Uterine endometritis: diagnosis, symptoms and treatment. Causes, symptoms, diagnosis and treatment of chronic endometritis

Content

Endometritis is a disease that occurs as a result of complications of the postpartum period, caesarean section, abortions, examinations and surgical interventions in the uterine area, untreated sexually transmitted infections and other diseases of the genital organs. can cause pathogens such as gonococci, streptococcal infections, trichomonas, chlamydia, staphylococcus, coli and even the common flu. The result can be infertility and multiple miscarriages, infection of other organs, and sepsis.

Forms of endometritis

Endometritis can be acute or chronic. It is not difficult to distinguish these two forms.

• Acute endometritis is always a clearly expressed symptomatology of the disease. Sharp increase temperatures up to 39-40 degrees, signs of intoxication (weakness, chills, tachycardia, lack of appetite, dizziness). Acute or nagging pain lower abdomen, extending to the lower back, possible bleeding from the uterus, copious discharge with an admixture of pus, serous matter or an admixture of blood with an unpleasant odor. Acute endometritis should be treated as early as possible; the risk of complications depends on this. Acute endometritis is treated in a hospital.
• Symptoms chronic endometritis many women simply choose not to notice. Periodic aching pain in the back and uterine area, pain during menstrual periods, yellowish, greenish, foamy, bloody, purulent or serous discharge from the genital tract (the type of discharge depends largely on the cause of endometritis), abundant and too long menstrual bleeding, insignificant increase in body temperature (up to 37-37.5 degrees). If the disease is in chronic stage, it can be treated on an outpatient basis.

Acute endometritis most often occurs as a result of unsuccessful surgery, complications of childbirth, or abdominal trauma. The chronic form is the result of infections genitourinary system.

Endometritis is divided according to etiology (depending on the type of pathogen) into:

• specific;
• nonspecific.

Specific endometritis is quite rare. It is caused by such well-known microorganisms as tuberculosis bacillus, gonorrhea, and fungal infections.

Non-specific Endometritis is a form in which it is not possible to identify a specific cause and isolate the pathogen. Today it is known that the most severe forms of the disease, difficult to treat and dangerous with serious complications, are caused by group B streptococci. A characteristic symptom of such an infection is an “acute abdomen.”

How to treat

The sooner you start treat endometritis, the higher the chances of a full recovery.

Treatment of endometritis is always individual approach. Medical history, age, accompanying illnesses, desire to have children in the future, duration of symptoms. Standard therapy is:

• antibacterial drugs to eliminate the causative agent of the disease;

• relief of symptoms (antispasmodics, antihistamines, sedatives);
• supporting immunity with a complex of vitamins and immunomodulators;
• curettage of the uterine cavity to remove the cause of infection (remnants ovum, placenta, suture material), removal of purulent accumulations and inflamed tissues or to simulate the process normal menstruation and the speedy restoration of a normal environment.

Antibiotics (“Cephalosporin”, “Metronidazole”, “Doxycycline”, “Cifran”, “Gentamicin”, “Metrogil”) are prescribed for a period of 5-10 days, depending on the severity of the condition. At the same time, treatment is carried out to relieve inflammation, pain and normalize the microflora of the vagina and intestines. If necessary, the doctor can supplement treatment with antifungal agents, anti-swelling allergy medications.

It can be treated more successfully not by intramuscular injections, but by injecting the drug directly into the mucous layer of the uterus. Direct application of the medicine kills pathogenic microorganisms faster and leads to a speedy recovery.

In some cases for quick recovery endometrium using combined oral contraceptives, which successfully normalize hormonal balance and promote the proper development of a new, healthy mucous layer.

For the period of treatment it is necessary to stop sexual activity.

Physiotherapy

Physiotherapeutic treatment in gynecology gives positive results both as an additional method of therapy and as a means of rapid recovery from illness. For endometritis it is used:

• ultra-high frequency therapy (UHF);
• infrared laser;
• paraffin therapy;
• iodine-bromine, radon and air baths;
• thalassotherapy;
• peloid therapy;
• SUV irradiation.

Physiotherapy accelerates the regeneration of uterine tissues, dilates blood vessels, improves local blood flow, metabolism in tissues, stimulates protein synthesis, lipid and carbohydrate oxidation, reduces inflammation and relieves tissue swelling, relieves pain and eliminates inflammatory process.

Contraindications to physiotherapeutic methods of treatment:

• acute endometritis;
• the presence of pus in the uterus;
• spread of inflammation to other organs and systems;
• bleeding from the uterus;
• the presence of neoplasms in the pelvis (fibroids, cysts, polyps, tumors);
• polycystic ovaries.

