of endometritis in the clinic is carried out by doctors.

Treatment of any type of endometritis is a complex set of measures. In no case can you independently determine the medications that will help. Treatment is prescribed only by a doctor!

Treatment of uterine endometritis

The treatment regimen for endometritis can be carried out in three ways:

• folk remedies;
• medications for the treatment of endometritis in women;
• local means.

Very often, treatment of endometritis involves a set of actions that are aimed at eliminating the problem. This complex includes the use of medicinal herbs and topical remedies. Almost all urological and infectious diseases are treated in this way. During treatment, the first thing to remember is full compliance with the rules of hygiene. Since endometritis often causes vaginal discharge, you need to buy and remember to wear special medical pads. They usually consist of two-layer material. The first layer is thin, it protects against leakage, the second is denser, and usually contains a treatment strip. These gaskets effectively protect against fungi and bacteria. The treatment regimen for endometritis in women can occur either in one way or in combination!

Treatment of endometritis with folk remedies

It should be noted right away that it is impossible to treat the acute form of endometritis in this way! So there are a number folk recipes for treatment:

1. The first method is based on treatment with bay leaf. To do this, you need to take a bunch of dry bay leaves and pour them into any container that can be placed on the stove. Add about 4-5 liters of water to the container and put on fire, boil for 5 minutes. After this, remove the broth from the heat and place it on the floor. The liquid should stand for about 20-30 minutes, but not until it cools completely. After this, pour the broth into a bucket and sit on it. You can sit for about 10 minutes. This remedy copes very well with inflammation of the pelvic organs, and also relieves painful sensations. It is recommended to carry out the procedure for about 2 weeks.
2. One of the oldest is the treatment method using sea buckthorn oil. To do this, you will need to buy a sterile bandage, cotton wool and oil at the pharmacy. The cotton wool needs to be wrapped in a bandage and soaked in oil. Use this tampon every day for 10 days. Sea buckthorn eliminates inflammation well and heals the endometrium (if it has been damaged).
3. An infusion of St. John's wort can quickly and effectively treat the initial stage of endometritis. You need to buy 20-30 grams of dry grass sprigs. Pour 500 milliliters of boiling water over them and let cool. You need to take this tincture 3 times a day after meals.
4. The easiest way to cure endometritis is with citrus fruits. To do this, you need to take a large glass of dried oranges and lemons. Next, they need to be ground on a grater or meat grinder. Then 10 drops of onion juice and 10 grams of sugar are added to this dry mixture. After this, using a blender, the mixture must be turned into a homogeneous paste. You need to take this remedy 4 times a day. The course of treatment lasts from 14 to 18 days.

Galina Alekseevna asks:

Can chronic endometritis be cured?

The choice of antibiotics in the treatment of this disease is a complex process. It is most rational to be guided by data obtained by growing bacteria on special media, which can show the sensitivity of pathogens. Otherwise, the attending physician prescribes antibiotics depending on the suspected pathogen. Maximum effectiveness is observed with intrauterine administration of antimicrobial drugs, when the drugs completely reach the infectious foci.

Symptomatic remedies.

When treating chronic endometritis, sometimes there is a need to use symptomatic therapy, the main goal of which is to normalize the patient’s current condition.

The following is used as symptomatic therapy:

• desensitizing agents;
• sedatives;
• painkillers.

Surgery.

Surgical treatment may be necessary to remove intrauterine contraceptives, which can sometimes trigger the development of chronic endometritis, as well as to cut intrauterine adhesions.

To speed up the recovery of the endometrium and improve menstrual and reproductive function, spa treatment is often recommended. With timely and adequate treatment The prognosis for this disease is quite favorable.

Often, as a result of difficult childbirth, complicated abortions, infertility, miscarriage, and various gynecological interventions, women are faced with a diagnosis of endometritis. Currently, the vast majority of cases of the disease, if treated in a timely manner, can be successfully treated and are completely cured.

