Inflammatory diseases of the female reproductive system are a common gynecological problem.
In approximately 40% of cases of secondary infertility, the cause is chronic endometritis.
More often, the disease is a consequence of untreated acute endometritis caused by trauma, infection of the endometrium during childbirth, abortion, and intrauterine interventions.
Asymptomatic course of chronic inflammatory process makes diagnosis very difficult. Often, pathology is detected by chance, during a preventive examination.
Causes
Chronic endometritis is an inflammation of the basal layer of the endometrium which is caused by a bacterial, fungal, viral or protozoal infection.
Against the background of chronic inflammation, the physiological cycle of development and rejection of the functional layer of the endometrium is disrupted, which manifested by menstrual irregularities.
With chronic endometritis, uterine bleeding, recurrent miscarriage, and infertility may occur.
Prerequisites for the development of the inflammatory process may be trauma to the uterine mucosa, the presence of an infectious agent.
Inflammation begins and proceeds acutely and becomes chronic. In this case, clinical manifestations fade, the influence of infection is reduced to a minimum.
Depending on the nature of the pathogen, inflammatory reactions may be specific or nonspecific.
Specific endometritis cause pathogenic microorganisms that penetrate the uterine cavity from the overlying or underlying parts of the reproductive system.
Chronic nonspecific endometritis are caused by representatives of opportunistic flora that normally live in the vagina, on the surface of the skin, and the mucous membrane of the rectum.
This disease can develop against the background of an intrauterine device, HIV, the use of hormonal drugs.
More often, the chronic form of the disease occurs when infection with mycoplasma, E. coli, and some strains of the human papillomavirus.
Provoking factors:
- intrauterine interventions, medical abortion, curettage of the uterine cavity, biopsy, embryo transfer, hysteroscopy;
- complicated childbirth;
- introduction of an intrauterine device, its prolonged use;
- vaginitis, cervicitis, cervical erosion without treatment;
- surgical treatment of diseases of the pelvic organs;
- sexually transmitted diseases.
In approximately 30% of cases, the cause of the disease cannot be determined.
Infection of the injured uterine cavity leads to the development of an acute inflammatory process, with the transition of the disease to chronic stage the role of infection is sharply reduced.
Physiological and structural disorders predominate at this stage, leading to disorders of the menstrual cycle and reproductive function.
According to the course of the disease, they are distinguished:
- Often recurrent form.
- Chronic inflammation in a phase of stable remission.
- Exacerbation.
Depending on the morphological changes The endometrium is distinguished:
- hypertrophic;
- atrophic;
- cystic endometritis.
Atrophic type changes lead to depletion and fibrosis of the mucous membrane. It is this form of pathology that most often leads to uterine infertility.
For hypertrophic endometritis the functional layer of the endometrium grows excessively; the cystic variation is characterized by fibrosis and the formation of cystic cavities.
The ICD-10 code for chronic endometritis is N71.9.
More about endometritis and methods of its treatment:
How to identify: symptoms, signs, pain, discharge
Symptoms of the disease are nonspecific and mild, so many women don't take them seriously.
Manifestations of malaise are sometimes attributed to the consequences of overwork, inappropriate posture during intimate contact, and diseases not associated with lesions of the reproductive system.
In chronic endometritis the following are observed:
- menstrual irregularities (scanty or too copious discharge during menstruation, spotting during the intermenstrual period, delayed menstruation);
- , appearing against the background of physical activity, before menstruation;
- discomfort or pain during sexual intercourse;
- purulent or mucous discharge with an unpleasant odor;
- general weakness, increased fatigue;
- increased body temperature in the evenings, at night;
- chills;
- miscarriage.
With mild chronic endometritis, there may be no subjective complaints at all. The disease is detected during an examination for infertility.
Outside of exacerbations, a woman may be bothered by the following symptoms:
- discomfort or pulling sensations lower abdomen before menstruation;
- irregular periods;
- heavy discharge after menstruation.
Pain in chronic endometritis is usually aching or pulling, tolerable, sharp sensations may appear during intimacy.
Color, consistency, amount of discharge vary greatly, they can be brown, greenish-yellow, mucous or purulent.
Why it’s dangerous: possible consequences, complications
The most common complication inflammatory diseases reproductive organs — infertility.
If pregnancy does occur, chronic endometritis is a prerequisite for its complicated course.
Against the background of pathology possible high or low water levels, disturbances of fetoplacental blood flow, intrauterine infection of the fetus.
Inflammatory processes in the uterus are risk factors for the development of other pathologies:
- ectopic pregnancy;
- endometrioid disease;
- hyperplastic diseases of the endometrium;
- inflammatory and purulent-inflammatory diseases of the pelvic organs;
- tumors and
Diagnostics
If you suspect possible damage to the reproductive organs you need to contact a gynecologist.
The earlier the disease is detected, the higher the chances of successful treatment and restoration of reproductive function.
To diagnose chronic endometritis, the following are carried out:
- microscopic examination of a vaginal smear;
- bacterial culture from the endocervix;
- determination of hormonal activity of the ovaries;
- Ultrasound of the uterus and appendages.
According to indications, they can be prescribed hysteroscopic examination, endometrial biopsy.
Ultrasound reveals pronounced changes in endometrial thickness and blood vessels uterus, expansion of the uterine cavity, adhesions, cords and other connective tissue formations.
Methods for diagnosing endometritis:
Treatment regimen
Therapy for chronic endometritis is carried out in several stages with periodic monitoring of the effectiveness of treatment.
Complex therapy includes:
- Elimination of infection.
- Strengthening the immune system.
- Normalization of metabolic processes.
- Treatment with hormonal drugs.
More often, gynecologists are faced with chronic inflammation of bacterial origin.
Drugs
The course of treatment begins with antibacterial drugs; treatment of chronic endometritis with antibiotics is more often used Metronidazole, Cefotaxime, Amikacin.
Antibiotics are administered intravenously, using droppers. Infusions are carried out 2 times a day. Amikacin is used as an intramuscular injection.
To normalize the menstrual cycle for patients prescribe contraceptives.
The drug is selected individually, taking into account age, general condition health and other characteristics of the body. The minimum duration of a course of hormonal therapy is 3 months.
After hormonal treatment prescribed for pregnancy Utrozhestan or other progestin drug. Among the more common methods of strengthening immune defenses is the use of immunostimulating drugs in the form of vaginal or rectal suppositories.
To restore normal metabolic processes in the endometrium, the patient is prescribed course of antioxidant and metabolic drugs, vitamin therapy.
Additionally, physiotherapeutic treatment is prescribed; the complex of procedures may include: phonophoresis, laser therapy, magnetic therapy, electrophoresis.
The greatest effect is observed after a course of electrophoresis with copper and zinc ions and microwave therapy.
The effectiveness of treatment is assessed according to several criteria:
- Removal of the infectious agent.
- Normalization of the menstrual cycle.
- Elimination of symptoms of inflammation.
- Restoring fertility.
How to cure with folk remedies
Inflammation of the uterus can be treated with herbal infusions.
To prepare the collection, take pine buds, cherry leaves, nettles, sweet clover grass, wormwood, lavender, cudweed, Leuzea roots, and marshmallows in equal parts.