As a final course and chronic course disease, a sanatorium-resort stay in balneological and climatic resorts with sources of hydrogen sulfide, radon, chloride-sodium and nitrogen-siliceous waters is recommended.

Treatment with traditional methods

Cure any female disease reproductive system only with the help traditional medicine impossible. Only an experienced gynecologist and modern drugs will help you quickly and permanently get rid of the disease and avoid complications.

After consultation with your doctor, you can supplement the standard therapy with decoctions. medicinal plants, which have a general anti-inflammatory and immunomodulating effect, stimulating the contraction of the walls of the uterus and the exit from its cavity of blood clots and decay products of diseased tissue areas. Let's look at some folk recipes for decoctions medicinal herbs for oral administration for endometritis.

• St. John's wort. Three teaspoons of dry grass are poured into a glass of boiling water and allowed to brew for about 15-20 minutes under the lid. Then the solution is filtered and water is added to obtain a total volume of broth equal to approximately 200 ml. A mug of such “tea” is drunk in small portions during the day after each meal. St. John's wort has a mild anti-inflammatory effect.
• Sage, pal-pala, knotweed, St. John's wort, calendula, nettle and lemon balm have a diuretic effect, relieve swelling and inflammation in the uterus. One spoonful of the collection is poured with boiling water and heated over low heat for several minutes, not bringing to a boil. A 200 ml portion is drunk gradually throughout the day between meals.
• Coltsfoot, thyme and wormwood are a famous folk remedy for the treatment of endometritis, which improves the condition of the mucous membrane and relieves inflammation in the pelvic area. It is necessary to take two tablespoons of the collection for half a liter of boiling water and let it brew in a dark place for 12 hours. The infusion is taken at least 3-4 times a day in small portions.

Today it is possible to treat endometritis at any stage. In the acute form of the disease, symptoms will disappear after the first 5-7 days of treatment. The chronic form takes a little longer to treat; it requires an integrated approach, which includes treatment of the cause of the disease, restoration of the immune system, as well as restoration of uterine tissue and reproductive function.

Endometritis refers to inflammatory diseases female reproductive system, which occur in at least half of women childbearing age(according to some data – 90%).

Among possible consequences inflammatory processes in the pelvic organs - miscarriage, infertility, chronic pelvic pain syndrome, ectopic pregnancy.

The acute form of the pathology accounts for about 2% of cases of inflammatory diseases, the chronic form – about 14%. Most often, endometritis develops after childbirth.

Is it possible to get pregnant with uterine endometritis? We’ll talk about the main symptoms and signs of the disease, including after childbirth, as well as methods of treating the disease in our review!

What kind of disease is this and why is it dangerous?

Endometritis of the uterus in women - what is it? accessible language? The uterine wall consists of three layers: endometrium, myometrium and perimeter.

The perimetry is one of the layers of the peritoneum and covers the outside of the uterus, the myometrium is formed by smooth muscles, the endometrium or mucous membrane is formed by epithelial tissue.

Endometritis is an inflammatory process in the lining of the uterus.. The endometrium consists of basal and functional layers.

The functional layer is subject to cyclic changes, as changes hormonal levels it grows and is rejected during menstruation.

With the onset of pregnancy, rejection of the functional layer does not occur, it ensures the further development of the embryo. The basal or germinal layer ensures the restoration of the functional layer of the endometrium.

With endometritis, it is the germinal layer of the mucous membrane that is involved in the inflammatory process.

Inflammation can progress and spread to muscle layer uterine wall, in such cases, endometritis turns into endometritis or metroendometritis.

The disease has infectious nature , that is, inflammation develops only due to the penetration of the pathogen into the uterine cavity. The development of the disease is promoted by damage to the mucous membrane. If the immune system is severely weakened or a particularly aggressive infection penetrates, damage to the entire tissue may occur.

Pathogens penetrate into the uterine cavity either from the appendages ( descending path), or from the vagina and cervical canal (ascending path).

Normally, the development of infectious processes is prevented acidic environment vagina, mechanisms of local immune defense (antibodies, immunoglobulins contained in mucus and the natural microflora of the vagina) and partly, the anatomical features of the structure of the reproductive system.

Inflammatory reactions develop against the background of disorders of natural defense mechanisms.

Causes in women and risk factors

Inflammatory processes are caused by bacteria, viruses, fungi and protozoa.. In most cases, we are talking about a combined pathology, when several infectious agents take part in the development of the disease.

