Is endometritis treated? Acute and chronic endometritis: symptoms and treatment

Chronic endometritis develops against the background of an untreated acute form of pathology. Diagnosed quite often. It occurs most often in women of childbearing age. Characterized by periods of exacerbation and remission.

Chronic endometritis is inflammatory process, the area of ​​localization of which becomes the basal layer of the endometrium. The pathology is caused by the penetration of fungi, bacteria, and viruses into it.

How it manifests itself

The clinical picture is poorly expressed. The constant weakness accompanying the condition is attributed to fatigue, so the woman is in no hurry to see a specialist.

During the period of exacerbation, the disease manifests itself in such conditions as:

• scanty/heavy menstrual flow, intermenstrual spotting, delays;
• pain during frictions;
• the appearance of unpleasant-smelling discharge, the presence of purulent inclusions is possible;
• fast fatiguability;
• increased body temperature, chills;
• recurrent miscarriage;
• pain in the projection area of ​​the uterus.

There are also ultrasound signs of the disease. This:

• thickening of endometrial tissues on days 5–8 of the cycle reaches 6–7 mm, while the norm is no more than 3–4 mm;
• premature thinning of the mucosa;
• the presence of hyperechoic inclusions in the lower endometrial layer;
• diffuse/focal formations in the myometrium;
• pathological dilatation of the veins of the uterus;
• disturbance of blood flow (determined by Doppler ultrasound).

Symptoms

When inflammation is chronic, there are no signs of an acute form. Symptoms chronic course are:

• A constant but slight increase in body temperature. The woman feels overwhelmed, tired, and her performance decreases.
• Menstrual irregularities. The patient notes lengthening/shortening of the cycle, changes in the volume of menstrual flow, metrorrhagia, spotting before and after menstruation. Similar symptoms are caused by fibrosis connective tissue, which leads to disruption of cyclical processes in the endometrium, poor contractility uterus and deviation in the process of platelet aggregation.
• Pain syndrome. Pain is felt in the projection area of ​​the uterus, in the lumbar region. It is possible that it develops during the emptying of the intestines, as well as during sex.
• Discharge. Vaginal leucorrhoea becomes profuse, mucous, and smells unpleasant. May include purulent components.
• Fertility disorders. A woman becomes unable to bear a child or cannot become pregnant at all.

How to treat chronic endometritis

Treatment tactics depend on the current clinical picture. As a rule, when the pathology worsens, a woman is offered hospitalization.

Medication

Treatment is aimed at solving the following problems:

• elimination of infection;
• boosting the immune system;
• normalization of metabolic processes.

Important! It is mandatory to take oral contraceptives.

Since the cause of chronic endometritis is a bacterial infection, the woman is prescribed antibacterial and antiviral agents.

During the period of exacerbation and the appearance of pronounced symptoms, the patient is prescribed 2–3 types of antibiotics. In this case, a woman can receive two drugs intravenously, by drip or orally, the third is intended for intrauterine sanitation. The drug is injected into the uterine cavity through a thin catheter.

In order to strengthen immune defense immunostimulants are used. Good results are obtained with the use of interferon or polyoxidonium.

The final stage is recovery natural processes in endometrial tissues. To achieve the goal, a woman is prescribed:

• hormonal contraception;
• drugs containing progesterone;
• hemostatic agents.

Important! To eliminate the inflammatory process, suppositories with indomethacin and dicrofenac can be used.

Surgical

In the chronic form, surgery is practiced relatively infrequently. The indication is the presence of polypous formations and adhesions in the uterine cavity in preparation for a planned pregnancy.

Removal is carried out using an electrocoagulator during the gesteroscopy procedure.

Treatment with folk remedies

Chronic inflammation can be treated with herbs.

• It is necessary to combine equal volumes of pine buds, nettle and cherry leaves, sweet clover herb, wormwood, lavender, cucumber, roots of Leuzea and marshmallow. Grind. Take 2 tbsp. mix and brew with boiling water. Leave warm all night. Filter. Drink one third of a glass up to 5 times a day for 60 days.
• 1 tbsp. pour dry St. John's wort with boiling water (200 ml) and simmer in a water bath at low boil for 15 minutes. Let cool, strain. Take 50 ml three times a day. Contraindication: arterial hypertension.
• Tampons with sea ​​buckthorn oil. Course duration is 10 days. Put tampons on all night.

Before starting treatment, you should definitely consult a doctor.

Is it possible to cure chronic endometritis?

Conducted in a timely manner diagnostic studies make it possible to identify the disease at an early stage, which significantly improves the prognosis for recovery.

When identifying pathology, it is important to draw up the “correct” treatment regimen, taking into account all factors:

• degree of endometrial damage;
• activity of the ongoing process;
• the presence of developed complications;
• type of pathogen.

Doctors carry out multi-stage treatment of the disease. In case of absence acute symptoms the course of therapy can be completed on an outpatient basis, i.e. at home.

How long does it take to treat

Everything is individual and the duration of therapy depends on many factors, in particular, the degree of development of inflammation and general condition patient's health.

It is worth noting that full recovery occurs in rare cases. But timely health care allows a woman to experience the joy of motherhood.

How does chronic endometritis develop?

The main reason for the chronicity of the disease is the lack of adequate treatment for acute inflammation of the endometrium.

Against the background of drug therapy, there is a decline in characteristic symptoms, but the inflammatory process remains not completely eliminated. Minor pain syndrome, menstrual irregularities, pathological vaginal discharge are diagnosed over the next few months.