Plant materials are crushed and mixed. Brew two tablespoons of the mixture in 0.5 liters of boiling water and leave in a thermos for at least 12 hours. Take a third of a glass 3-5 times a day. The course of treatment is 2 months.
In equal parts, take chamomile flowers, viburnum bark, mint, motherwort, thyme, shepherd's purse, and mantle leaves, chop and mix. Prepare and take the infusion according to the scheme indicated above.
For maximum effect, two courses of treatment with different preparations must be carried out sequentially.
For endometritis You can take a decoction of St. John's wort. 1 tbsp. Pour a glass of boiling water over the chopped herbs and boil for 15 minutes. Strain the cooled broth, take a quarter glass three times a day.
St. John's wort is contraindicated in cases of exacerbation of inflammation, as well as in patients suffering from hypertension.
Can be used to treat inflammation tampons with sea buckthorn oil.
Used in a course for 10 days. It is better to coordinate treatment with traditional methods with your doctor.
At correct use Using traditional medicine, a noticeable improvement in the condition occurs about a week after the start of treatment.
The patient is worth be patient and complete the entire recommended course.
Is it possible to get pregnant: pregnancy before and after recovery
One of the most pressing symptoms of chronic endometritis is reproductive dysfunction, which can manifest itself as inability to conceive or miscarriage.
IVF attempts in such patients often end in failure. In the early stages of a chronic inflammatory process, pregnancy is possible, but in most cases it occurs with complications.
After treatment, chances of getting pregnant and giving birth healthy baby increase significantly.
Inflammatory processes in the uterus are incompatible with IVF.
If chronic endometritis is detected, before IVF, both a course of treatment according to the standard regimen and mandatory prevention of post-inflammatory complications are prescribed.
After treatment, the chances of a successful embryo transfer increase, but it is impossible to guarantee the success of the procedure in advance.
When pregnancy occurs the expectant mother is under close medical supervision and regularly undergoes preventive therapy to prevent complications.
Enhanced medical supervision is also required when pregnancy occurs against the background of endometritis. There is no treatment for the pathology at this time; therapy is aimed at maintaining the pregnancy.
What to do to prevent the disease
The chronic inflammatory process in most cases is preceded by an exacerbation of endometritis.
Among preventive measures, timely and correct treatment of inflammatory diseases of the reproductive system.
The risk of developing the disease is reduced by strictly following the doctor’s recommendations when using an intrauterine device, preparing for diagnostic and medical procedures in the uterine cavity.
Important compliance with the rules intimate hygiene and sexual hygiene.
Patients with chronic endometritis rarely achieve complete recovery. But the course of treatment helps to achieve a state in which it is possible to conceive, carry and give birth to a healthy child.
It is no coincidence that in the first days after childbirth in the maternity hospital, the doctor examines the woman daily, she undergoes ultrasound examinations and tests. The body of a new mother after childbirth is vulnerable, so it is necessary to take care of it and listen to what is happening in it, so that when warning signs take action in time.
One of the most common complications after childbirth is endometritis. This is an inflammation of the endometrium, the lining of the uterus. Let's figure out why it occurs and why it is dangerous.
Causes and consequences of endometritis
Unfortunately, many women who have just become mothers face the problem of postpartum endometritis. Why is he so dangerous? The fact is that complications of untreated endometritis can be very serious. The most severe among them is sepsis (blood poisoning). In addition, pus (pyometra) can accumulate in the uterus; when it enters the pelvic area, pelvioperitonitis develops, inflammation of the ovaries and tubes (oophoritis and salpingitis), the formation of adhesions both in the uterus and pelvis itself, and in the intestines, polyps and endometrial cysts, menstrual irregularities. Since the endometrium is the most important layer of the uterus, ensuring the normal development of pregnancy, any of its diseases can lead to various complications when carrying the next child, the threat of miscarriage, placental insufficiency, and sometimes infertility.
The endometrium undergoes changes under the influence of hormones throughout the menstrual cycle. The uterus is preparing to receive a fertilized egg, and if conception does not occur, inner layer The uterus is shed and menstruation occurs. If inflammation begins in the uterus after childbirth, the normal functioning of the endometrium is disrupted. As a rule, the uterine cavity is well protected from infection, but there are situations, including childbirth, after which the uterus becomes a large wound surface. In this case, pathogenic bacteria can enter it and provoke an inflammatory process - endometritis.
Other risk factors for endometritis include:
- diagnostic curettage, abortion and other manipulations inside the uterus;
- incomplete removal of the remaining placenta from the uterus, accumulation of blood and clots after childbirth;
- caesarean section and postoperative trauma;
- non-compliance or insufficient compliance with the rules of personal hygiene, especially in postpartum period;
- hematomas and suppuration in the perineum that appeared after childbirth;
- long-term use of an intrauterine device;
- immunodeficiency states;
- exacerbation chronic diseases genitourinary system, nervous, endocrine and other body systems, which contributes to the development of erased forms of inflammatory processes;
- infection with sexually transmitted diseases;
- constant stressful situations, severe overwork, weakening the body's defenses and making it vulnerable to infectious agents.
Endometritis can occur in two forms - acute and chronic. He definitely needs proper treatment. When chronic, symptoms may not be obvious and the disease may be difficult to recognize. Therefore, this type of endometritis is more difficult and longer to treat. Of course, it is much better and more correct to catch it in the acute, initial phase. And self-medication is completely unacceptable here - only a qualified doctor can prescribe adequate and effective therapy.
How does endometritis manifest?
Acute endometritis most often develops 2–14 days after infection. Contact your doctor as soon as possible if you notice:
- increase in body temperature to 38–39°C;
- painful, pressing sensations in the lower abdomen, which can radiate to the lower back;
- the appearance of any unusual vaginal discharge with an unpleasant odor: it can be bloody, purulent, serous discharge. Normally, heavy bleeding after childbirth lasts for several days. Their number decreases all the time, disappearing completely by the eighth week. But with endometritis, heavy and bloody discharge occurs constantly;
- weakness, weakness, headache, chills
Chronic endometritis, as a rule, is a consequence of an acute form of the disease that has not been fully cured, occurring after childbirth or abortion.
In chronic endometritis, symptoms are less pronounced or not expressed at all. One of the signs may be frequent post- and premenstrual bleeding. Between menstruation there is scanty purulent or serous-purulent discharge. From time to time, a woman may be bothered by nagging and aching pain in the lower abdomen.
How is endometritis diagnosed?
The acute form of endometritis is easy to detect during a routine gynecological examination. The gynecologist will pay attention to the fact that the size of the uterus does not correspond to the norm (it will be enlarged), pain in the lower abdomen, including at the time of palpation, bloody or purulent discharge with an odor. With such signs, the doctor will definitely refer the woman for an ultrasound of the pelvic organs, which will show the condition of the uterine cavity, ovaries, structural changes in the endometrium, the presence of adhesions, etc. It will be necessary to take general analysis blood to see if the level of white blood cells is elevated, which may indicate an inflammatory process, as well as smears on the flora from the vagina.
If residual placental tissue is detected on ultrasound, hysteroscopy is performed to remove the contents of the uterine cavity. This is a painless examination under general anesthesia, during which a special optical instrument– a hysteroscope, which allows you to examine its walls and take a tissue sample for subsequent histological examination. Histology helps to accurately make or refute the diagnosis: with endometritis there will be characteristic changes in tissues, visible under a microscope. In addition, histological examination excludes or confirms the presence of a malignant tumor. Hysteroscopy is also performed to diagnose chronic endometritis, if the picture is unclear from ultrasound and tests.