The viral form is caused by some types of papillomaviruses., cytomegalovirus, herpes simplex virus. Infection with fungi of the genus Candida leads to the development of fungal endometritis.

Bacterial endometritis is caused by:

• Enterobacter;
• Klebsiella;
• Streptococcus;
• Gonococcus;
• Proteus;
• Mycoplasma;
• Chlamydia;
• Escherichia coli.

Sometimes cases of infection with pathogens of diphtheria and tuberculosis are detected., as well as microorganisms related to opportunistic pathogens.

Endometritis can also have a protozoal nature, in some cases the causative agent of the disease is Trichomonas.

Most often, infection occurs through an ascending route. Infection occurs when two conditions coincide: an open cervical canal damage to the endometrium.

Among the most probable causes, provoking inflammation of the endometrium:

Sometimes the inflammatory process develops as a comorbidity against the background of fibroids, polyps, infectious diseases excretory system, immunodeficiency states, endocrine disorders.

Very rarely there are cases of infection spreading from foci of chronic inflammation through the blood or lymphatic system. Most often, gynecologists encounter postpartum endometritis. After independent childbirth, inflammatory processes develop in about 20% of cases, after cesarean section - in 45%.

Classification, ICD-10 code, symptoms and treatment

The code for acute endometritis according to ICD-10 is N 71.0, chronic – N 71.1.

In gynecology, according to the course of the disease, three forms of endometritis are distinguished:

• Spicy;
• Subacute;
• Chronic.

Based on their origin, they distinguish between specific and nonspecific endometritis. By specific is meant an inflammatory process caused by pathogenic microorganisms; nonspecific inflammatory reactions are caused by representatives of conditionally pathogenic microflora against the background of weakened immunity.

Based on the severity of clinical manifestations, the following degrees of severity of the disease are distinguished:

• Light;
• Moderate;
• Heavy.

How does the acute form manifest itself?

Symptoms of an acute inflammatory process appear 3-4 days after infection. Manifestations of the disease depend on several factors:

• The nature and aggressiveness of the pathogen;
• Area of ​​endometrial damage;
• Presence of concomitant pathologies;
• Immunity states;
• Predisposing conditions;
• Patient's age.

The most severe course of the disease is observed after complicated childbirth, spontaneous abortions, and the use of an IUD.

The acute form begins with a feeling of heaviness and pain, most often above the pubis, in the middle part lower section abdomen, less often - in the lumbar or sacrum. Sometimes the pain radiates to the legs or under the shoulder blades. The intensity of the sensations ranges from mild to unbearable, the nature of the pain is aching or cramping.

With severe inflammation, there is a risk of developing peritonitis. At the same time with pain syndrome body temperature rises to 39-40 degrees, sweating and chills are possible.

As the disease progresses, other signs of general intoxication appear: lethargy, general weakness, loss of appetite, nausea, and sometimes vomiting.

One of the most characteristic symptoms – copious discharge, mucopurulent, sanguineous or purulent, sometimes mixed with blood. With the development of a purulent process, the discharge has a pronounced unpleasant odor.

With postpartum endometritis, bleeding is possible. Accession staphylococcal infection leads to the development of a purulent process, there is a threat of sepsis.

Anamnesis data when diagnosing endometritis are supplemented by gynecological examination data and laboratory research.

The patient needs to undergo clinical tests urine and blood, vaginal and cervical smears. Additionally, ultrasound is prescribed, and if indicated, hysteroscopy.

Treatment tactics for acute endometritis are selected individually, depending on predisposing circumstances. If the disease develops due to the use of an IUD, it is removed. After this, the uterine cavity is scraped.

After curettage, the patient is prescribed:

• Antibiotics;
• Antibacterial drugs;
• Anti-inflammatory drugs.

Additionally, desensitizing and restorative therapy is carried out. For antibiotic therapy, drugs are mainly used wide range actions. If anaerobic microflora is detected, Metronidazole or Ornidazole is additionally prescribed; according to indications, vaginal sanitation is carried out.

Purulent processes are indications for use infusion therapy drugs that improve blood flow and eliminate intoxication of the body. In severe cases, radical surgery may be required.

As the patient’s condition improves and the inflammatory process subsides, physiotherapeutic treatment is prescribed. The complex of physiotherapeutic procedures includes magnetic therapy, laser therapy, and low-intensity ultrasound.