Causes

The initiators of an acute form of inflammation of the lining layer of the uterus are pathological microorganisms that penetrate into its cavity from the vagina. But this is only possible if it is opened cervical canal and the presence of endometrial trauma.

Factors that provoke inflammation include:

• violation of aseptic rules when performing abortions/diagnostic curettages;
• spontaneous miscarriage, as a result of which unremoved pieces of embryonic tissue remain in the uterine cavity - an ideal base for the proliferation of pathogenic microorganisms;
• forced expansion of the cervical canal during the procedure of hysteroscopy or hysterosalpingography;
• procedure for placing an intrauterine device;
• frequent vaginal irrigation;
• complex, prolonged labor;
• sexual relations during menstruation.

Less common reasons are:

• probing the body of the uterus;
• separation of the “baby seat” after completion of childbirth manually;
• impaired immune defense;
• IVF procedure and artificial insemination.

Diagnostic methods

When diagnosing a chronic form of endometritis, the gynecologist is based on the patient’s complaints and the results of the examination. gynecological examination.

The specialist fixes the slightly enlarged softened uterus. When trying to palpate an organ, a woman experiences pain. Pain is also felt when palpating the vaginal vaults, which signals the development of adnexitis.

Additionally assigned:

• general blood analysis;
• examination of the obtained smears;
• bacteriological examination of vaginal discharge;
• Ultrasound of the pelvic organs;
• hysteroscopy (if necessary accompanied by diagnostic curettage).

Types (classification)

The classification of the disease is based on various factors. Depending on the type of pathogen, the following forms of chronic endometritis are distinguished:

• nonspecific - development is due to the active reproduction of its own opportunistic microflora;
• specific - caused by the penetration of pathogenic bacteria from outside.

Accompanying the disease morphological characteristics also form the basis of classification. Within this gradation, it is customary to distinguish the following types of chronic endometritis:

• atrophic – characterized by atrophy of the glands;
• hypertrophic – accompanied by excessive growth of the endometrium;
• cystic - the form is characterized by the proliferation of fibrous tissues with the subsequent formation of cystic formations.

Depending on the strength of the inflammatory process, there are:

• moderate – signs of inflammation are present on ultrasound, there are characteristic symptoms;
• sluggish – manifestations of the disease are minimal, detected only during transvaginal ultrasound;
• chronic inactive - signs of inflammation can only be diagnosed by examining endometrial cells under a microscope.

Additional classification:

• according to the degree of prevalence - focal and diffuse;
• according to the depth of the lesion - superficial and deep.

Do's and Don'ts

But since the disease occurs against the background of reduced immune defense, to strengthen it, the woman is advised to reconsider her diet. It is advisable to increase the content fresh vegetables and fruits to replenish the deficiency of vitamins and microminerals.

Important! During the period of exacerbation of the disease, it is necessary to minimize any physical exercise and refuse to visit baths and saunas.

Forecast

Complete recovery occurs in rare cases. The main direction of treatment is to eliminate signs of the inflammatory process and restore the patient’s fertile abilities. Timely therapy prevents the development of infertility.

Complications of endometritis

TO typical complications chronic forms of endometritis include:

• development of ectopic pregnancy;
• endometrial diseases;
• pathological processes in the pelvic organs;
• cystic and other formations in the ovarian tissues.

Important! The course of pregnancy against the background of the disease is difficult.

Prevention

Specific preventive measures that can prevent the development of endometritis have not been developed by medicine. Experts advise eliminating factors from life that can cause the development of an inflammatory process in endometrial tissue. Desirable:

• refusal of casual sex, unprotected sex is especially dangerous;
• refusal of artificial termination of pregnancy.

It is extremely important to adhere to the rules of personal intimate hygiene. It is also necessary to regularly visit a gynecologist for preventive purposes.

Chronic endometritis and IVF

Carrying out in vitro fertilization against the background of a chronic form of inflammation of endometrial tissues is often unsuccessful. The reason is a violation of the structure of the endometrium, which is an obstacle to the full attachment of the implanted embryo.

Before IVF, to increase the effectiveness of the procedure, a woman may be prescribed:

• long-term hormonal support;
• taking phlebotonics and anticoagulants;
• use of immunostimulants.

If necessary, physiotherapeutic procedures are prescribed.

About pregnancy during pathology

Conception against the background of chronic endometritis proceeds safely, since the ovulation process is not disrupted. Difficulties begin after the fertilized egg enters the uterine cavity: it cannot be successfully implanted into the tissue of the modified endometrium.

Even if cell attachment does occur, there is a risk of spontaneous miscarriage and the development of intrauterine fetal pathologies. The reason is the insufficient supply of the embryo with the substances necessary for full development.

Carrying out treatment before pregnancy significantly increases the likelihood of its successful completion.

Important! Approximately 25% of difficult births and cesarean sections result in the development of postpartum endometritis.

What does the remission stage mean?

Remission means the absence of symptoms characteristic of the disease. It is during this period that the onset and successful development of gestation is possible.

What to do during an exacerbation

An exacerbation is accompanied by the appearance of the entire spectrum of pathological symptoms - an increase in body temperature to high levels, chills accompanying fever, and severe pain in the lower abdomen.

When clinical manifestations inflammation, you must immediately consult a doctor and undergo a course of treatment.