How to treat endometritis?
If endometritis is severe or complicated, for example, by inflammation of the pelvic area, treatment should be carried out in a hospital with complete rest and bed rest. In uncomplicated cases, the doctor may recommend treatment at home.
The most important part of the treatment of endometritis is the prescription of antibiotics, which are selected individually for each individual woman (for this purpose, an antibiotic sensitivity test is taken). Depending on the indications, antibiotics can be administered intramuscularly, intravenously (for severe forms of the disease) or in tablet form (for uncomplicated endometritis). Anti-inflammatory and antihistamines, vitamins, as well as products that strengthen the general immune system.
If necessary, medications are used to increase the tone of the uterus, to contract it and expel it as quickly as possible. postpartum discharge. Anticoagulants and, in some cases, hormonal medications may also be needed.
If placenta remains, clots, polyps, cysts and other foreign bodies are found in the uterus, curettage or vacuum aspiration of the uterine cavity is performed under general anesthesia. In particularly difficult cases, plasmapheresis is prescribed. This is a blood purification procedure that allows you to remove the liquid part from it - plasma, which contains various wastes, toxins and other harmful substances.
To treat endometritis comprehensively and prevent it from becoming chronic, physiotherapy or infrared laser therapy may be indicated. Physiotherapy promotes a faster and more complete drainage of pus from the uterine cavity, and also has a beneficial effect on the recovery process. Laser therapy for endometritis is used to cut adhesions in the uterine cavity or in the pelvic area. This method of treating adhesions is safe and fast.
You need to pay attention to the correct balanced diet, cleansing the body of toxins. It is important to drink enough liquid.
With proper and timely treatment, the woman’s condition returns to normal within a couple of days, but treatment must be continued for at least 6–7 days.
When treating chronic endometritis, an integrated approach is very important. Antimicrobial, immunomodulatory, restorative, and physiotherapy are usually prescribed. As a rule, hormonal therapy is carried out, usually taking oral contraceptives for at least three months to eliminate bleeding and restore normal endometrial structure and ovarian function. Adhesions can also be removed surgically or using laser therapy.
In the vast majority of cases timely treatment endometritis leads to positive results and complete recovery. Now, with abundance the latest methods treatment, the effect is achieved in an extremely short time.
Treatment of endometritis and breastfeeding
The question of the possibility of breastfeeding with endometritis should be decided purely individually, depending on the woman’s condition, the severity of the disease and other factors. However, in most cases, if the course of endometritis is not complicated and the woman is treated at home under the supervision of a doctor, she can be prescribed antibiotics that are compatible with breastfeeding and do not penetrate into milk. There is no serious need to deprive a child of mother's milk in mild forms of endometritis. Unfortunately, in severe cases, when very intensive treatment and hospitalization are needed, short separation from the child cannot be avoided. But even in this situation, milk can be preserved. Expressing milk will help here or, in emergency situations, transferring the baby to formula for a short time. In the hospital, you need to continue to pump in order to return to breastfeeding immediately after treatment, unless, of course, for some reason natural feeding becomes impossible.
Prevention of endometritis
The development of endometritis can and should be prevented by excluding those unfavorable factors that lead to its occurrence. It is necessary to carefully observe personal hygiene, refuse abortions, promptly treat sexually transmitted infections and other diseases, regularly see a gynecologist, healthy image life, strengthen the immune system. During pregnancy and after childbirth, you need to carefully monitor your condition, follow all the instructions of your doctor, and do not forget about hygiene and cleanliness, since this is especially important during pregnancy and the postpartum period. Women at risk for the development of postpartum endometritis (who have suffered gestosis, various complications during childbirth: protracted labor, long anhydrous period, premature abruption or placenta previa, trauma to the birth canal, large blood loss during childbirth; infected at the time of birth with pathogens of sexually transmitted diseases that have foci chronic infection etc.) in the maternity hospital, antibiotics are administered once or three times. You should definitely ask your doctor whether the drug is compatible with breastfeeding. In addition, the young mother’s temperature is measured daily, sutures are examined and treated if there are any, and an ultrasound is performed before discharge - all this is aimed at early diagnosis any complications.
If you monitor your health and condition, see an experienced professional doctor, promptly treat foci of infection in the body, prepare for childbirth both physically and psychologically, then the likelihood of you developing postpartum endometritis will be negligible and you will be able to freely enjoy your new life with your baby.
Endometritis refers to the inflammatory process in the endometrium - the internal mucous layer uterus. This disease is often combined with inflammation of the muscle layer of this organ - endomyometritis.
The endometrium is the inner functional lining of the uterus, which changes its structure throughout the menstrual period.
In each cycle, it matures and grows anew, preparing for the process of attachment of a fertilized egg, and is rejected if pregnancy does not occur.
Normally, the uterine cavity, which is lined by the endometrium, is reliably protected from the penetration of any infectious agents. However, under certain special conditions the infection easily penetrates this organ and causes inflammatory reactions in its inner layer - endometritis.
Causes of endometritis
In the occurrence of this pathological condition important role plays a decrease in barrier defense mechanisms that prevent the penetration of infectious agents directly into the internal genital organs.
This can be caused by many reasons, including:
- maternal birth injuries. Injuries to the cervix, vagina, and perineum during childbirth contribute to infection entering the genital tract and its further penetration into the uterine cavity;
- mechanical, chemical, thermal factors that damage the vaginal mucosa. Frequent douching, poor genital hygiene, and the use of special vaginal spermicides lead to changes normal microflora vagina and indicators of its protective properties;
- childbirth, abortion, menstruation. Bleeding may cause secretions to be washed away cervical canal, alkalization of the vaginal environment (normally it is acidic) and a decrease in its bactericidal properties. Under such conditions, various pathogenic microorganisms can easily penetrate from the external environment and then actively multiply on the wound surfaces of the uterus;
- intrauterine contraceptives. Intrauterine devices, which remain in the cavity of this organ for a long time, become a potential source inflammatory reactions, facilitating the penetration of infection upward along the threads of this device. If endometritis occurs, it must be urgently removed;
- use of vaginal tampons. They absorb bloody secretions and are therefore optimal environment for the development of the infectious process. Tampons should be changed every four to six hours and should not be used at night, before or after menstruation, or in hot climates. Violation of the rules of use can lead to the so-called toxic shock syndrome;
- overwork, chronic stress, insufficient hygiene. These factors also weaken the body and make it susceptible to infection.
Classification of endometritis
According to the nature of the course, acute and chronic forms of endometritis are distinguished. By etiological principle distinguish specific and nonspecific forms of this disease.
The disease can be nonspecific in the presence of bacterial vaginosis, HIV infection, the use of intrauterine devices, or when taking hormonal contraceptives.
The following morphological variants of chronic endometritis are also distinguished: atrophic (it is characterized by atrophy of the glands, infiltration of the mucous membrane with lymphoid elements), cystic (fibrous (connective) tissue compresses the ducts of the glands, as a result their contents thicken), hypertrophic (chronic inflammation leads to proliferation of the mucous membrane ).