You can learn about diagnostic measures for urethritis in women, as well as what medications are usually prescribed for its treatment: in this article:

Chronic inflammation

If there is insufficient or untimely treatment spicy pathological process can go to chronic form. Clinical manifestations weakly expressed Approximately 40% of cases are asymptomatic.

Chronic endometritis is indirectly indicated by:

• Abundant or very scanty discharge during menstruation;
• Violations of the duration of menstruation;
• Change in the cycle of menstruation;
• Intermenstrual bleeding, mucous, mucopurulent and bloody issues;
• Periodic or constant pulling pains in the lower abdomen;
• Habitual miscarriage, infertility, unsuccessful IVF attempts (with endometritis, attempts to conceive are almost unattainable).

Since the symptoms of the disease are nonspecific, the main diagnostic value have the results of bacteriological and microscopic examinations of the contents of the vagina, uterine cavity, and cervical canal.

Additionally, ultrasound and Doppler ultrasound are performed at the beginning and second half of the menstrual cycle. On days 7-11 of the cycle, hysteroscopy and endometrial biopsy may be recommended.

Used for chronic inflammation step-by-step treatment. At the first stage, broad-spectrum antibiotics are prescribed. in combination with antifungal drugs and metronidazole.

When a combined infection is detected Prescribe combined antimicrobial agents and antiseptics. Chronic inflammatory processes of viral origin require the use of antiviral and immunomodulatory drugs.

At the second stage, the patient is prescribed antioxidant, hepatoprotective, metabolic, enzyme preparations, as well as agents that improve blood microcirculation.

At the third stage, physiotherapeutic treatment is carried out. The course of treatment may include magnetic therapy, mud therapy, plasmapheresis, and iontophoresis. Additionally, cyclic hormone therapy can be performed.

Postpartum type

How does postpartum endometritis manifest? With postpartum endometritis, the patient is bothered by constant aching pain, prolonged bleeding.

There may be an increase in body temperature and other signs of intoxication. Postpartum endometritis is also manifested by a slowdown in uterine contraction.

During treatment postpartum endometritis factor in breastfeeding. In severe cases, the need to refuse breastfeeding cannot be ruled out.

In addition to therapy aimed at eliminating the acute inflammatory process the patient is prescribed oxytocin and no-spa to improve the outflow of secretions from the uterine cavity and improvement of myometrial contractility.

Curettage may be performed to remove the contents of the uterus., vacuum aspiration or a relatively new method - enzymatic curettage.

After caesarean section

In most cases, in case of inflammatory complications after cesarean section, the following is carried out:

• infertility in this article.

  Read about the treatment plan chronic cystitis in women, and how to remove unpleasant symptoms in its acute form.

  Is pregnancy possible with a diagnosis

  Is it possible to get pregnant with endometritis? Pregnancy with endometritis is not excluded, but often inflammatory processes lead to infertility. If uterine endometritis is detected in a timely manner after treatment, reproductive function is restored and there is a chance of pregnancy.

  Endometritis of the uterus in women - what is it and is it treated, in simple language the expert from the following video will tell:

  Prevention

  Maximum risk inflammatory reactions swept aside when using the IUD, after an abortion and caesarean section. For the prevention of endometritis after complex gynecological manipulations prescribe a course of antibiotics, which should not be neglected.

  It is very important to visit a gynecologist in a timely manner, especially when using intrauterine devices. Practice preventive examinations increases the chances of early detection and treatment of gynecological diseases.

  It is important to carefully follow intimate hygiene and the use of barrier contraceptives, especially during sexual intercourse during menstruation.

By modern ideas, endometritis, or inflammation of the uterine mucosa, is classified as pelvic inflammatory disease (PID) in women. According to the observations of doctors, in Lately Throughout the world, there is a clear trend towards an increase in the incidence of PID, including endometritis.

Of particular danger is the chronic course of the disease, the prevalence of which, according to various sources, ranges from 10 to 85%. Such a wide range is due to the difficulty of diagnosis and the mild symptoms of chronic endometritis. The disease is often detected already at the stage of complications: for example, miscarriage or infertility. In this regard, the question becomes particularly relevant: is it possible to cure endometritis and prevent the development of its consequences?

A little anatomy

Before answering the question: what is endometritis, it is necessary to briefly dwell on anatomical features uterine walls. As is known, its structure consists of three layers or shells:

• External (perimetry).
• Muscular (myometrium).
• Internal (endometrium).