Treatment of chronic, acute and other endometritis - in the largest gynecology clinic in Moscow

Endometritis is an inflammatory process in the uterine mucosa, which is a significant risk factor for the formation of the uterine form of infertility. In the absence of a full course of treatment, problems may arise associated with conceiving a child and an increased risk of developing gynecological diseases such as uterine fibroids, endometriosis, hyperplasia and endometrial polyps.

Make an appointment with a gynecologist and we will solve the issue together!

Endometritis: what is it?

According to the severity of inflammation:

• acute endometritis;
• subacute;
• chronic.

By degree of distribution:

• diffuse;
• focal.

According to the depth of the inflammatory process:

• superficial endometritis;
• endomyometritis, in which damage occurs muscle tissue uterus.

Causes of endometritis

A prerequisite for the occurrence of an inflammatory process is the presence of infection.

These can be opportunistic microbes (staphylococcus, streptococcus, coli), but most often endometritis occurs due to infection with sexually transmitted microorganisms, which include:

• chlamydia;
• mycoplasma;
• gonococci;
• Trichomonas;
• herpes viruses;
• fungal diseases.

In addition to the presence of microbes great importance have predisposing and contributing factors:

• high sexual activity with frequent changes of sexual partners;
• any options for artificial termination of pregnancy;
• complications during childbirth (tight placenta, cesarean section, postpartum endometritis);
• any therapeutic and diagnostic gynecological procedures (diagnostic hysteroscopy, hysteroresectoscopy, diagnostic scraping from the uterine cavity, hysterosalpingography);
• long-term wearing of an intrauterine contraceptive device;
• decreased immune defense against the background of common serious diseases.

Endometritis: symptoms

Due to the paucity of symptoms, the presence of chronic endometritis is usually detected during an examination for infertility.

Vivid manifestations of the inflammatory process in the uterine cavity occur with acute endometritis, in which the following typical symptoms are observed:

• pain in the lower abdomen of varying severity;
• increased body temperature with a more pronounced reaction in the evening;
• copious purulent discharge from the genital tract.

Chronic endometritis is characterized by minimal and unexpressed manifestations, which include:

• recurrent aching or nagging pain in a stomach;
• menstrual irregularities (scanty or prolonged menstruation);
• periodic vaginal discharge with an unpleasant odor;
• psychological disorders and problems in sexual life;
• infertility and miscarriage.

A woman, having contacted a doctor with complaints about the absence of pregnancies, undergoes a full course of examination, during which it is discovered typical signs chronic inflammation in the uterus.

Diagnosis of endometritis

The inner lining of the uterus, which grows and sheds every month, is called the endometrium. When an infection gets inside the cavity and an inflammatory process occurs, endometritis develops. Exist various options diseases.

Ultrasonography

Echography is carried out on days 5-7 and 21-24 of the menstrual cycle. Typical ultrasound signs of chronic endometritis will be the following manifestations:

• heterogeneity and unevenness of the endometrial structure;
• change in the thickness and uniformity of the M-echo, indicating thinning of the inner surface of the uterus;
• enlargement and expansion of the uterine cavity due to exudate and the presence of gas bubbles;
• change in the thickness of the walls of the uterus with the appearance of small brushes in the muscle layer.

The presence of ultrasound signs alone will not be the basis for an accurate diagnosis. Required condition- coincidence with clinical symptoms and the results of other examination methods.

Laboratory research

For quality treatment, it is necessary to identify the causative factor of endometritis. To do this, the doctor will evaluate the results of the following studies:

• vaginal smears;
• bacterial cultures from the vagina, cervical canal and uterine cavity;
• taking blood from a vein to test for antibodies to sexually transmitted infections;
• special studies (PCR) that allow high-precision detection of bacteria and viruses.

Diagnostic hysteroscopy

A visual examination of the uterine cavity will be required if there are complications or to clarify the extent of the lesion. It is optimal to use mini-hysteroscopy to identify problems with the endometrium. During an endoscopic examination, the doctor will see the following manifestations of the disease:

• the presence of focal defects on the inner surface of the uterus;
• thinning of the endometrium;
• vascular disorders in the uterine mucosa;
• presence of inflammatory fluid.

During hysteroscopy, the doctor will definitely take a small piece of the mucous membrane for histological examination, which will be ideal for diagnosing chronic endometritis.

Endometritis in women: treatment

Any therapeutic measures depend on the severity of the inflammatory process and the presence of symptoms that disrupt menstrual and reproductive functions.

Treatment of acute endometritis

At the 1st stage of treatment, in the presence of a temperature reaction, severe pain and vaginal leucorrhoea with typical ultrasound signs, the doctor will begin treatment by prescribing antibacterial drugs.

For the purpose of pain relief and to reduce inflammatory reaction Non-steroidal anti-inflammatory drugs (NSAIDs) should be used.

At stage 2, if the condition improves, the doctor will use medicines to improve immunity and physiotherapeutic measures. Electrophoresis or phonophoresis with anti-inflammatory drugs, ultraviolet irradiation of blood, and laser therapy will give an excellent effect.

Treatment of chronic endometritis

The main goals of treating chronic inflammation of the uterine mucosa include:

• normalization of ovarian function with regulation of hormonal functions;
• improvement of blood flow in the pelvic area;
• creating conditions for pregnancy;
• improvement psychological state women;
• relief from periodic pelvic pain;
• increasing immune defense.

In most cases, at stage 1 it is necessary to use an antibacterial or antiviral drug, the choice of which depends on the type of microorganism and the detected sensitivity to drugs.