Endometritis– inflammation of the inner mucous layer of the uterine body (endometrium). The development of inflammation in the endometrium is provoked by viruses and various opportunistic microorganisms: gonococci, coli, staphylococci, streptococci, chlamydia and trichomonas. This disease is quite common and is often accompanied by inflammation of the muscle tissue of the uterus.

Description and types of endometritis

With this disease, a very important part of the functioning is affected. female body the inner mucous membrane in the uterine cavity, its most fragile and sensitive upper layer is the endometrium. There are many factors for the occurrence of the disease, as well as its varieties.

According to the form of manifestation, the disease occurs in:

• Acute, which mainly manifests itself immediately after infection with pathogenic bacteria or pathogenic viruses as a result of mechanical damage and is characterized by severe symptoms.
• Subacute, which can develop as a complication of acute endometritis. Typically occurs in patients with weak immune systems. At this stage, the disease develops into a chronic form. It is urgent to start treatment because it is subacute form E. can lead to female infertility. During treatment, the doctor prescribes antibiotics, complex preparations from medicinal plants, physiotherapeutic procedures.
• Chronic (latent) form. Chronic E. develops as a result of infection with infections that are transmitted through sexual contact. The patient may not be aware of her problem. The disease is often discovered after a comprehensive infertility examination.

By etiological principle All forms of endometritis divided into:

• Specific. This disease, which affects the mucous layer of the uterus, is caused by strictly defined types of microorganisms - tuberculosis bacteria, herpes simplex viruses, pathogens of toxoplasma, mycoplasma, gonococci, candida, protozoa, cytomegaloviruses, fungal flora. Also the causative agents of ailments are diseases that are sexually transmitted.
• Nonspecific. All other forms of disease in the uterine cavity, when it is not possible to detect a specific pathogenic pathogen of opportunistic microflora, are nonspecific.

Causes of endometritis

There are quite a large number of causes of infection of the uterine cavity by various bacteria. Often the cause of the disease is minimally invasive diagnostic procedures, so you can catch the disease even while staying in a medical institution.

Infection is promoted by:

• Poor personal hygiene.
• Non-regular sexual partners. Often, the infection enters the uterine cavity from the vagina during casual sexual intercourse and unprotected sexual intercourse with a carrier of the infection.
• Weakened immune system.
• Gynecological interventions. Abortions, medical and diagnostic curettage, probing the uterine cavity can become a factor of inflammation.
• Hysteroscopy or endoscopic interventions. When performing microsurgical manipulation for the purpose of diagnosis, it is also possible to get inflammation of the uterine cavity.
• Mechanical injury to the integrity of the uterus and cervix during childbirth. Sometimes, after labor is completed, the placenta is not born and the doctor has to scrape it out, damaging the inner lining of the uterus.
• Deep postpartum tears in the cervix.
• Dishormonal disorders.
• Concomitant chronic diseases.
• Installation of the IUD. Often, after the installation of intrauterine contraceptives, as a result of injury to the cervix, the inner mucous layer of the uterine body becomes inflamed.
• Physical intimacy during menstruation without protection. Sexual contact during menstruation, even with a healthy partner, can become a factor in the development of endometritis.
• Chronic stress conditions.

Main symptoms of endometritis

The disease in the initial stages can occur latently, without manifestation severe symptoms, so a woman cannot detect endometritis in a timely manner and consult a doctor for treatment. This is precisely what threatens serious consequences - female infertility, compaction of the walls of the uterine cavity, or the formation of intrauterine adhesions. Severe symptoms are characterized by an acute form of endometritis.

Symptoms of manifestation acute endometritis :

• Increase in body temperature to 38-40° C.
• Weak painful sensations in the lower abdomen of an aching or pulling nature, radiating to the sacrum or lower back.
• Bleeding from the uterus.
• Changes in the menstrual cycle. Observed during the transition from acute to chronic form.
• Copious vaginal discharge. Cloudy discharge resembling clots and containing blood and pus with an unpleasant characteristic odor.
• Deterioration in general health.