The endometrium is abundantly supplied with blood and is a hormonally dependent tissue. It, in turn, is formed by two layers:

• Superficial or functional. Consists of columnar epithelium and many glands. This part of the endometrium of the uterus is “responsible” for the normal attachment (implantation) of the embryo. If conception does not occur, this layer falls off and is removed from the uterus during menstrual bleeding.
• Basal or sprout. Connects to the underlying muscle layer. Causes restoration of the superficial part of the endometrium.

The thickness of the endometrium directly depends on the effects of female sex hormones during the menstrual cycle, reaching its maximum in the luteal phase. At the same time, its structure also changes.

In this way the uterus prepares for possible pregnancy, causing everything the necessary conditions for normal attachment and further development embryo.

Endometritis - what is it?

This term literally means “inflammation of the endometrium (inner lining of the uterus).” Endometritis in women usually develops during childbearing age, causing many problems that affect the possibility of conceiving and carrying a pregnancy in the future.

Inflammation of the uterine mucosa, both in acute and chronic forms of the disease, usually affects both layers of the endometrium. The most common inflammatory process is:

• Diffuse (the entire mucous membrane is affected).
• Ochagov.

In addition, chronic endometritis is often combined with inflammatory lesions of other structures of the female genital tract, for example, fallopian tubes. Also, the pathological process can spread to the deeper layers of the uterus (myometrium), changing the normal cellular structure uterine wall. All this ultimately leads to serious disturbances in a woman’s menstrual and reproductive functions.

Consequently, we can characterize the chronic course of endometritis as the direct cause of female infertility.

Causes

The main causes of endometritis are infection in combination with certain risk factors. The inflammatory process can be caused by bacteria, viruses, fungi, protozoa and other infectious agents.

According to statistics, sexually transmitted infections (STIs) play a large role in the occurrence of endometritis. It is detected in more than 70% of cases. The most common STI pathogens are:

• Gonococci.
• Chlamydia.
• Urea and mycoplasma.
• Genital herpes virus.
• Cytomegalovirus and others.

Also, the inflammatory process in the uterine cavity can be caused by opportunistic flora, the pathogenic properties of which are activated under the influence of various unfavorable factors. In this case, they play a big role anaerobic bacteria(bacteroids, Escherichia coli, some types of streptococci and others.).

In a significant number of cases of endometritis, an association of microorganisms is isolated, that is, the inflammatory process is caused by several infectious agents at once.

How does the infection enter the uterus?

The main routes of penetration of an infectious pathogen into the uterine cavity are:

• Sexual. A special role is played by the active transfer of certain STI pathogens by sperm, for example, chlamydia.
• Ascending (from the vagina through the cervix).

In a healthy woman, the uterine cavity is sterile. This condition is determined primarily by the normal function of the cervix, which is a barrier between aggressive external environment And internal structures female genital tract. If the cervical barrier is broken, the infection gains free access to the uterine cavity and other internal genital organs of the woman.

In other cases, the infection can enter in the following ways:

• Hemato- or lymphogenous (respectively, through blood or lymphatic vessels).
• From nearby purulent foci along the peritoneum (for example, with appendicitis).

Sexual and ascending path infections are leading in the development of the disease and occur in more than 90% of women.

Risk factors

Acute endometritis most often occurs after mechanical injury endometrium or disruption of the cervical barrier. This occurs in the postpartum period or after certain medical procedures:

• Curettage of the uterine cavity (diagnostic, for the purpose of abortion).
• Hysteroscopy.
• Introduction intrauterine contraceptive device(“spirals”).
• Probing of the uterine cavity.
• Carrying out the in vitro fertilization procedure.

Endometritis after curettage of the uterine cavity or other diagnostic and treatment procedures may occur due to failure to comply with sterile conditions during the procedure.

The development of endometrial inflammation in the postpartum period is influenced primarily by the nature of childbirth. Thus, the risk of developing endometritis increases in the following conditions:

• Delivery by caesarean section, application of obstetric forceps.
• Bleeding.
• Premature birth
• Chorioamnionitis.
• Injuries of the birth canal.
• Manual examination of the uterine cavity (for example, in case of delayed separation of the placenta) and other pathologies.

In addition to the direct mechanical effect on the uterine mucosa, other factors are also related to the development of endometritis. These include:

• Extragenital diseases.
• Hormonal imbalance.
• Immunodeficiency states.
• Endocrine diseases (especially diabetes mellitus).
• Chronic inflammatory pathology.
• Anomalies in the development of the genital organs.
• Sexual behavior (frequently changing partners, neglecting barrier protection, sex during menstruation, etc.).
• Prolonged stress, poor nutrition, physical overload, bad habits and others external influences, reducing immune resistance.