An excellent effect will be achieved by using hormonal drugs that will act on the uterus and ovaries, providing excellent therapeutic effect. Typically, the doctor will use oral contraceptives within 3-6 months.

Symptomatic therapy includes angioprotectors (medicines to improve blood flow), vitamins, and immunomodulators.

Non-drug treatment options include:

• irrigation of the uterine cavity with antiseptics;
• electrophoresis or phonophoresis with anti-inflammatory solutions of copper, zinc, iodine;
• phototherapy using infrared laser;
• ozone therapy;
• balneotherapy (baths, mud);
• Spa treatment.

An excellent result of treatment of acute or chronic endometritis is the normalization of menstruation and the onset of the desired pregnancy.

Endometritis: prognosis

The degree of damage to the uterine mucosa is of great prognostic significance for getting rid of endometritis. If injury or inflammation damages only the functional layer of the endometrium (the one that is shed monthly), then complete recovery is guaranteed.

If damage has occurred to the basal layer (the deep part of the endometrium from which the functional layer is formed), then the prognosis for getting rid of chronic endometritis is much worse. Even if a full course of treatment is carried out, it is impossible to restore all functions of the endometrium with guaranteed certainty.

Prevention of endometritis

To prevent any types of endometritis, the following recommendations must be followed:

• exclude any options for artificial termination of pregnancy;
• use intrauterine contraception only after childbirth;
• when changing sexual partners frequently, use protected sex;
• promptly treat inflammation in the vagina;
• lead healthy image life and eat right, avoiding a decrease in immunity;
• strictly follow the doctor’s recommendations when treating acute endometritis;
• perform any diagnostic tests only according to strict indications.

With chronic endometritis, the most unpleasant thing will be infertility. If conception occurs despite proper treatment, you should be wary of complications during pregnancy. Every woman should be aware: interrupting the very first pregnancy in her life is unacceptable, because this with a high degree of probability can cause chronic endometritis.

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Zhumanova Ekaterina Nikolaevna

Head of the Center for Gynecology, Reproductive and aesthetic medicine, PhD, doctor highest category, Associate Professor of the Department of Regenerative Medicine and Biomedical Technologies of the Moscow State Medical University named after A.I. Evdokimova, board member of the Association of Aesthetic Gynecologists ASEG.

• Graduated from the Moscow Medical Academy named after I.M. Sechenova, has a diploma with honors, completed clinical residency at the Clinic of Obstetrics and Gynecology named after. V.F. Snegirev MMA named after. THEM. Sechenov.
• Until 2009, she worked at the Clinic of Obstetrics and Gynecology as an assistant at the Department of Obstetrics and Gynecology No. 1 of the MMA named after. THEM. Sechenov.
• From 2009 to 2017 she worked at the Federal State Institution “Treatment and Rehabilitation Center” of the Ministry of Health of the Russian Federation
• Since 2017, he has been working at the Center for Gynecology, Reproductive and Aesthetic Medicine of Medsi Group of Companies JSC.
• She defended her dissertation for the degree of Candidate of Medical Sciences on the topic: “Opportunistic bacterial infections and pregnancy"

Myshenkova Svetlana Aleksandrovna

Obstetrician-gynecologist, candidate of medical sciences, doctor of the highest category

• In 2001 she graduated from the Moscow State Medical and Dental University (MGMSU)
• In 2003, she completed a course of study in the specialty “obstetrics and gynecology” at the Scientific Center for Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences
• He has a certificate in endoscopic surgery, a certificate in ultrasound diagnostics of pathologies of pregnancy, fetus, newborn, in ultrasound diagnostics in gynecology, a certificate of a specialist in the field of laser medicine. All knowledge gained during theoretical studies, successfully applies in his daily practice
• She has published more than 40 works on the treatment of uterine fibroids, including in the journals “Medical Bulletin” and “Problems of Reproduction”. Is a co-author methodological recommendations for students and doctors.

Kolgaeva Dagmara Isaevna

Head of pelvic floor surgery. Member of the scientific committee of the association for aesthetic gynecology.

• Graduated from the First Moscow State University medical University them. THEM. Sechenov, has a diploma with honors
• She completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov
• Has certificates: obstetrician-gynecologist, specialist in laser medicine, specialist in intimate contouring
• The dissertation is devoted to surgical treatment genital prolapse complicated by enterocele
• The sphere of practical interests of Dagmara Isaevna Kolgaeva includes:
  conservative and surgical methods treatment of prolapse of the walls of the vagina, uterus, urinary incontinence, including the use of high-tech modern laser equipment

Maksimov Artem Igorevich

Obstetrician-gynecologist of the highest category

• Graduated from Ryazan State Medical University named after academician I.P. Pavlova with a degree in general medicine
• Completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology Clinic named after. V.F. Snegirev MMA named after. THEM. Sechenov
• Owns full spectrum surgical interventions at gynecological diseases, including laparoscopic, open and vaginal access
• The scope of practical interests includes: laparoscopic minimally invasive surgical interventions, including single-puncture access; laparoscopic operations for uterine fibroids (myomectomy, hysterectomy), adenomyosis, widespread infiltrative endometriosis