The development of acute endometritis is preceded by abortion, mini-abortion or childbirth, hysteroscopy, diagnostic curettage of the uterine cavity or other intrauterine manipulations. Incomplete removal of the placenta, fetal egg remnants, accumulation of clots and liquid blood create good conditions for the development of infection and acute inflammatory processes of the inner surface of the uterus.
In the development of this disease, the state of the endocrine, immune, and nervous systems, which often aggravate its course, is of particular importance.
Acute endometritis most often develops three to four days after infection.
It is manifested by pain in the lower abdomen, discharge from the genital tract with an unpleasant odor, increased heart rate, increased temperature, painful urination, and chills.
Acute endometritis has a particularly rapid and severe course in those patients who use intrauterine devices. The first signs of this disease are a reason to immediately contact a gynecologist.
A gynecological examination may reveal a moderately painful and enlarged uterus, serous-purulent or sanguineous discharge. The acute stage lasts from one week to ten days and, with well-chosen therapy, ends full recovery, otherwise the disease becomes chronic.
Chronic endometritis
Chronic forms of endometritis are often the result of an untreated or inadequately treated acute form of this disease, which usually occurs after intrauterine manipulation, abortion, due to the presence of various foreign bodies of the uterus.
In eighty to ninety percent of cases this pathological condition occurs in women of the reproductive period and has a steady upward trend, which can be explained by the widespread prevalence of intrauterine contraception, the increase in the number of intrauterine therapeutic and diagnostic procedures, abortions.
Chronic endometritis is the most common cause miscarriages, infertility, failed attempts at in vitro fertilization, complications afterbirth, childbirth and pregnancy.
To identify infectious agents in this disease, highly accurate immunocytochemical diagnostics are used. Chronic forms of endometritis in most cases have a mild clinical course without severe symptoms microbial infection.
When conducting a gynecological examination, thickening of the uterine mucosa, hemorrhages, serous plaque, and fibrous adhesions are noted, which lead to disruption of the normal functioning of the endometrium.
Severity of the current chronic form This disease is determined by the duration and depth of changes in the structure of the endometrium.
The main manifestations of chronic endometritis are changes in the menstrual cycle (heavy or scanty periods), pathological bloody or serous-purulent discharge, uterine bleeding, uterine bleeding, aching pain in the lower abdomen, painful sexual intercourse.
When conducting a two-handed gynecological examination, a slight increase in size and thickening of the uterus is determined. With this disease, changes in the structure of the endometrium can cause the formation and further growth of cysts and polyps.
Chronic endometritis causes infertility in ten percent of cases, and miscarriage in sixty percent of cases.
The inflammatory process can often involve muscle layer uterus. The result is myoendometritis.
Postpartum endometritis
Postpartum endometritis is understood as an infectious inflammation of the inner lining of the uterus that occurs after a cesarean section (in more than twenty percent of cases) or spontaneous childbirth (in two to five percent of cases).
The main causative agents of this disease are Escherichia coli, Klebsiella, Proteus, Enterococci, Enterobacteriaceae, Peptostreptococcus, Staphylococcus, Streptococcus B.
The infection can be transmitted ascendingly (from the vagina), hematogenously (from another source of inflammation (angina, pyelonephritis), lymphogenously (through lymphatic vessels), intraamnially (with a variety of invasive interventions performed during pregnancy (cardocentesis, amniocentesis).
Risk factors for the development of postpartum endometritis include slowing down the processes of uterine involution after childbirth (return of the organ to its previous size), retention of lochia in the uterus, prolonged labor, bleeding during childbirth or in the postpartum period, a long anhydrous period (more than twelve hours from the moment of direct rupture). waters before the birth of the child), trauma to the tissues of the birth canal.
This disease is characterized by the following symptoms:
- pain localized in the lower abdomen;
- an increase in body temperature to thirty-eight degrees, in severe cases chills appear, this figure increases to thirty-nine degrees;
- unpleasant odor of discharge after childbirth (lochia);
- increased fatigue;
- weakness;
- increased drowsiness;
- decreased appetite;
- increased heart rate.
The disease usually begins on the third or fourth day after birth and lasts six to ten days.
Complications of postpartum endometritis include metritis (the inflammatory process is localized in all membranes of the uterus), parametritis (inflammation of the surrounding tissue), thrombophlebitis of the pelvic veins, peritonitis (inflammation of the peritoneum), and sepsis.
Chronic catarrhal endometritis
Chronic inflammation of the uterine mucosa, which is characterized by the constant release of catarrhal exudate from the cavity of this organ - chronic catarrhal endometritis.
Most often, this form of the disease develops from untreated forms of acute endometritis. The infectious process can spread both ascending and lymphogenous and hematogenous.
Chronic catarrhal endometritis is characterized by periodic or constant discharge of flaky cloudy mucus from the uterus. Usually there is no pain in the uterus, its contractility is either absent or weakly expressed. This disease is often the cause of infertility. With timely and adequate treatment, it usually goes away without a trace.
Purulent endometritis
Purulent endometritis is one of the most dangerous forms endometritis and if not treated in a timely manner often leads to the development of infertility and miscarriages. Its cause is the accumulation of pus inside the uterine cavity, as a result of which various infectious agents (streptococcus, staphylococcus, E. coli) penetrate into it.
Very often, this form of the disease occurs after abortion or childbirth. The uterus does not contract sufficiently and its cervix becomes clogged with blood clots and remnants of placental tissue, as a result of which the outflow of its contents becomes difficult. In addition, purulent endometritis can occur as a result of the breakdown of malignant tumors.
Symptoms of this disease can be both hidden and obvious. In the latter case, an increase in body temperature is observed, pain occurs in the lower abdomen, and pathological discharge from the vagina appears. A gynecological examination reveals a painful or enlarged uterus.
If endometritis is detected early in pregnancy, it does not affect the development of the fetus.
In this case, it is necessary to carry out rational therapy and prevent further spread of the pathological process.
Detection of endometritis at a later date or a woman’s untimely visit to the doctor can cause the development of complications such as miscarriage or miscarriage.
More likely, pathological process in this case, it has spread to a significant part of the endometrium and its treatment will be long and difficult.
Therefore, it is important to contact a gynecologist in a timely manner if at least one suspicious symptom is detected and further conduct a full examination to clarify the diagnosis and select adequate therapy.
Diagnosis of endometritis
To diagnose acute endometritis, complaints and medical history are collected, all symptoms and predisposing factors are clarified. A gynecological examination is one of the most informative ways to diagnose and clarify the diagnosis of this disease. A clinical blood test and bacterioscopic examination of smears are of particular importance.
Since there is a possibility of development severe complications septic nature (peritonitis, pelvioperitonitis, parametritis), women with acute forms of endometritis should be treated inpatiently.
Some women living in big cities and taking hormonal medications are in the group increased risk occurrence of uterine fibroids.
For the diagnosis of chronic forms of endometritis, in addition to clarifying the history of the disease and clinical signs, special importance is given to curettage of the uterine mucosa, which is carried out for diagnostic purposes. Histological examination of the endometrium (altered) also allows us to confirm this diagnosis. Important diagnostic methods Also included are ultrasound and hysteroscopy, which directly reveal structural changes in the endometrium.
In the acute phase of the disease, patients are prescribed inpatient treatment with bed rest, physical and mental rest, drinking regimen, and a nutritious, easily digestible diet.