Chronic endometritis often develops as a result of adequate treatment acute inflammatory process.

Manifestations

Symptoms and treatment of endometritis directly depend on the phase of the inflammatory process (acute or chronic), as well as the root cause of the disease.

It is often possible to trace a direct connection between previous intrauterine intervention and the manifestations of the disease. Remains of placental tissue, fetal parts (with incomplete abortion) serve as an excellent breeding ground for pathogenic bacteria and contribute to the development of inflammation in the uterus.

Chronic endometritis is often diagnosed in women with miscarriage, a history of unsuccessful IVF attempts, and other pathologies. And it is sometimes simply impossible to establish the true duration of the disease.

Spicy

Symptoms of endometritis in women with its acute course usually develop a few days after infection. Acute endometritis is manifested by the following symptoms:

• A sharp increase in body temperature, often up to high numbers (39–40 degrees).
• Severe intoxication manifestations: increased heart rate, chills, weakness, headache and so on.
• Sharp pain in the lower abdomen.
• Vaginal discharge with endometritis becomes sanguineous or purulent and has an unpleasant odor.
• Frequent and painful urination is often observed.

Upon examination, the doctor reveals an enlarged and painful uterus, purulent discharge from the cervical canal. Palpation of the lateral walls of the uterus also becomes painful, which is associated with damage to the lymphatic vessels.

Acute endometritis usually lasts up to ten days. With insufficient or ineffective treatment of endometritis in this phase, it becomes chronic.

Chronic

This form of the disease is sometimes called “sluggish endometritis,” which accurately characterizes its course. Signs of chronic endometritis are usually mild and, in most cases, are nonspecific.

An asymptomatic course of the disease is also common, in which signs of endometritis can only be detected when additional methods examinations. In such women, the disease is often diagnosed already at the stage of complications (most often infertility).

Chronic endometritis is most often characterized by the following symptoms:

• Periodic or constant pain in the lower abdomen (sometimes in the lower back).
• Pathological vaginal discharge which are mucopurulent or serous in nature.
• Menstrual irregularities. Uterine bleeding, intermenstrual spotting, prolonged and/or heavy menstruation are common.
• Discomfort or even pain during sexual intercourse.

Chronic endometritis is not accompanied by an increase in body temperature, manifestations of intoxication and other symptoms characteristic of the acute phase. A the above signs endometritis may be mild or absent altogether. This fact greatly complicates the timely diagnosis and treatment of chronic endometritis.

Diagnostics

Correct and timely diagnosis significantly increases the success of treatment of endometritis in women. The following methods are used for this:

• Anamnesis collection. In most cases, the onset of the disease is preceded by intrauterine interventions, childbirth (especially pathological), insertion of an IUD, etc.
• General clinical and gynecological examination.
• Ultrasound scanning using Dopplerography (usually performed at the beginning and end of the menstrual cycle).
• Endometrial biopsy or diagnostic curettage with mandatory follow-up histological examination the received material.
• Hysteroscopy.
• Detection of an infectious pathogen (bacteriological, bacterioscopic method, ELISA, PCR, etc.).

Usually, all these measures are carried out in a comprehensive manner, which makes it possible to more accurately establish a diagnosis and find out how to treat uterine endometritis.

Endometritis on ultrasound is characterized by an enlarged uterus, pronounced changes the thickness of the endometrium, the unevenness of its contours. Areas of varying echogenicity and density are noted.

In addition, echo signs of chronic endometritis often include the identification of gas bubbles in the uterine cavity and its expansion, clear hyperechoic inclusions in the endometrium (calcifications) and other symptoms.

Instrumental examination (biopsy, hysteroscopy, uterine curettage) is usually carried out in the first phase of the cycle in order to diagnose the chronic course of the disease. Based on the histological conclusion, it is determined morphological changes endometrium, active or inactive endometritis, etc.

Treatment

Treatment of inflammatory lesions of the endometrium is a rather difficult task. Acute endometritis requires urgent hospitalization and treatment in a hospital. In the chronic course of the disease, therapy is carried out on an outpatient basis.

How to cure endometritis? First of all, you should carefully follow all doctor’s orders. For example, an incomplete course antibacterial therapy is often the main factor in the transition of the acute form of the disease to the chronic form.