Pritula Irina Alexandrovna

Obstetrician-gynecologist

• Graduated from the First Moscow State Medical University named after. THEM. Sechenov.
• She completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov.
• She is certified as an obstetrician-gynecologist.
• Possesses the skills of surgical treatment of gynecological diseases on an outpatient basis.
• Is a regular participant scientific and practical conferences in obstetrics and gynecology.
• The scope of practical skills includes minimally invasive surgery (hysteroscopy, laser polypectomy, hysteroresectoscopy) - Diagnosis and treatment of intrauterine pathology, cervical pathology

Muravlev Alexey Ivanovich

Obstetrician-gynecologist, gynecological oncologist

• In 2013 he graduated from the First Moscow State Medical University named after. THEM. Sechenov.
• From 2013 to 2015, he completed clinical residency in the specialty “Obstetrics and Gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University named after. THEM. Sechenov.
• In 2016, he underwent professional retraining at the State Budgetary Institution of Healthcare of the Moscow Region MONIKI named after. M.F. Vladimirsky, specializing in Oncology.
• From 2015 to 2017, he worked at the Federal State Institution “Treatment and Rehabilitation Center” of the Ministry of Health of the Russian Federation.
• Since 2017, he has been working at the Center for Gynecology, Reproductive and Aesthetic Medicine of Medsi Group of Companies JSC.

Mishukova Elena Igorevna

Obstetrician-gynecologist

• Doctor Mishukova Elena Igorevna graduated with honors from the Chita State Medical Academy with a degree in general medicine. She completed clinical internship and residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov.
• Mishukova Elena Igorevna has a full range of surgical interventions for gynecological diseases, including laparoscopic, open and vaginal access. He is a specialist in providing emergency gynecological care for diseases such as ectopic pregnancy, ovarian apoplexy, necrosis of myomatous nodes, acute salpingoophoritis, etc.
• Mishukova Elena Igorevna is an annual participant in Russian and international congresses and scientific and practical conferences on obstetrics and gynecology.

Rumyantseva Yana Sergeevna

Obstetrician-gynecologist of the first qualification category.

• Graduated from the Moscow Medical Academy named after. THEM. Sechenov with a degree in general medicine. Completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 First Moscow State Medical University them. THEM. Sechenov.
• The dissertation is devoted to the topic of organ-preserving treatment of adenomyosis using FUS ablation. He has a certificate as an obstetrician-gynecologist and a certificate in ultrasound diagnostics. Proficient in the full range of surgical interventions in gynecology: laparoscopic, open and vaginal approaches. He is a specialist in providing emergency gynecological care for diseases such as ectopic pregnancy, ovarian apoplexy, necrosis of myomatous nodes, acute salpingoophoritis, etc.
• Author of a number of published works, co-author of a methodological guide for doctors on organ-preserving treatment of adenomyosis using FUS ablation. Participant of scientific and practical conferences on obstetrics and gynecology.

Gushchina Marina Yurievna

Gynecologist-endocrinologist, head of outpatient care. Obstetrician-gynecologist, reproductive specialist. Doctor ultrasound diagnostics.

• Gushchina Marina Yurievna graduated from Saratov State Medical University. V.I. Razumovsky, has a diploma with honors. She was awarded a diploma from the Saratov Regional Duma for excellent achievements in studies and scientific activities, recognized as the best graduate of Saratov State Medical University named after. V. I. Razumovsky.
• She completed a clinical internship in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov.
• He is certified as an obstetrician-gynecologist; ultrasound diagnostics doctor, specialist in laser medicine, colposcopy, endocrinological gynecology. Repeatedly took advanced training courses in “ Reproductive medicine and surgery”, “Ultrasonic diagnostics in obstetrics and gynecology”.
• The dissertation is devoted to new approaches to differential diagnosis and tactics for managing patients with chronic cervicitis And early stages HPV-associated diseases.
• Proficient in the full range of minor surgical interventions in gynecology, performed both on an outpatient basis (radiocoagulation and laser coagulation of erosions, hysterosalpingography) and in a hospital setting (hysteroscopy, cervical biopsy, cervical conization, etc.)
• Gushchina Marina Yuryevna has more than 20 scientific published works, is a regular participant in scientific and practical conferences, congresses and conventions on obstetrics and gynecology.

Malysheva Yana Romanovna

Obstetrician-gynecologist, pediatric gynecologist adolescence

• Graduated from the Russian National Research Medical University. N.I. Pirogov, has a diploma with honors. She completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the Faculty of Medicine of the First Moscow State Medical University. THEM. Sechenov.
Graduated from the Moscow Medical Academy named after. THEM. Sechenov with a degree in general medicine
• She completed clinical residency in the specialty “Ultrasound Diagnostics” at the Research Institute of Emergency Medicine named after. N.V. Sklifosovsky
• Has a Certificate from the FMF Fetal Medicine Foundation confirming compliance with international requirements for 1st trimester screening, 2018. (FMF)

Knows how to perform ultrasound examination:

• Abdominal organs
• Kidney, retroperitoneum
• Bladder
• Thyroid gland
• Mammary glands
• Soft tissues and lymph nodes
• Pelvic organs in women
• Pelvic organs in men
• Upper vessels, lower limbs
• Vessels of the brachiocephalic trunk
• In the 1st, 2nd, 3rd trimester of pregnancy with Doppler ultrasound, including 3D and 4D ultrasound

Kruglova Victoria Petrovna

Obstetrician-gynecologist, gynecologist for children and adolescents.

