Endometritis is an inflammation of the lining of the uterus, called the endometrium. This condition usually occurs due to an ascending bacterial infection, which means bacteria enter the uterus from the vagina or cervix.
What is the definition of endometritis?
Endometritis is a inflammation of the lining of the uterus, called the endometrium. “It usually occurs as a ascending bacterial infectionwhen bacteria from the vagina or cervix travel up to the uterus, explains Professor Elodie Chantalat, gynecological surgeon. Endometritis is more common after an endo-uterine procedure (hysteroscopy, biopsy, curettage), childbirth, miscarriage, abortion with retention, or after insertion of an IUD (IUD), but it can also occur without apparent cause“. The bacteria most commonly implicated in endometritis are normal intestinal bacteria such as Escherichia coli (E. coli), Streptococcus, Staphylococcus, and other anaerobic germs. “Common symptoms of endometritis include fever, lower abdominal or pelvic pain, feeling unwell general, a vaginal discharge abnormal, sometimes with an unpleasant smell, abnormal periods or tenderness or pain on palpation of the uterus”. “If endometritis is not treated, it can lead to potentially serious complications, such as pelvic abscess, infertility (by joining the walls of the uterus, obstruction of the tropes…), and, in rare cases, a potentially fatal generalized infection called sepsis“. The diagnosis of endometritis is usually based on symptoms, clinical examination and additional tests such as blood tests, vaginal or cervical swabs for bacterial culture, or ultrasound to assess the condition of the uterus. “The treatment of endometritis usually involves the administration antibiotics to eliminate the bacterial infection. In severe cases, hospitalization may be requiredespecially if surgery is required to drain an abscess or remove infected tissue“.
Is endometritis acute or chronic?
Endometritis can be both acute and chronic, depending on the duration and nature of the infection.
► Acute endometritis grows rapidly and is characterized by intense inflammation of the mucous membrane of the uterus. “It usually occurs after giving birth, miscarriage, abortion, or surgerycontinues the Professor. Acute endometritis is often caused by pathogenic bacteria, such as infectious agents specific to the hospital environment (nosocomial infections) or sexually transmitted infections, such as chlamydia or gonococcus“.
► Chronic endometritis, on the other hand, is a prolonged or recurrent form of inflammation of the endometrium. “It can develop as a result of acute untreated endometritis or recurrent infections. In some cases, chronic endometritis may be due to low-grade infections, bacterial imbalances or other non-infectious causes”. “Acute endometritis often requires immediate, probabilistic, multi-germ treatment with antibiotics to prevent serious complications“. If endometritis becomes chronic, treatment may be more complex and require careful evaluation to identify underlying causes and contributing factors.
What are the symptoms of endometritis?
Common symptoms of endometritis include a high body temperature usually above 38°C and localized pain in the lower abdomen or pelvic region. “The pains can be constant or intermittent and can be described as cramping or a feeling of pressure“, specifies our interlocutor. Unusual vaginal discharge may be present. “It may be thicker, yellowish or greenish, and have an unpleasant odor“. Heavier, more painful or irregular periods can also occur. “On physical examination, the doctor may find tenderness or pain on palpation of the uterus with very painful vaginal examination and uterine mobilization“. The patient may also feel general feeling of being unwell, fatigue, loss of appetite or a feeling of weakness. Finally, in some cases, endometritis can also cause general symptoms such as chills, nausea, vomiting or headache.
What is the cause of endometritis?
This infection can be caused by germs (gonococci, chlamydia, mycoplasma) present in the vagina. “Endometritis often occurs after childbirth, which is why it is sometimes referred to as postpartum endometritis, emphasizes Professor Chatalat. But it can also occur in following an endo-uterine procedure or the placement of an IUD”. These procedures can introduce bacteria into the uterus, increasing the risk of infection. The main cause of endometritis is a ascending bacterial infection, which means bacteria enter the uterus from the vagina or the cervix. “Bacteria normally present in the vagina can travel up into the uterus and cause inflammation of the endometrium“. Other factors that increase the risk of developing include certain sexually transmitted infections (STIs), such as chlamydia and gonorrhea. “These infections are usually caused by bacteria and can spread to the uterus during unprotected sex.“Similarly, if the membranes that surround the fetus in the womb rupture prematurely, it can make it easier for bacteria to enter the womb and increase the risk of endometritis.”Finally, the use non-sterile medical instruments during procedures involving the uterus can lead to bacterial contamination and the development of endometritis“. It is important to note that endometritis can also be caused by other types of infections, such as fungal or viral infectionsalthough this is less common.
Severe, untreated endometritis can lead to sepsis
The diagnosis of endometritis can be made by combining several elements, in particular the medical history, patient-reported symptoms, physical examination and tests complementary. “The doctor will first ask about symptoms, medical history, recent procedures involving the uterus, sexual activity…, details our interlocutor. He will then perform a physical exam to assess the tenderness of the uterus, look for signs of infection and assess other associated symptoms“. blood tests can be done to check for inflammatory markers such as complete blood count (NFS), sedimentation rate (ESR) and C-reactive protein (CRP). “High levels of these markers can indicate infection or inflammation“. Samples of vaginal or cervical secretions may be taken to perform a microbiological analysis and determine if a bacterial infection is present. “This may include a bacterial culture to identify the organisms causing the infection“. A Pelvic ultrasound can be performed to assess the uterus and surrounding structures. “This can help identify signs of inflammation, such as endometrial thickening, fluid in the uterus or pelvic cavity, or the presence of abscesses.”. A scanner can complete exploration if ultrasound is not very contributive.
What are the potential complications ?
Untreated or poorly treated endometritis can lead to a variety of potentially serious complications. “This can lead to the formation of a pelvic abscesswhich is a collection of pus in the pelvic area“, warns Professor Elodie Chantalat. This may require surgical drainage. “Endometrial infection can also spread to the membrane that covers the abdominal organs, called the peritoneum, resulting in peritonitis. This can cause a severe abdominal pain, abdominal distension and require emergency surgery“.
Severe, untreated endometritis can lead to generalized infection (sepsis). “This can cause multiple organ failure and be life threatening“Complications during pregnancy are possible,”including premature rupture of membranes, preterm labor, neonatal infection and miscarriages“.
What treatment to treat endometritis?
Treatment for endometritis usually involves the use of antibiotics to eliminate the bacterial infection responsible for the inflammation of the endometrium. “Antibiotics are given intravenously over a period of 24 to 48 hours in a hospital setting or, in some cases, orally if the infection is mild and has no signs of complication“, notes the gynecologist. The duration of antibiotic treatment generally varies 7 to 14 days, depending on severity of the infection, the bacteria involved and the patient’s response to treatment. In addition to antibiotics, medicines to relieve pain and fever can be prescribed. “Removal of an IUD may be necessary, as well as surgical management in the context of complicated endometritis (tubal and/or ovarian abscess, peritonitis)”.
Thanks to Professor Elodie Chantalat, gynecological surgeon and anatomist at Toulouse University Hospital.