Basic principles of treatment:

• Antibacterial therapy. Antibiotics for endometritis are always used, taking into account the infectious and inflammatory genesis of the disease. Such drugs are prescribed taking into account the sensitivity of the isolated microflora. Typically, cephalosporins, semisynthetic penicillins, aminoglycosides and other groups of antibacterial drugs are used.
• It is necessary to prescribe agents that affect the anaerobic flora (for example, metronidazole).
• Drugs with detoxifying and immunomodulatory effects.
• Local drugs ( vaginal suppositories with antibiotics and metronidazole).
• Non-steroidal anti-inflammatory drugs.
• Prevention of dysbacteriosis - antifungal drugs.
• Surgical treatment for acute endometritis (removal of the remnants of the fetal egg, placental tissue, etc.) is carried out only against the background of massive antibiotic therapy.

In order to completely cure endometritis, they are successfully used various methods physiotherapeutic effects, sanatorium-resort treatment. IN acute phase endometritis physiotherapy should be used only after the inflammatory manifestations subside.

Chronic

Given the "insidiousness" of the course of this disease, the question is natural: is it possible to cure chronic inflammation of the endometrium?

The treatment regimen for chronic endometritis is determined only by the attending physician. In this case, morphological changes in the structure of the endometrium, the presence of synechia in the uterine cavity and concomitant disorders of the woman's reproductive system are necessarily taken into account. Therefore, it is possible to cure chronic endometritis only with an integrated approach to therapy, and the patient's compliance with all doctor's prescriptions.

Treatment of chronic inflammation of the endometrium in most cases is carried out in several stages. The goals of such therapy are:

• Elimination of bacterial or viral factors that damage the endometrium.
• Recovery normal function damaged endometrium.

At the first stage, antibacterial or antiviral drugs are used, taking into account the identified infectious agent. If it is impossible to determine the type of microbe, then so-called empirical therapy with broad-spectrum antibiotics is used. Antibacterial drugs are used both systemically and locally (by injection into the uterine cavity).

Restoring the impaired function of the uterine mucosa takes quite a long time. The following treatment methods are usually used:

• Enzyme therapy.
• General strengthening drugs, vitamins, immunostimulants, etc.
• Desensitizing therapy.
• Physiotherapy – exposure to magnetic fields, electrophoresis, UHF, ultrasound, infrared rays etc.
• Mud therapy and balneotherapy (baths, irrigation).
• Surgical intervention is used only in the presence of synechiae (adhesions or adhesions) in the uterine cavity.

If the menstrual function hormonal drugs are prescribed, for example, combined oral contraceptives or single drugs (estrogens, progesterone).

Consequences

The inflammatory process in the uterine mucosa, especially if it lasts for a long time, can provoke the development of serious complications. These include:

• Spread of the infectious process to other structures of the woman’s genital tract.
• Infertility.
• Increased risk of ectopic pregnancy.
• Miscarriage.
• Pathology of placenta attachment.
• Complicated pregnancy: placental dysfunction, fetal hypoxia, etc.
• Premature birth.
• Infection of the fetus and newborn.
• Stillbirth.
• Autoimmune pathology.
• Menstrual irregularities, uterine bleeding.
• Antiphospholipid syndrome.
• Chronic pelvic pain syndrome.
• Adhesive processes in the uterine cavity (Asherman's syndrome).
• Leiomyoma of the uterus.
• Endometriosis.
• Dyspareunia (pain during sexual intercourse) and other disorders.

Prevention of the development of inflammatory lesions of the endometrium is not difficult. It consists, first of all, in observing basic rules of sexual hygiene (a regular sexual partner, the use of barrier methods to protect against sexually transmitted infections). It is also important to regularly visit a gynecologist for early detection and treatment. hidden infections female genital tract.

Endometritis affects the mucous membrane of the uterus, its uppermost layer is the endometrium. There are many reasons for the appearance of this disease, as well as types.

Types of endometritis:

• Spicy. It appears immediately after infection with a virus or bacteria. It is characterized by pronounced symptoms.
• Chronic. The patient may not suspect that she is sick for a long time. Often the disease is diagnosed after an infertility examination.
• Specific. Caused by specific pathogens, more precisely, sexually transmitted diseases. In this case, the symptoms are pronounced.
• Not specific. Caused by opportunistic microflora, which has grown due to hypothermia or decreased immunity.