• Victoria Petrovna Kruglova graduated from the Federal State Autonomous Educational Institution higher education"Peoples' Friendship University of Russia" (RUDN).
• Completed clinical residency in the specialty “Obstetrics and Gynecology” on the basis of the department of the Federal State Budgetary Educational Institution of Additional vocational education"Institute for Advanced Studies of the Federal Medical and Biological Agency."
• He has certificates: obstetrician-gynecologist, specialist in the field of colposcopy, non-operative and operative gynecology of children and adolescents.

Baranovskaya Yulia Petrovna

Ultrasound diagnostics doctor, obstetrician-gynecologist, candidate of medical sciences

• Graduated from the Ivanovo State Medical Academy with a degree in general medicine.
• She completed an internship at the Ivanovo State Medical Academy, a clinical residency at the Ivanovo Research Institute named after. V.N. Gorodkova.
• In 2013 she defended her PhD thesis on the topic “Clinical and immunological factors in the formation of placental insufficiency”, awarded academic degree"Candidate of Medical Sciences".
• Author of 8 articles
• Has certificates: ultrasound diagnostics doctor, obstetrician-gynecologist.

Nosaeva Inna Vladimirovna

Obstetrician-gynecologist

• Graduated from Saratov State Medical University named after V.I. Razumovsky
• Completed an internship at the Tambov Regional clinical hospital specializing in obstetrics and gynecology
• He is certified as an obstetrician-gynecologist; ultrasound diagnostics doctor; specialist in the field of colposcopy and treatment of cervical pathology, endocrinological gynecology.
• Repeatedly took advanced training courses in the specialty “obstetrics and gynecology”, “Ultrasonic diagnostics in obstetrics and gynecology”, “Fundamentals of endoscopy in gynecology”
• Owns full volume surgical interventions on the pelvic organs, performed by laparotomy, laparoscopic and vaginal approaches.

The question is whether it can be cured forever chronic endometritis sounds more and more often in the gynecologist's office. This is due to the fact that many girls do not want to pay due attention to their health, and allow a seemingly easily treatable disease to turn into chronic form. In this case, it will not be possible to get rid of the disease without medical intervention. That is why we will consider in detail the issue of treatment of chronic endometritis.

What is chronic endometritis?

This disease is an inflammation of the endometrial layer. Diagnosing the development of such inflammation is quite difficult. Most often it occurs after an abortion or quite a long period of infertility.

Why does the disease develop?

The reasons for the development of this disease are due to the peculiarity female body. Every month, the uterus undergoes a process that allows you to conceive a child. The endometrial layer of the uterus is supplied nutrients and reacts quite sensitively to the passage of any changes, which allows the fertilized egg to implant and develop at the proper level.

But if an inflammatory process occurs in a woman’s vagina caused by infections, it can spread to the uterus.

With low immunity, no proper treatment or its absence, the infection begins to develop in the cells of the mucous membrane. At times under the influence external factors the infection can make itself known, affecting the immune system and provoking the development of a chronic form of the disease.

If this kind of inflammation is not treated, then the formation of special tissue begins in the endometrial layer. In addition, circulatory disorders occur and the level of its sensitivity to hormonal changes decreases. As a result of this process, the fertilized egg is not able to implant in the uterus.
In addition, the chronic form of this disease can cause:

• Difficulty conceiving.
• Insufficient duration of phase 2 of the cycle.
• Miscarriage.
• Complicated pregnancy.
• Problem childbirth.

Among the factors that provoke the development of endometritis, experts identify:

• Artificial termination of pregnancy.
• Deformation of the uterine body.
• Difficult birth.
• Postpartum complications.

Symptoms of the disease

There are quite a few symptoms that help recognize the development of this disease. These include:

• Uterine bleeding.
• Abdominal pain.
• Problematic menstruation.
• Pain during sexual intercourse.
• Copious discharge.
• Infertility.

However, quite often the disease can occur in an asymptomatic form.

How is endometritis diagnosed?

Diagnosing this disease is quite difficult. In addition, it is also very difficult to detect it during a routine gynecological examination.
That is why, to determine the diagnosis, experts prescribe the following studies:

• Ultrasound diagnostics. When performing ultrasound diagnostics, a certain expansion of the uterine cavity and a change in the composition of its mucous membrane can be observed. Very often, doctors prescribe 2 procedures in the first and second half of the cycle.
• Hysteroscopy. When undergoing such a study, it is possible to determine the heterogeneous thickness of the mucous layer and increased level bleeding. As a rule, the procedure is carried out on the 10th day, after the end of the menstrual cycle.
• Histological examination. This research method allows you to diagnose endometritis as accurately as possible. As a rule, such a study is carried out 7-10 days after the end of the menstrual cycle.

How is the disease treated?

First of all, treatment of this disease is aimed at restoring reproductive function and improvement of the endometrium.
As a rule, therapy is complex and carried out in stages:

1. At the first stage, they are used for treatment antibacterial drugs. Their appointment is carried out only after the causative agent of the disease has been identified. In addition, intrauterine treatment can be performed as prescribed by a doctor. Quite often, additional immunostimulants are prescribed.
2. At the second stage, drug therapy is carried out to improve the state of local immunity. It may also be prescribed physiological effects, which will increase blood circulation in the organ. In some cases it is prescribed hormone therapy, to restore ovarian function.

The full course of treatment for this disease takes about 3 months. As a rule, the effectiveness of treatment is determined only when 2/3 of the course has been completed. In most cases timely treatment the chronic form of the disease allows you to normalize reproductive function.

Is it possible to cure a chronic type of disease?