Symptoms when chronic endometritis :

• Vaginal discharge. In this form, they correspond in smell and color to the causative agents of the disease. With trichomoniasis, the discharge is copious and foamy green. With gonorrhea - cloudy yellowish-green mucous discharge.
• Changes in the length of the menstrual cycle. Heavy and prolonged periods are observed, more than seven days.
• Spotting at the beginning and after the menstrual cycle.
• Minor or, conversely, copious discharge during menstruation.
• Repeated spontaneous cases of termination of pregnancy before the natural term.
• A woman’s inability to conceive a child for a long time (infertility).
• A weak and fleeting feeling of pain in the lower abdomen.
• Increased body temperature, often subfebrile, within 37.2° C.

Diagnosis of endometritis

When you first contact the doctor, based on clinical signs and a medical history, a presumptive diagnosis of endometritis is established. At this stage, the doctor asks about all the symptoms that worry the patient.

In addition to this information, a number of activities and laboratory tests are also carried out:

1. On a gynecological chair, the uterus is examined and the discharge is assessed by smell, quantity, color.
2. Examination of a vaginal smear for bacterial culture. Based on the results of bacteriological examination of a vaginal smear, it is possible to more accurately determine the infectious causative agent of the disease and its reaction to various medications.
3. Collection and immunohistochemical examination of a vaginal smear. It is carried out to detect infection and the number of leukocytes in the smear.
4. Blood test - general analysis.

If necessary and to establish accurate diagnosis Additional examinations are carried out:

• Diagnostic intrauterine curettage.
• Histological examination of the endometrium. To confirm the diagnosis of changes in the mucous membrane (the inner mucous layer of the uterine body).
• Ultrasound examination of the uterus and appendages of the female genital organ.
• Endoscopic examination.
• Enzyme-linked immunosorbent test for antibodies (ELISA). The test also helps identify sexually transmitted diseases.
• PCR diagnostics. Polymerase chain reaction is a highly accurate research method used to identify numerous specific infections.

This diagnosis of E. is quite sufficient, although various stages different diagnostic methods will be carried out for the disease. Patients with this disease and in order to avoid the likelihood of developing complications of a septic nature in the form of pelvioperitonitis, peritonitis, undergo treatment in medical institutions in a hospital setting.

Features of endometritis treatment

The treatment regimen for the disease depends on the results of the examination. With properly selected treatment, this disease can be completely healed in a week, and women who are faced with the disease will have a chance to become pregnant and give birth to completely healthy babies. As a rule, treatment is carried out with broad-spectrum antibiotics.

For successful treatment used drug treatment in combination with physiotherapeutic treatment, vitamins and agents that improve microcirculation, hormonal drugs are prescribed if necessary. As an addition to traditional therapy prescribed by a gynecologist, timely treatment use traditional medicine.

Treatment of endometritis with drugs.

When treating E., a qualified doctor first of all prescribes antibiotics, which help relieve inflammation and reduce discharge. In addition, antibacterial therapy, which is best performed in the early stages of detection and course of the disease. Patients are often prescribed protected drugs.

If the disease is not very severe, the doctor may prescribe antibiotics, during which the woman can even continue breastfeeding the child. If the pathology is severe, you will still have to stop breastfeeding and undergo treatment with strong antibiotics.

The drugs are usually prescribed in tablet form, administered through IVs, or intravenous injections, and also local remedies, allowing you to get rid of itching and burning sensation in the vaginal area.
In addition to antibiotics, an experienced doctor may prescribe the use of antifungal drugs in parallel.

Basic medical supplies in the treatment of endometritis:

• Antispasmodics. A group of medications that eliminate painful attacks of spastic pain. In a hospital setting, the patient is administered the drug twice a day. Medicines reduce pain in the lower abdomen and sacral spine.
• Antibiotics. In the early stages of the development of the disease, antibiotics with a diverse range of effects are prescribed. In a medical facility, these drugs are administered by injection. When treated at home, they are prescribed in tablet form.
• Antifungal medications. If necessary, the prescription of antibiotics is combined with the simultaneous use of antifungal drugs, due to possible risk development of candidiasis.
• Antipyretic. Such drugs are prescribed when the patient has an elevated body temperature.
• Agents that relieve swelling of the mucous membrane. To block histamine in the body, fairly effective and safe decongestant drugs are prescribed. These medications help reduce the size of the uterus, relieve inflammation and tissue swelling.