The basis of drug therapy is antibacterial drugs, taking into account the individual sensitivity of the pathogen (ampicillin, amoxicillin, gentamicin, clindamycin, lincomycin, kanamycin and others). For mixed microbial flora, several antibiotics are prescribed. Since anaerobic pathogens are often associated with the underlying infection, metronidazole is included in the treatment regimen.
To relieve symptoms of intoxication, protein and saline solutions of up to two to two and a half liters per day are injected intravenously. The inclusion of multivitamins, immunomodulators, antihistamines, antifungals, and probiotics in the treatment regimen for acute endometritis is also advisable.
For anti-inflammatory, analgesic and hemostatic (hemostatic) purposes, cold is applied to the abdominal area (two hours - cold, then a break of thirty minutes).
When the intensity of symptoms decreases, hirudotherapy (treatment with medicinal leeches) and physiotherapy are prescribed. Therapy for chronic endometrium is based on an integrated approach, which includes immunomodulatory, antimicrobial, restorative, and physiotherapeutic treatment.
Therapy is carried out in stages. The first step is to eliminate infectious agents, then a course is carried out to help restore the endometrium.
Broad-spectrum antibacterial agents (doxycycline, sparfloxacin) are usually used.
The recovery course is based on a combination of metabolic (riboxin, actovegin, vitamin E, ascorbic acid, Wobenzym) and hormonal (Utrozhestan plus Divigel).
Medicines should be injected directly into the uterine mucosa, which helps create their increased concentration at the site of inflammation, which ensures the highest possible healing effect. To eliminate uterine bleeding, a solution of aminocaproic acid or hormonal drugs is prescribed.
Physiotherapy takes second place in the treatment of chronic endometritis. Electrophoresis of zinc, copper, iodine, lidase, UHF, magnetic therapy, and ultrasound therapy are used. Physiotherapeutic treatment reduces the severity of inflammatory edema of the endometrium, stimulates immunological reactions, and activates blood circulation. Patients with this form of the disease are indicated for resort therapy (hydrotherapy, mud therapy).
The effectiveness of therapy for chronic endometritis is assessed according to the following criteria:
Restoring the normal menstrual cycle;
- restoration of the morphological structure of the inner layer of the uterus (according to ultrasound results);
- disappearance pathological signs(bleeding, pain);
- elimination of infection;
- restoration of reproductive function.
Complications and prevention of endometritis
Endometritis can cause complications during pregnancy (placental insufficiency, threat of miscarriage, postpartum hemorrhage), the formation of adhesions inside the uterus, endometrial cysts and polyps, and disturbances in the menstrual cycle.
With this disease, the inflammatory process may involve the tubes and ovaries, peritonitis, and adhesions of the pelvic and intestinal organs may develop.
Adhesive disease often leads to infertility.
When examining women with infertility, the diagnosis of chronic endometritis is crucial. It belongs to the group of female pelvic inflammatory diseases (PID) and ranks first among them.
PID occurs in 46-90% (according to various sources) of women of childbearing age ( average age- 36 years). In the total number of causes of the development of chronic pelvic pain syndrome, they account for 24%, ectopic pregnancy - 3%, miscarriage - 45%, infertility -40%. Chronic inflammatory processes lead to menstrual irregularities in 40-43%, and infertility in 80%.
Endometritis - what is it?
Endometritis is an inflammation of the uterine mucosa (endometrium), morphologically consisting of two layers - functional and basal. The first is facing the uterine cavity and consists of a single layer of columnar epithelial cells. Between them are glandular cells that produce protective mucus, and a large number of small branches of spiral arteries. During each menstruation, the functional cell layer is destroyed and removed with blood and mucus, after which it is restored again from the cells of the basal layer in the first phase of the menstrual cycle.
So natural defense mechanisms, How anatomical features structures, protective mucus of the uterine cavity and cervical canal containing immunoglobulins and antibodies, acidic environment of the vagina, microbiocinosis of these parts, local immune defense in most cases they are able to prevent the development of infection in the genitals. When they are disrupted in this particular case, acute or chronic endometritis develops, the manifestations of which depend on the severity of the inflammatory reaction.
Acute endometritis
Most often it is caused by urogenital infection with herpes simplex and Epstein-Barr viruses, mycoplasma and ureaplasma and cytomegalovirus, E. coli, streptococci, meningococci, enteroviruses and trichomonas, mycobacteria tuberculosis. Less commonly, the disease is caused by opportunistic microorganisms. Usually mixed microflora is found in crops.
Risk factors that create favorable conditions in the uterus for the development and reproduction of an infectious pathogen include:
- natural childbirth and cesarean section, as a result of which postpartum endometritis develops in 4-20% and 45%, respectively;
- diagnostic and therapeutic (for bleeding, frozen pregnancy) curettage and other diagnostic procedures, for example, hysteroscopy and hysterosalpingography, probing of the uterine cavity, aspiration biopsy of the endometrium;
- insertion or removal of an intrauterine device, as well as, against its background, artificial insemination or in vitro fertilization;
- spontaneous or artificial termination of pregnancy, especially instrumental;
- menses, infectious processes in the vagina and uterine appendages, as well as in the urinary system, polyps of the cervical canal and endometrium, uterine fibroids;
- hormonal dysfunctions or taking hormonal drugs (glucocorticoids);
- weakening of general immunity as a result of prolonged or frequent stressful conditions, diabetes mellitus and other common chronic diseases;
- transfer of pathogens with blood or lymph from chronic foci of infection (very rare).
The most likely risk factors are listed in the first four points.
Clinical manifestations
Symptoms of acute endometritis occur 3-4 days after infection. The disease begins acutely and occurs:
- Aching pain and a feeling of heaviness in the lower abdomen.
- General malaise, fever.
- Copious serous or sanguineous, sometimes with an odor, discharge from the genital tract.
- Bleeding if endometritis develops after childbirth or abortion.
In case of joining staphylococcal infection Acute purulent endometritis (pyometra) develops, in which the condition is much more severe due to general intoxication. It is accompanied by chills, high temperature, severe cramping pain in the lower abdomen, the appearance of abundant serous-purulent and purulent discharge, the development of a septic condition is possible.
Diagnosis of endometritis with an acute course of the process is carried out on the basis of an anamnesis (history of the disease), which allows us to establish a risk factor and partially determine the treatment plan, clinical course and symptoms of the disease, data gynecological examination. In addition, clinical examination of blood and urine, clinical and bacteriological examination of smears from the vagina and cervix, culture of the contents of the genital tract for the sensitivity of pathogenic microflora to antibiotics are carried out, if necessary.
Principles of treatment
Treatment of endometritis (acute non-purulent) consists of removing the intrauterine device followed by curettage of the uterine cavity, in curettage after spontaneous or artificial abortion in order to remove the remnants of the fertilized egg, after childbirth - in order to remove the placental lobule or remnants of the fetal membranes.
After this, antibiotics, anti-inflammatory and antibacterial agents, desensitizing and restorative drugs are prescribed. The main treatment of endometritis with antibiotics is the use of broad-spectrum drugs, as well as in combination with each other and in combination with antibacterial drugs. For example, cephalosporins or broad-spectrum penicillin antibiotics are used in combination with aminoglycosides, as well as their combination with Metranidazole or Ornidazole.