Many women are concerned about the question of whether the disease can be cured forever. The answer to this question is ambiguous. It is, of course, possible to cure chronic endometritis, but to determine exactly how much is enough therapeutic effect, Not sure it's going to happen.

The thing is that an incorrect lifestyle or the influence of other factors can provoke the reverse development of the disease.

How to avoid developing endometritis?

There are no specific measures to prevent the occurrence of this disease. As a rule, the main measures are to avoid the risk factor.
To do this, you must adhere to the following recommendations:

• Avoid termination of pregnancy.
• Observe hygiene rules.
• Use condoms.
• Get examined after birth.
• Visit your gynecologist regularly.

Regular visits to the gynecologist are one of the most important measures that allows you to identify chronic endometritis as early as possible. It is best to undergo scheduled examinations once every six months. As a rule, such an examination is enough to identify the disease.

To summarize, we can say that the chronic form of the disease can be diagnosed in any woman who does not pay enough attention to her health. As a rule, chronic endometritis develops due to the lack of treatment for this disease. A fairly large number can cause endometritis various factors, among which are both the simplest and most complex mechanical influences. In any case, the disease becomes chronic due to the lack of proper treatment.

Chronic endometritis is especially dangerous for women of reproductive age, since its development becomes a rather strong obstacle to pregnancy. This is due to the fact that when the mucous membrane is inflamed, the fertilized egg cannot implant.

There are quite a few symptoms of the development of this disease; quite often it occurs in an asymptomatic form. Therefore, in order to determine its development as early as possible, it is necessary to regularly visit a gynecologist. This disease can only be diagnosed through comprehensive research. It can also be cured only by complex therapy. Most often, treatment takes about 3 months and includes several stages. The first stage is the elimination of the infection, and the second is the normalization of the endometrium and strengthening of local immunity. As for preventive measures, there are no specific actions aimed at preventing the development of this disease. The best preventative measure– elimination of factors influencing the development of this disease and regular visit gynecologist.

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 medicinal substances 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 current state sick.

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.

Every woman whose uterine mucosa is inflamed wants to know how chronic endometritis is diagnosed and exactly how it is treated.

Treatment of chronic endometritis directly depends on the examination results obtained by the doctor. The treatment process takes a long time. Today there are several treatment options. Each of them is aimed at eliminating inflammation and preventing complications.

The main task of the doctor to whom the patient turns is to find out the causes and symptoms, develop the correct treatment regimen that can eliminate the infection and resume full functioning of the endometrium. If the treatment is chosen correctly, then all the symptoms of the disease will quickly disappear, and the woman will have a chance to become a mother.

Many women who at one time successfully completed a course of treatment believe that antibiotics, general therapy and laboratory diagnostics were more effective.

Expert opinion Against the background of a sluggish process, an exacerbation may occur when the symptoms of chronic endometritis are similar to acute form. Advanced cases of endometritis lead to the spread of inflammation to muscle layer uterus and the development of myoendometritis.

Cost of endometritis treatment

Procedures and operations
Initial consultation with a gynecologist	from 2300 rub
Ultrasound gynecological expert	from 2800 rub
Endometrial biopsy	from 3500 rub.
Hysteroscopy of the uterus	from 20500 rub.
Hysterosalpingoscopy	from 7000 rub
Cytology smear	from 800 rub
Ureaplasma parvum (PCR)	from 450 rub
Ureaplasma spp (PCR)	from 450 rub

If endometrial treatment is identified and promptly provided, a woman has a chance to give birth to a baby. But in order for the symptoms of the disease to be identified on time, a woman needs to regularly visit a gynecologist for a preventive examination.

If the inflammation is acute, antibiotic therapy may not help desired results. Therefore, before deciding on the necessary treatment, the doctor must take a scraping from the cervix and send it for bacteriological examination.

In cases where chronic endometritis was caused by an infection, antibiotics must be injected into the uterine mucosa. Thanks to this therapy, blood circulation in the pelvis is normalized, the affected areas will heal, and the body’s overall defenses will increase.

When diagnosing uterine inflammation, which is accompanied by improper healing of the endometrium, adhesions may form. They can only be detected by hysteroscopy. The resulting adhesions can be eliminated through surgery.

If during the course of treatment doctors managed to completely restore the two-phase cycle, then we can say that hormonal treatment has produced positive dynamics. Hormonal dysfunction can be completely normalized using combined hormonal drugs, but only those prescribed by the attending physician.

For chronic endometritis, which is caused by various pathological changes in the fallopian tubes, gynecologists can diagnose infertility. Treatment for aggravated endometritis must begin in a timely manner, otherwise the infection can penetrate deep into the uterus, after which the fallopian tubes become blocked and deformed. With proper treatment, the patency of the tubes will be restored, which means that the woman will certainly be able to conceive a child.

The causes of functional obstruction are disruptions in the production of hormones that affect the condition of the internal lining of the fallopian tubes.

Chronic form - treatment regimens

Whether it is possible to successfully treat the chronic form of the disease without preliminary diagnosis is impossible.

Signs of chronic endometritis are mild. The main course of therapy is aimed, first of all, at completely eliminating swelling and inflammation, as well as at healing all affected areas of the epithelium. If a diagnosis of purulent catarrhal endometritis has been established, this form of the disease requires emergency treatment.

Many doctors prescribe standard drugs belonging to the following groups:

>

• Hormones.
• Antibiotics.
• Vitamins.
• Medicines to enhance immunity.
• Electrophoresis.