Treatment of endometritis with topical medications

If the disease was caused by an infection that is transmitted through sexual contact, in this case, in addition to antibiotics, the doctor prescribes topical medications. Candles and medicinal substances in the form of a suppository contribute quick deliverance from secretions and destroy pathogenic microorganisms directly at the source of infection.

Suppositories and ointments used in the treatment of endometritis:

• Preparations with the active substance – chlorhexidine, the action of which is aimed at combating bacteria, viruses and fungal diseases. Effectively used in the treatment of endometritis caused by microorganisms of the genus Trichomonas, opportunistic bacteria Gardnerella and chlamydia. Medicines in the form of suppositories are given twice a day. In the morning and in the evening before bed.
• Combined candles, universal action. These drugs are effective against pyogenic bacteria, fungi of the genus Candida, microorganisms of the genus Trichomonas and Gram (+) bacteria. Such a wide variety of effects of drugs is due to the substances contained in the suppositories. To cure E., medications are given two times a day for ten days.
• Drugs prescribed after ultrasound examination and confirmation of the presence of adhesions and severe inflammation in the uterine cavity. The drugs have antioxidant, pronounced immunomodulatory, anti-inflammatory effects. Thanks to the components included in the preparations, swelling of the uterus is reduced and adhesions are destroyed.
• Combined vaginal capsules. The suppositories contain antimicrobial and antifungal substances. The main advantage of the product is that its components do not cause disruption of the beneficial microflora of the vagina. Suppositories are used for E. caused by Gram (+) and Gram (-) microorganisms.
• Vaginal suppositories, actively used in gynecological practice. Thanks to the substances contained in their composition, the drug has a pronounced antimicrobial, antifungal, antiprotozoal effect, and also helps to accelerate the process of formation of the stratum corneum. The drug is used in the treatment of acute and chronic form E., the causative agent of which is infections transmitted through sexual intercourse.
• Suppositories containing iodine, which has an inhibitory effect on the growth and reproduction of pathogenic and opportunistic microorganisms. The drug is characterized by antiseptic, antifungal, disinfectant and antiprotozoal effects, and has a wide spectrum of antimicrobial activity. The medicine is effective against E., the development of which is provoked by fungus, viruses and bacteria (including Staphylococcus aureus and Escherichia coli), as well as protozoa.

Physiotherapy for endometritis

When E. for therapeutic effects on some organs or on the entire body, the use of physiotherapy is an important component of treatment, because it helps to improve the conductivity of drug therapy and the patient’s rapid recovery.

Physiotherapeutic treatment methods are prescribed to reduce pain (analgesic methods), relieve inflammation in the uterine mucosa and restore the structure of the endometrium (reparative and regenerative methods), and activate local immunity (immunostimulating methods).

Physical methods of treating patients with endometritis:

• UHF therapy. Anti-exudative technique with the effect on the body of high-frequency electro magnetic field and helps reduce the inflammatory process.
• Reparative and regenerative methods. The method involves carrying out procedures using laser therapy with infrared radiation on the area of ​​​​the projection of the uterus, paraffin therapy - using medical paraffin, iodide-bromine baths, radon baths, hydrogen sulfide, as well as peloid therapy procedures - limiting fluid secretion and tissue swelling, promoting the development of connective tissue and treatment with ozokerite therapy.
• The analgesic method is ultraviolet irradiation (UVR). Medium wave ultraviolet irradiation in erythemal doses. UVR of the vaginal mucosa leads to the death of most pathogenic microorganisms. The method will be especially effective if the cause of the disease is vaginosis.
• Immunostimulating methods: LOC therapy, heliotherapy, thalassotherapy treatment, SUV irradiation in suberythemal doses, air bath treatment.
• Interference therapy. The essence of the method is the effect of two currents on the human body mid frequency, which form the so-called interference low-frequency current, while having a positive effect on tissue. This therapy raises the pain threshold and thanks to this, subjective pain irritation disappears.
• Laser therapy. Exposure of the tissue of the mucous layer of the uterus to radiation of light waves of a certain length increases local immunity, improves microcirculation and promotes rapid healing of damaged tissue. Laser radiation also has a certain bactericidal effect, causing the death of pathogenic microorganisms.
• Magnetotherapy. Method alternative medicine using the influence of a magnetic field on the human body, it reduces the inflammatory process and swelling, improves microcirculation, increases metabolic processes in the mucous layer of the uterus, promoting rapid healing and restoration of damaged tissue. In addition, local immunity and other cells of the immune system are activated, and the protective forces of the female body are increased.
• Ultrasound therapy (UT). Exposure to ultrasound at a certain frequency causes a number of changes in the tissues of the body, promoting the activation and acceleration of metabolism. Microcirculation and tissue trophism also improve, connective tissue loosens, which prevents the formation of adhesions.
• Electrophoresis. The treatment procedure is aimed at penetration medicinal product deep into tissues under the influence of electric current using copper, iodine, zinc, 10% calcium iodide solution for the treatment of pain.