If anaerobic microflora is detected in smears, the addition of Ornidazole or Metranidazole is mandatory, and for a mixed infection, vaginal sanitation is additionally carried out using local impact in the form of gels or suppositories with antimicrobial drugs (Poliginax, Terzhinan), washing with antiseptic solutions (Betadine, Hexicon).
In addition, after reducing the severity of inflammatory processes (decrease in temperature), physiotherapeutic procedures are used - low-intensity ultrasound, magnetic therapy, laser, inductothermy.
In case of acute purulent endometritis, intravenous therapy is added with solutions that reduce the effects of intoxication and improve the rheological properties of blood, protein solutions. There may be a need for more radical surgical treatment (supravaginal amputation or hysterectomy).
After acute endometritis, especially purulent, synechiae (adhesions, connective tissue septa) can form in the uterine cavity.
Chronic endometritis
Its prevalence is, according to various authors, 10-85%. This wide statistical range is explained by the complexity of diagnosis, as well as clinical and morphological (tissue structure) confirmation.
Currently, the chronic form of endometritis is considered as a clinical and morphological syndrome, in which, as a result of damage to endometrial cells by an infectious agent, functional and structural changes in the endometrium occur. The latter disrupt its cyclic transformations (detachment and restoration), the receptor reaction of the cells of the mucous membrane of the uterine cavity and its ability to implant a fertilized egg.
Some authors believe that chronic endometritis is not a clinical, but a morphological concept, and it is difficult to navigate by clinical symptoms. Very often, women do not come with any inflammatory complaints, but only about infertility. And only when diagnosing the cause of infertility is the presence of asymptomatic endometritis revealed.
Autoimmune processes in chronic endometritis
PID in Lately are considered as diseases caused by infectious pathogens and subsequently developing as a pathological, self-sustaining autoimmune reaction. An important factor its development is the insufficiency of the immune system as a result of its maladaptation. The resulting secondary immunodeficiency causes a decrease in the body's resistance to the effects of infectious agents.
Active viruses or bacteria, which are antigens and have caused long-term chronic endometritis, damage epithelial cells with additional formation of antigens in the form of destroyed proteins of the endometrial tissues (autoantigens).
In addition, the infectious agent disrupts the formation of antibodies, resulting in the accumulation of additional antigens. The local immunocompetent system is activated, aimed at neutralizing antigens. There is an overload and gradual depletion, the inclusion of a weakened general immune system of the body in the process, which is already destroying autoantigens and healthy tissues due to the lack of protein differences between them.
That is, the immune system ceases to distinguish between its destroyed and healthy cells, as a result of which the formed autoimmune mechanism affects the healthy endometrium. Chronic endometritis turns into a self-sustaining inflammatory chronic process - autoimmune endometritis, for the maintenance of which there is no longer a need for an infectious pathogen. Therefore, it is often not detected during research.
Thus, autoimmune endometritis is not an independent disease, but a later stage of the same chronic endometritis.
Is it possible to get pregnant with endometritis?
The sensitivity of the endometrium and, accordingly, reproductive functions at the initial stage of chronic endometritis are still maintained at a satisfactory level, due to the presence of certain compensatory mechanisms. Their effectiveness largely depends on the presence of concomitant pathology of the reproductive organs, the activity of the infectious agent, the adequacy of hormonal regulation, and the activity of the immune system. Therefore, pregnancy in the initial stages of chronic endometritis is quite possible.
Chronic endometritis can develop unnoticed on its own, be the result of the risk factors listed in the section “Acute endometritis” or acute endometritis. In accordance with modern classification Endometritis is conventionally classified as:
- Specific. The trigger for the development of inflammation is practically any microorganisms that are present in the vagina, except for bifidobacteria and lactobacilli, that is, the same ones that can cause acute endometritis. However, the most common are ureaplasma and genital herpes virus (about 80%), cytomegalovirus, chlamydia, mycoplasma, gardnerella and microbial associations.
- Nonspecific, in which specific infectious pathogens are not detected in endometrial cells. In these cases, predisposing factors are mainly long-term use of intrauterine contraceptives, untreated long-term bacterial vaginosis, HIV infection and the use of radiation therapy for oncological diseases pelvic organs.
Clinical manifestations
The disease is characterized by nonspecific clinical manifestations, a long course, a small number of symptoms and their mild or no symptoms at all (in 35-40%), the presence of erased forms. The clinical course is a reflection of the depth of functional and structural changes endometrial tissue. Main clinical symptoms:
- Heavy bleeding during menstruation and an increase in its duration.
- Scanty discharge of blood during menstruation, the volume of which does not even reach the physiological level (50 ml).
- Bloody, serous or serous-purulent leucorrhoea or bleeding between periods.
- Irregularity of menstruation.
- Periodic, less often constant, unexpressed nagging pain in the lower abdomen and dyspareunia.
- Infertility, recurrent pregnancy loss (miscarriages) and unsuccessful attempts at IVF or embryo transfer.
Diagnostic methods
Diagnosis of chronic endometritis is based on the analysis of the following data:
- anamnesis (history) of the disease;
- symptoms, if any;
- microscopic examination of smears from the vagina, cervical and urethra;
- results of microflora culture, polymerase chain reaction (PCR) of vaginal contents, uterine cavity and cervical discharge.
- transvaginal ultrasound of the pelvis with Doppler ultrasound on days 5-7 and 22-25 after the onset of menstruation.
- hysteroscopy and endometrial biopsy in the first half of the menstrual cycle (on days 7-11).
How to treat chronic uterine endometritis
Practitioners mainly use a step-by-step treatment regimen for chronic endometritis. Its principle is:
- Stage I - elimination (removal) of infectious agents from the endometrium.
- II- restoration of the level of cells of the immune system.
- III - restoration of the structure of the endometrium and the expression of its receptors (sensitivity of the specific cellular receptor apparatus to the action of estrogens and progesterone).
Stage I includes combinations of broad-spectrum antibiotics that can easily penetrate the cell:
- drugs from the group of nitroimidazoles with macrolides latest generation;
- 3rd generation cephalosporins with macrolides;
- macrolides with protected penicillins, for example, Amoxacillin + Clavulonic acid;
- nitroimidazoles with fluoroquinolones.
One of these combinations is used from the 1st day of menstruation for 5-10 days. At the same time, antifungal drugs are prescribed - Levorin, Fluconazole, Ketoconazole, etc.
If anaerobic pathogens are present in the culture of smears, Metronidazole is added - on average 10 days. Combined infection is an indication for use vaginal suppositories etc. with combined antimicrobial agents(Polygynax) or antiseptics (Hexicon).
If a viral infection is detected after antibiotic therapy, a course of treatment with antiviral and immunomodulatory drugs is carried out.
Stage II consists of the use of hepatoprotective, metabolic (vitamins, antioxidants, macro- and microelements), enzymatic, immunomodulatory (bioflavonoids) and microcirculation-improving agents.
At stage III, maximum importance is attached to physiotherapeutic methods. For this purpose they are used laser therapy, including intravenous blood irradiation with laser beams (ILBI), plasmapheresis, mud therapy, magnetic therapy, iontophoresis with copper and zinc ions. In addition, stimulation of receptor expression is carried out through courses of cyclic hormone therapy with progesterone (Duphaston) and estrogens, as well as phytoecdysteroids.