It is necessary to adhere to all the doctor’s recommendations, take tests on time, not give up the use of folk remedies, intrauterine irrigation, suppositories, Longidaza, and undergo all examinations on time.

Physiotherapy

It is aimed at completely normalizing the functioning of the female genital organs and restoring the full functioning of the ovaries.

Expert opinion This is a type of physiotherapy based on certain medicines into the hearth, to the required depth using an electric current. The effect of current on a drug implies ionization active ingredients medicines. The current seems to carry the necessary ions to the tissue depth indicated by it.

Many doctors say that you should never self-medicate, as inflammation can become serious and cause infertility.

The only measures that can be carried out at home, after consultation with a doctor, are electrophoresis and hirudotherapy. Few people know, but leeches can help women with many gynecological diseases. Moreover, every patient can install them at home. It is convenient to use this method of treatment - you do not have to travel to medical institution, stand in line for several hours.

Physical methods impact on reproductive organs have a number of advantages for women. They are painless, non-invasive and absolutely non-toxic.

At acute stage Endometritis is allowed to carry out physiotherapeutic procedures only during the recovery period. The first thing to do is to eliminate the inflammatory process and take a course of antibiotics. The procedure itself is based on the impact of energy (it can be sound, heat) on the damaged area.

After the patient has completed a course of physical therapy, she experiences the following changes in her body:

• The pain syndrome subsides.
• Complications are avoided.
• The uterine mucosa does not swell.
• The menstrual cycle is completely normalized.
• The body's protective properties increase.

Interference therapy

Doctors influence the affected areas using a medium-frequency current, the power of which is no more than 10 Hz.

When carrying out such a procedure, the nerve endings in the uterus are irritated, due to this it can again acquire contractile activity, and its tone will increase. At the same time, blood supply to all organs will be improved.

This therapy is much more effective than, for example, the use of folk remedies. With this effect, the woman completely gets rid of previously disturbing pain. The procedure itself does not last more than 10 minutes. The general course of treatment lasts exactly two weeks; this is usually enough to completely get rid of inflammation.

Magnetotherapy

This treatment has several main advantages: the affected areas are completely restored and healed, inflammation is relieved.

When a magnetic field is applied to the entire affected area, microcirculation is normalized, fast healing, normalization of blood supply.

Magnetic therapy is indicated to activate immune reaction, stimulate lymphocytes, increase the general protective properties of the entire body as a whole.

Expert opinion With the help of magnetic radiation, blood flow to the pelvic organs is improved, microcirculation and tissue nutrition are improved, the magnet causes a good analgesic effect, including an excellent hemostatic property, which is especially useful in women with various cycle disorders and uterine bleeding.

Magnetic therapy cannot be compared with folk remedies, since this procedure is safe and also does not last long. One procedure does not last more than 30 minutes, and the total course of treatment is 3 weeks.

Magnetic therapy should not be used for women who frequently experience uterine bleeding.

Magnetic therapy gives good results in the treatment of adhesions and algomenorrhea.

UHF therapy

If the patient goes to a medical facility on time and the disease is not in an advanced stage, then UHF therapy can be used.

The affected areas are exposed to high-frequency magnetic field. The energy that is released after the absorption of blood and lymph gradually releases heat, which has a thermal effect on the entire body and warms it up.

With UHF therapy blood vessels expand and immune cells as if released into inflammatory foci. The longer the therapy lasts, the faster the inflammation heals, the pain disappears, and the endometrium heals.

The duration of one such procedure is exactly 10 minutes. Despite all the effectiveness, there are some contraindications: uterine bleeding, prolonged menstruation.

UHF should not be performed for more than two weeks, as adhesions may form in the inflamed area.

How does electrophoresis treatment work?

This method is based on the effect of electrical particles on the affected areas. The procedure is performed as follows:

• The patient takes a comfortable position lying on the couch, and charged electrodes are placed on her body.
• The cathode and anode are surrounded by special gaskets made of gauze; their side is impregnated with a special drug.
The electrodes are installed in such a way that the affected organ is located between them.
• The doctor begins to apply current.
• The medicine moves between the electrodes and penetrates deep into the affected tissue.

Electrophoresis is a safe procedure that does not cause pain or discomfort. In order to cure endometritis, specialists use electrophoresis with a copper or zinc solution. In order to anesthetize the procedure, many inject their patients with a 2% solution of novocaine.

The insidiousness of treatment - is it possible to get pregnant?

After women have had endometritis, doctors' forecasts are not reassuring; their chances of having a child are almost zero. In some cases, pregnancy still occurs, but after exposure pathological processes a miscarriage occurs.

In many cases, the disease is diagnosed on late stage, and therefore becomes the cause of infertility. Every attempt to get pregnant is either simply unsuccessful or ends in miscarriage. If a woman has contraindications to conceive a child naturally, doctors may suggest IVF.

In order for a woman to safely bear a fetus, her endometrium must be completely healthy. Herbs and traditional methods powerless. If there are diseases, then fetal rejection cannot be avoided.

IVF cannot be performed if the endometrium is not completely cured. This will negatively affect the health of not only the mother, but also the fetus. Initially, it is necessary to get rid of the pathology, strengthen the body, and only after that try to conceive a child.

If the disease is accompanied by numerous complications, then even IVF cannot be performed; in this case, only surrogacy can be used.

IVF for endometritis is possible because, despite the disease, the ovaries continue to function normally and the egg successfully matures.