Although relatively harmless, physiotherapeutic procedures still have some contraindications that should be taken into account when prescribing.

The use of physiotherapeutic treatment of endometritis is absolutely contraindicated in the following cases:

• acute period of the disease;
• purulent E. (metroendometritis);
• pelvioperitonitis;
• during pregnancy;
• uterine bleeding;
• neoplasms (tumors in the affected area);
• polycystic ovary syndrome;
• when the internal mucous layer of the uterine body (endometrium) grows outside the uterine cavity.

In other cases, the use of physiotherapeutic treatment is decided by the attending gynecologist and physiotherapist.

Hormonal treatment

In view of the fact that the cause of inflammation of the internal functional lining of the uterus can be not only infections and bacteria, but also a disturbance in the processes of development and rejection of the mucous layer, the attending physician can schedule an appointment for three to six months hormonal drugs(usually oral contraceptives).

Taking combined oral contraceptives helps restore the menstrual cycle, and after a woman stops taking OCs against the background of the so-called contraceptive pill withdrawal syndrome, pregnancy can quite often occur.

Treatment with folk remedies

When treating E., gynecologists often prescribe traditional medicine to eliminate vaginal discharge. However, it should be remembered that if this disease was caused by quite dangerous microorganisms and viruses, then it will not be possible to cure endometritis without special help and taking medications.

With O.E. You cannot use treatment only with traditional medicine. ethnoscience To treat the disease, he offers douching with infusions or decoctions of medicinal herbs.

Recipes from traditional healers:

• Coltsfoot grass. Tannins contained in the plant have a pronounced antibacterial and anti-inflammatory effect. To prepare the decoction, pour 50 grams of crushed raw materials into one liter of boiling water and leave for four hours. After this, strain and take one tablespoon four to five times a day.
• Bay leaf. For medical procedure you will need 20 grams of dry raw materials. Pour the plant into a deep enamel container, add water and boil for about five minutes. Let the broth cool a little and sit on a bucket, wrapped in a terry sheet. Carry out the procedure before bedtime for two weeks. The decoction is excellent for inflammation of the genitourinary system.
• Stinging nettle leaves. The plant suppresses the inflammatory process, has an antimicrobial effect, stimulates metabolism in the body and improves contractile activity muscle walls uterus (myometrium). To prepare the medicine, pour one tablespoon of crushed raw materials into one liter of boiling water and leave in within three hours. Strain the broth and take one tablespoon of the broth four times a day, 30 minutes before meals and before bed.
• Sea buckthorn oil. This is an old and quite effective method. It is necessary to soak a cotton swab wrapped in a sterile bandage sea ​​buckthorn oil. Place the tampon overnight. The duration of treatment is two weeks. The oil relieves inflammation and helps heal the tissue of the cervix.
• Herb St. John's wort. To prepare the decoction, you need to pour 20 grams of dry raw material into half a liter of boiling water and simmer for about ten minutes over low heat. Ready product strain and take three times a day, 1/2 tbsp.
• Blueberries. A decoction of the berries of the plant inhibits the development of inflammation, has an astringent, antimicrobial and slight diuretic effect. To prepare the medicine, pour one liter of dried berries of the plant into one liter. cold water, bring to a boil and simmer for ten minutes. Cool the broth and consume 1/2 tbsp. (100 milliliters) 3 r/day.
• Forest hay. You need to place an armful of hay in a bucket and fill it with five liters of water. Bring to a boil and remove from heat. Place the patient on a bucket and wrap herself in a blanket. You need to sit until the broth cools. The duration of treatment is two weeks.
• Dried fern leaves. You need to pour 20 grams of raw material with 280 milliliters of cold water and boil for two minutes. Strain the finished broth and consume 70 milliliters three to four times a day. The duration of treatment is two weeks.
• Citrus fruits. Wash well and thoroughly dry one large orange and one lemon each. Grind tropical fruits in a blender or grind in a meat grinder. Add ten drops into the resulting mass. onion juice and 10 grams of sugar. Cover the jar with a lid and shake well. Take the drug one teaspoon three to four times a day. The duration of treatment is three weeks.