There is disagreement among researchers regarding the need for antibiotics and antibacterial agents. Some of them believe that in the absence of obvious inflammatory processes, antibiotics have no effect and can lead to dysbiosis. However, most clinicians express the opinion that therapy for endometritis cannot be sufficiently effective if the microbial factor is underestimated and without the use of antibiotics.
Differences between endometritis and endometriosis
Endometriosis is a benign proliferation of tissues that are similar in their morphological characteristics and functional properties to the endometrium. These tissues include not only the upper layer of the latter, but even glandular cells and a connective tissue supporting structure (stroma). However, they are only similar to healthy endometrial tissue.
Molecular defects and genetic changes in endometrioid cells provide them with the ability to grow into neighboring tissues and metastasize with blood and lymph to more distant organs, where they grow and destroy healthy tissue.
Endometriosis lesions can be localized on the uterine appendages and in the space behind it (Douglas pouch), on the septum between the rectum and vagina, on the peritoneum, on the surface of the walls of the intestine and bladder, in skin scars left after laparoscopy. Foci of endometriosis are even found, which happens much less frequently, in the vagina and bladder, in the head and spinal cord, in the lungs.
This disease is a long-term and progressive process that occurs with exacerbations. It can contribute to inflammatory processes, but is not their cause. In its properties, endometriosis resembles malignant tumors, has nothing to do with the inflammatory-immune processes in endometritis and is completely different from them clinical course and the results of laboratory diagnostic studies.
During inflammation, the processes of death and growth of the endometrium are disrupted, as a result the cycle is disrupted, infertility may occur, and the endometrium may open. uterine bleeding, and a miscarriage may also occur.
Treatment of chronic endometritis- This is a long procedure that involves repeated changes of medications.
Endometritis– this is the formation of inflammation in the inner part of the mucous membrane of the uterus, the so-called endometrium. This disease is caused by various infections.
The endometrium changes its structure throughout the menstrual cycle, namely, it grows and matures, preparing for future fertilization of the egg, and dies if conception does not occur. The uterine cavity is in normal condition and has a reliable protective barrier against infectious pathogens if it is lined with the endometrium.
The disease usually occurs:
- after curettage of the uterine cavity,
- intensive obstetric care,
- termination of pregnancy,
- wearing a spiral for a long time,
- caesarean section,
- inflammation of the ovaries,
- gynecological operations,
- endometrial biopsy.
Inflammation develops rapidly and is acute. Several pathogenic microorganisms are involved in the infection.
Types of endometritis
There are two forms of endometritis:
- Acute form of the disease develop as a result of childbirth, mini-abortions or abortions, as well as diagnostic curettage of the uterine cavity, hysteroscopy, etc. Poor-quality removal of the placenta or parts of the fertilized egg, the formation of clots or liquid blood is an ideal microflora for the occurrence of an acute inflammatory process and the initiation of infection. Quite often the cause of postpartum infection is postpartum endometritis. It begins in 40% of cases after cesarean section and in 20% during natural form childbirth This is due to massive changes in the functioning of the immune and hormonal systems female body, because while carrying a baby, immunity and resistance to bacteria “falls”. The cause of acute endometritis is sometimes even simple herpes and mycobacterium tuberculosis. In addition, gonococci, chlamydia, cytomegaloviruses, mycoplasmas, etc. can provoke the disease.
- Chronic endometritis is a consequence of acute endometritis, not completely cured. In almost 90% of cases, such a disease accompanies representatives of reproductive age and is very common with intrauterine therapeutic and diagnostic activities, with a large number of abortions. This type of endometritis becomes one of the common reasons for miscarriage, infertility, poor-quality in vitro fertilization, during difficult pregnancy and childbirth, as well as in the period after childbirth.
Diagnosis of the disease
In order to refute or confirm the established diagnosis, find pathogens and identify the degree of their activity, you should undergo the following studies:
- Examination on a gynecological chair. To make a diagnosis, the doctor examines the condition of the uterus - whether there is enlargement and slight thickening. At the same time, smears are taken from the cervical canal and vagina. They show whether the mucous membrane is inflamed or not. In addition, mucus is collected from the cervix for future use. bacteriological research, which will reveal the causative agent of the disease.
- Ultrasonography. The ultrasound procedure is repeated twice: the first time at the beginning of the menstrual cycle, and the second time in the second half of the cycle. With this study, you can see signs of endometritis: polyps, cysts, endometrial adhesions and thickening.
- Hysteroscopy. This procedure involves a detailed microscopic examination of the penis using a fiber optic instrument. The examination is carried out under anesthesia in the second week of the cycle. At the same time, during the examination, a biopsy of several sections of the endometrium is performed at once. As a result, you can get not only the cause itself, but also find out how active it is.
If the diagnosis is confirmed, the doctor will need to prescribe additional tests to understand the exact cause of the disease:
- blood test for antibodies (ELISA)– allows you to determine the presence viral infection(cytomegalovirus and herpes virus),
- sowing material taken from the uterine cavity and with its help the causative agents of inflammation are identified, which makes it possible to understand which antibiotics will cure the infection,
- PCR diagnostics mucus from the uterus will help to accurately find all the viruses and bacteria that caused the formation of a chronic form of the disease.
In case of infertility, the patient is prescribed a blood test for hormonal levels.
Acute endometritis
The pathogen enters the uterine cavity during sex or when the reproductive organ is damaged. If treatment is not carried out in a timely manner, it can cause health-threatening complications, transition to the chronic stage and even infertility.
Even ordinary hygienic tampons can become a consequence of the disease if the standards for their use are not followed. With improper hygiene, frequent douching and the use of intrauterine contraceptives, problems with the formation and death of the endometrium may occur.
Symptoms of acute endometritis
The acute form of endometritis is similar in its symptoms to ailments that arise in digestive system: proctitis, appendicitis, paraproctitis. This type of disease appears already on the third day after exposure to the virus.
It is characterized by pain in the lower abdomen, painful urination, fever, chills, purulent discharge with an unpleasant odor, bloody clots, increased heart rate, and in rare cases, uterine bleeding.
Treatment of acute endometritis
Acute endometritis must be dealt with in a clinical setting, because bed rest in combination with drug treatment is required. Antibiotics are prescribed, which are selected by taking a smear.
Based on its results, the doctor will determine the sensitivity of the infection to various types of antibiotics and select the most effective ones. The reaction to taking medications appears only a week after the start of treatment.
In addition to antibiotics, the following are prescribed:
- vitamins,
- antihistamines,
- infusion therapy with glucose-salt solutions to detoxify the body,
- antioxidants and immunostimulants,
- antimycotic agents.
If a woman has uterine bleeding, then when fighting acute endometritis, use an ice pack and place it on the stomach. In case of purulent inflammation, the uterus is washed with antiseptics. If endometritis has an inactive phase, then the disease is treated with hirudotherapy (leech treatment) and physiotherapy.
The difference in the choice of drugs and procedures is based mainly on the type of infection, the dynamics of the process, the state of the immune system and the stage of the disease.
At acute form Endometritis should not be forgotten about intoxication of the body, because bacteria release a huge amount of toxins. For this, gynecologists prescribe Vastors, used as an intravenous system: rheopolyglucin, almubin, saline, refortan. Antioxidants in the form of vitamin C are a useful addition to this treatment.