Endometritis and pregnancy, after childbirth

It is impossible to become pregnant with endometritis, endure a normal pregnancy and give birth to a healthy child. Moreover, if the disease is not cured in a timely manner, then the developed pathology can lead to incurable infertility. With the development of E., the complex processes of conception and implantation of the embryo into the mucous membrane that covers the inner surface of the uterus are disrupted, and this makes the mechanism of development and gestation impossible.

During pregnancy This disease is one of the most dangerous, so you cannot treat this problem irresponsibly. At the first signs of the disease, you should immediately consult a doctor and have endometrial scrapings tested. If the diagnosis is confirmed, it is necessary to immediately begin treatment, and if the doctor prescribes antibiotic therapy, one cannot refuse, otherwise, as the disease develops, the consequences can be extremely dire - the fetus will die.

To increase the chances of successful conception, you need to undergo a course of treatment in the future. hormonal therapy, which will have a beneficial effect on the normal course of pregnancy.

E. after childbirth is a common complication after a difficult delivery, and is usually diagnosed using ultrasound.

The causes of postpartum E. are considered:

• Complication of a normally developing pregnancy (preeclampsia).
• A prolonged labor period, especially if the child has been without amniotic fluid for a long time.
• Birth of a large baby, malpresentation of the fetus.
• Narrow birth canal.
• A woman gives birth after her forty-first child.
• Childbirth in early age- up to nineteen years of age.
• Placental abruption prematurely.
• Infection of a woman in labor with an STD.

Is it possible to have sex with endometritis?

It is not recommended to enter into intimate relationships with endometritis, because this can not only provoke complications during the course of the disease, but also cause infection of the sexual partner. During sexual intercourse, the integrity of the mucous plug secreted by numerous glands is disrupted - a barrier that blocks the entrance to the uterine cavity and prevents infection of this area from the external genitalia and environment. If you do not use a mechanical means of protection (condom), infection from an unhealthy partner can penetrate the uterus and cause E..

Intimacy with endometritis can be complicated:

• Spread of microbial infection to neighboring organs and throughout the body.
• The occurrence of adhesions and nodes in the fallopian tubes leads to infertility. This creates an obstacle to the movement of the egg into the uterus and makes it impossible to get pregnant and carry a child to term normally.
• The appearance of polyps in the uterus.
• Germination of the mucosal layer into muscle tissue uterus (myometrium) and beyond the uterine mucosa, directly into abdominal cavity. With adenomyosis, scars form in the uterus, which prevent the conception of a child. In addition, spotting and pain during sexual intercourse are constantly observed.
• Cysts form. Constant inflammation leads to the formation of benign neoplasms in the uterus or ovaries.
• The danger of pregnancy failure (miscarriage) in the early stages and the likelihood of premature birth.
• Malfunctions of the menstrual cycle.

Prevention of endometritis

Preventive measures for this disease are aimed at eliminating factors predisposing the occurrence of the inflammatory process and the penetration of pathogenic microorganisms into the uterine cavity, and if this does happen, at their speedy elimination.

Measures to prevent endometritis include:

• Timely treatment of infections transmitted through sexual intercourse.
• Treatment of complications that arise during childbirth.
• Refusal of artificial termination of pregnancy (abortion).
• Regular gynecological examinations and examination of the microflora of a woman’s vagina after childbirth and before medical procedures.
• A woman’s attentive attitude towards herself: maintaining personal hygiene of the genital organs, promptly contacting a qualified obstetrician-gynecologist.
• News healthy image life (HLS), prevent diseases and improve health.
• Using condoms during sexual intercourse.
• Strengthen the immune system.

Endometritis is an inflammatory disease that affects inner layer uterus (endometrium).

Endometritis is widespread gynecological disease and in 90% of cases it is diagnosed in women of reproductive age.

When the uterine mucosa becomes inflamed, the infection will inevitably spread to the muscle layer, so it makes more sense to talk about endomyometritis.

Kinds

According to the process, acute, subacute and chronic endometritis are distinguished.

Postpartum endometritis should be listed in a separate column. Endometritis after childbirth ranks first among purulent-inflammatory diseases postpartum complications(about 40%).

According to the severity of the disease, endometritis can be mild, moderate and severe.

Causes

The cause of endometritis is pathogenic microorganisms, not only bacteria, but also viruses, protozoa and fungi:

• streptococci;
• staphylococci;
• coli;
• Proteus;
• Klebsiella;
• chlamydia and mycoplasma;
• Mycobacterium tuberculosis;
• yeast-like fungi;
• gonococci;
• Trichomonas and others.

An infection that causes inflammation of the uterine mucosa enters it due to mechanical damage to the endometrium and a decrease in the body's defenses. Predisposing factors include:

• intrauterine manipulations (probing of the uterus, installation of an IUD, diagnostic curettage, abortions, miscarriages, hysteroscopy, metrosalpingography);
• complicated childbirth (weakness of labor, weakness of pushing, bleeding in succession period, long anhydrous period - more than 12 hours, cesarean section);
• poor personal hygiene and sexual intercourse during menstruation;
• violation of the douching procedure;
• remnants of the fertilized egg after an abortion or remnants of the placenta after childbirth.

Chronic endometritis occurs as a result of untreated or inadequately treated acute endometritis.

Symptoms of endometritis

Acute endometritis

Acute endometritis begins with sudden increase temperatures reach febrile levels (39.0 - 40.0 °C), chills alternate with fever, sweating increases, signs of general malaise appear (weakness, lack of appetite, fatigue).

Characteristic sharp pains lower abdomen or cramps in the presence of a foreign body: IUD, remnants of placenta/fertilized egg.

The pain can radiate to the lower back and sacrum.

Discharge from the genital tract during acute course the diseases are profuse, serous-purulent or bloody, the color of “meat slop” with an unpleasant odor.

If there are remnants of the fertilized egg, severe bleeding is possible.

Chronic endometritis

The clinical picture of the chronic process is blurred.

The patient complains of a constant low-grade fever (37.1 - 37.8 °C).

Chronic endometritis is characterized by constant aching pain in the lower abdomen, radiating to the sacrum and lumbar region. There is also a disturbance in the menstrual cycle (pre- and postmenstrual spotting, bleeding in the middle of the cycle), which is associated with hormonal disorders, disturbances in the transformation of defective endometrium, increased vascular permeability and pathology of the contractile function of the uterus.

The chronic process is accompanied by weakness, fatigue, and impaired psycho-emotional state.

Pain may occur during sexual intercourse (dyspareunia) and bowel movements. 50% of patients have problems conceiving and carrying a pregnancy.

Postpartum endometritis

Postpartum endometritis develops 3–5 days after childbirth or cesarean section. The symptoms of postpartum endometritis are the same as those of the acute form.

Diagnostics

Differential diagnosis of endometritis is carried out with adnexitis (inflammation of the appendages), ectopic pregnancy, appendicitis and parametritis (inflammation of the periuterine tissue).