Chronic endometritis
If the fight against acute endometritis is delayed, it will smoothly turn into chronic. When treating the disease, its symptoms subside slightly, but a disturbance in the menstrual cycle remains, slight pain, discharge slightly decreases, but does not stop.
Very often, the disease appears with prolonged dysbiosis of the genital organs and with acute chronic forms of sexually transmitted diseases. During a caesarean section, endometritis is provoked by the presence of suture material that has been in the uterus for a long time, as well as during a poorly performed abortion, due to the presence of fetal remains in the genital organ.
There are several classifications of acute endometritis:
- focal– inflammation does not occur throughout the entire internal part of the membrane, but on its individual parts,
- diffuse– the change is not in the entire area of the endometrium, but in more than half of it.
There is a classification based on the depth of the lesion:
- endomyometritis– the muscular layer of the uterine cavity is affected,
- surface- occurs only in the inner lining of the uterus.
Depending on the nature of the disease, chronic endometritis is divided into:
Symptoms of chronic endometritis
Often chronic endometritis occurs in the absence of symptoms.
But if the disease is moderately active, then inflammation is represented by the following symptoms:
Causes of chronic endometritis
The causes of the formation of a chronic form of endometritis are penetration into the uterine cavity harmful microorganisms– yeast-like fungi, viruses and bacteria. At nonspecific form an illness caused by “ordinary” flora, which is located on the labia, perineum and anus.
In a normal state, the uterine cavity is closed from external influences, because... it ends in a narrow tube in the cervix, filled with thick and viscous secretion. Microbes can penetrate into it only during childbirth and menstruation, because they can penetrate the uterine cavity, which at this moment is non-sterile.
Causes:
When is there an increased risk of chronic endometritis?
Most often, the chronic form occurs in women who are of reproductive age (21-45 years) and are sexually active. The disease is no less developed among representatives of the fair sex who are not sexually active.
Women at increased risk include:
- after endometrial biopsy,
- with intrauterine device,
- after miscarriage and biopsy,
- for bacterial candidiasis and vaginosis,
- after hyteroscopy and hysterosalpingography,
- with infection with cytomegavirus and genital herpes,
- after diagnostic curettage,
- after sexual diseases - mycoplasmosis, chlamydia, trichomoniasis and gonorrhea,
- at chronic inflammation cervix (cervicitis).
- infectious complications after childbirth, for example, postpartum endometritis,
- polyps or submucosal fibroids of the uterus.
Interestingly, a third of women cannot find the cause of chronic endometritis.
Infections caused by disease
This disease is usually caused by various types infections. Usually they are the same in chronic and acute forms.
These are diseases caused by protozoa chlamydia and ureaplasma, advanced candiosis, as well as bacteria and microbes various types, and, of course, sexually transmitted diseases. Any disease localized in the vagina can quickly spread to the uterine cavity.
Exacerbation chronic course inflammation occurs when immunity decreases and usually goes into the active stage, which in no way depends on the type of infection.
Complications
Endometrium- This is the most responsible functional layer of the uterus, responsible for the normal course of pregnancy.
Inflammatory processes in it carry with them the threat of miscarriage, difficult gestation, placental insufficiency and, possibly, bleeding after the end of childbirth. Therefore, a woman who has had endometritis should be under special attention at the gynecologist.
Among the consequences of this terrible disease there are adhesions inside the uterine cavity, i.e. intrauterine synechiae, menstruation disorders, endometrial cysts and polyps, hardening of the uterus.
The tubes and ovaries, adhesions of the pelvic organs can participate in the inflammatory process of this disease, and peritonitis may even develop. As a rule, with adhesive disease there are severe pain in the stomach, which can cause infertility.
To avoid endometritis, you should avoid abortion, maintain personal hygiene, and especially during menstruation. It is imperative to prevent the occurrence of post-abortion and postpartum infections, and use condoms to prevent sexual diseases. With timely detection of infections and control of them, in most cases, doctors give a positive prognosis for pregnancy and childbirth.
Treatment of chronic endometritis
More than half of women wonder whether it is possible to overcome chronic endometritis. Of course, you can when selecting individual treatment, which depends on the stage of activity of the process and the presence of complications.
In therapy, modern gynecologists use an integrated approach: immunomodulatory, antimicrobial, physiotherapeutic and restorative treatment. The fight against the disease is carried out in stages.
The first is to eliminate infections, the second is to restore the endometrium. For this purpose, broad-spectrum antibiotics are used. The recovery process is based on a combination of metabolic and hormonal therapy.
Medicines are injected into the mucous membrane of the uterine cavity to increase the concentration at the site of inflammation, and this gives a high effect of treatment.
Antibiotics and antiviral drugs
For endometritis with a bacterial infection, antibiotics are strictly prescribed. Because various bacteria are very sensitive to certain types of antibiotics. Today there is still no special universal treatment regimen.
For each patient, it is developed individually, focusing on the pathogen and its sensitivity to the drug. In the acute stage, antibiotics are administered intravenously, namely Metrogyl in combination with Cephalosporin. If necessary, the patient is given Gentamicin injections.
If the genital herpes virus was found in the uterus, then antiviral drugs are required. Usually it is Acyclovir. Immunomodulators are also prescribed, that is, drugs to enhance immunity.
The duration of antibiotic use should be no more than ten days.
The most popular of them:
- Amoxicillin is an affordable drug with a broad spectrum of action, used for intravenous and oral treatment. Apply from 0.75 to 3 grams per day per day.
- Ceftriaxone– used intravenously to block sepsis and suppress the infectious agent. It should not be prescribed at the beginning of pregnancy. The dose should not exceed two grams per day.
Amoxicillin
Ceftriaxone
Hormonal drugs
The chronic form is based not only on infection, but also on the death of the endometrium and disruption of the process of its formation. Therefore, hormonal therapy is an integral step in the fight against the disease.
Usually, various contraceptive medications are prescribed and must be taken for a period of three to six months. After taking these drugs, as a rule, it is restored menstrual cycle. And after undergoing treatment, a woman can become pregnant.
If a woman is pregnant, then to preserve the fetus she is prescribed medications based on estrogen hormones.
In other cases, if the woman is not in position, it is applied next diagram treatment:
Treatment of endometritis with folk remedies
Is it possible to completely cure endometritis? grandma's means? As they say 50/50, and only after consulting with your doctor. He will select drug treatment for you in combination with folk remedies to obtain the best result.
With this combination treatment the doctor can prescribe additional tests, which will show how effective this method of herbal treatment is, because in the end you can only relieve the symptoms of the disease, but the inflammation in the body will remain.
Endometritis and pregnancy
Women suffering from endometritis, like others, hope for successful conception. But the trouble is that it is almost impossible to bear a fetus and give birth to a child.
There are two important threats that interfere with a normal pregnancy:
But do not be discouraged, because chronic endometritis can be completely cured, which means that in the future it will be possible to plan a pregnancy. With positive dynamics of treatment and a decrease in the inflammatory process, restorative physiotherapeutic procedures are carried out, which help restore the properties of endometrial cells.
You need to plan a pregnancy only after repeating all tests and ultrasound if you receive positive results.