• Collection of medical history and complaints. Recent intrauterine interventions, the course of labor and postoperative period(after caesarean section or abortion).
• Gynecological examination. During a gynecological examination, the uterus and appendages are palpated. In acute endometritis, a softened, enlarged and painful uterus is determined; in a chronic process, the uterus becomes denser, slightly larger than normal, sensitive to palpation and displacement behind the cervix. The nature of the discharge (color, quantity, smell) is assessed.
• Vaginal smears for microflora. Smears from the cervical canal and vagina are examined to identify pathogenic microorganisms and assess the degree of purity. Held bacteriological culture secretions onto culture media for the purpose of identifying the pathogen. Prescribed according to indications additional tests for sexually transmitted infections (chlamydia, mycoplasmosis, cytomegalovirus and others).
• Are common clinical tests blood and urine. IN general analysis blood reveals an increase in ESR, an increase in the number of leukocytes with a shift in the leukocyte formula to the left. In chronic endometritis, there is a decrease in platelets, which indicates a blood clotting disorder, and a possible decrease in hemoglobin (anemia).
• Ultrasound of the pelvic organs. During an ultrasound, the uterus and appendages are assessed. The size of the uterus and its cavity, the presence of blood clots, pus, remains of the fertilized egg or synechiae are determined ( intrauterine adhesions), endometrial thickness (M-echo), correspondence to its phase of the menstrual cycle.
• Hysteroscopy. An examination of the uterus with a hysteroscope is carried out if chronic endometritis is suspected; according to indications, the endometrium is taken (endometrial biopsy) for further histological examination.

Treatment of endometritis

Treatment of acute form

Treatment of patients with acute endometritis and exacerbation of chronic endometritis is carried out in a hospital. The therapy is prescribed and monitored by a gynecologist.

First of all, antibiotics are prescribed intramuscularly or intravenously (depending on the severity of the disease). Antibiotic therapy is selected taking into account the cultured causative agent of endometritis. Preference is given to cephalosporins (kefzol, ceftriaxone, cefotaxime) and fluoroquinolones (ciprofloxacin, clindamycin).

The combined prescription of antibiotics from different groups is often practiced. In addition, metronidazole is prescribed in tablets or intravenously (metrogyl), which suppresses the anaerobic flora.

Against the background of antibiotics, antifungal drugs (pimafucin, clotrimazole, Diflucan) are used to prevent vaginal candidiasis and intestinal dysbiosis.

For the purpose of detoxification and reduction of temperature, it is prescribed infusion therapy(saline solution, intravenous glucose solution).

Additionally, non-steroidal anti-inflammatory drugs (indomethacin, diclofenac in tablets and suppositories) are used, which have anti-inflammatory and analgesic effects. Taking vitamins and correcting immunity with immunomodulating drugs (Tactivin, Thymalin) is indicated.

Treatment lasts 7-10 days.

Treatment of the chronic form

After cupping acute period and for chronic endometritis outside of exacerbation, physical therapy is recommended (UHF on the lower abdomen, electrophoresis with lidase or copper and zinc in the phases of the menstrual cycle, SMT, etc.). Patients with chronic endometritis are prescribed oral hormonal contraceptives (to restore the menstrual cycle) for 3 to 6 months.

Surgical intervention (curettage of the uterine cavity) is carried out in the presence of remnants of the fertilized egg or parts of the placenta, hematometers (stagnation of blood in the uterus with a “closed” cervix). If synechiae are detected in the uterus, they are separated and excised during hysteroscopy.

Complications and prognosis

TO possible complications endometritis include:

• adnexitis (spread of infection to the uterine appendages);
• parametritis;
• thrombophlebitis of the veins of the pelvis and lower extremities;
• sepsis;
• menstrual irregularities;
• infertility;
• habitual miscarriage;
• pelvic pain syndrome (constant aching pain in the lower abdomen for no apparent reason).

The prognosis for acute endometritis is favorable. With adequate treatment and preventive courses, pregnancy occurs in 90% of cases of chronic endometritis.