Causes of endometritis

List of causes of endometritis:

1. Curettage or abortion. After curettage, scraps of mucous membrane and blood clots may remain in the uterus. This is what causes inflammation.
2. Hysteroscopy. During such diagnostic procedure You can also get inflammation of the endometrium. The fact is that the probe injures the mucous membrane. Opportunistic microorganisms from the blood can enter wounds.
3. Intrauterine device. Very often, after installation of the IUD, the endometrium becomes inflamed. This is due to the fact that the device injures the cervix.
4. Sex during your period. Many infections are transmitted through blood. Even after sexual intercourse with a healthy partner during menstruation, endometritis can develop. This is due to the fact that cervical canal is slightly open and bacteria penetrate into the uterus much faster.
5. Childbirth followed by placenta curettage. Quite often after childbirth, the placenta is not born, as it is attached to the uterine cavity. In this case, the doctor scrapes it out, violating the integrity of the inner layer of the uterus. The resulting wounds are an entry point for infection.
6. Messy sex life . Very often, the infection enters the uterine cavity from the vagina. This happens during unprotected sexual intercourse with a carrier of the infection.

Main symptoms of endometritis

List of symptoms of acute and chronic endometritis:

• Temperature. In acute endometritis, an increase in temperature up to 40°C may be observed. In chronic cases it is often present low-grade fever around 37-37.2°C.
• Vaginal discharge. In the acute course of the disease, abundant purulent and cloudy discharge with a characteristic odor is observed. In chronic endometritis, they differ in color and smell depending on the causative agent of the disease. With trichomoniasis, the discharge is thick and green. Gonorrhea produces cloudy, whitish, foamy mucus.
• Changes in the menstrual cycle. Observed after the acute form has passed into the chronic form. Chronic endometritis is characterized by long periods, more than 7 days. At the beginning and at the end of the cycle there is spotting.
• Lower abdominal pain. In acute endometritis, the pain is aching, which can radiate to the sacral area. My back often ache. In chronic endometritis, it is weak and passes quickly.
• Uterine bleeding. This is often observed in acute endometritis after cleansing by abortion. In some cases, uterine pyometra is possible. This is an accumulation of pus.

Features of treatment of endometritis

Before treating endometritis, consult your doctor. This disease can be treated with both medications and folk remedies. Healers' recipes and traditional healers are an addition to the therapy prescribed by the gynecologist. Acute endometritis cannot be treated only with folk remedies!

Treatment of endometritis with folk remedies

Traditional recipes for the treatment of endometritis:

1. Bay leaf. To carry out the procedure, you will need 20 g of dry leaves. You need to take an enamel bucket and pour the leaves into it. After this, it is worth boiling the herb in a container for 2-5 minutes. Let the liquid cool slightly and sit on the bucket, wrapped in a towel. This remedy copes well with inflammation of the genitourinary system. Carry out the procedure at night for 14 days.
2. Sea buckthorn oil. It's quite old and effective way, which our grandmothers used. You need to take a piece of sterile bandage and put cotton wool inside. Tie it into a knot and soak it in sea buckthorn oil. Leave the tampon in overnight. The course of treatment is 10-12 days. The oil reduces inflammation and promotes healing of cervical tissue.
3. St. John's wort. Interesting and effective recipe. You need to pour 20 g of dry herb into 500 ml of boiling water and simmer over low heat for 10 minutes. Next, the product is filtered and taken half a glass three times a day.
4. forest hay. You need to take an armful of hay and place it in a bucket. Pour in 5 liters of water and put on fire. Bring to a boil and remove from heat. Place the patient on a bucket and cover her with a towel. You need to sit until the liquid cools completely. The course of treatment is 14 days.
5. Fern. Buy dry fern leaves at the pharmacy. It is necessary to pour 20 g of dry raw material with 280 ml of cold water and boil for 2 minutes. After this, strain the broth and take 70 ml 3-4 times a day. Continue treatment for 10-15 days.
6. Citrus. Take one large lemon and an orange. Wash tropical fruits thoroughly and dry them. Grind in a meat grinder or blender. Enter 10 drops onion juice and 10 g granulated sugar. Close the jar and shake it. Take the medicine one teaspoon at a time. You need to take 3-4 spoons of medicine per day. The course of treatment is 18 days.

Treatment of endometritis with drugs

Review medical supplies for the treatment of endometritis:

• Antispasmodics. These types of medications are used to reduce pain. In the hospital for acute endometritis, Spazmalgon and No-Shpu are used by injection. The drugs are administered twice a day. This significantly reduces painful sensations in the lower abdomen and sacral area.
• Antibiotics. In general, broad-spectrum antibiotics are prescribed at the very first stages. In the hospital these are injectable drugs such as Ceftriaxone, Ceftazidime. If treatment is carried out at home, antibiotic tablets are prescribed: Doxycycline, Ofloxin, Ormax, Metronidazole.
• Antifungal drugs. Antibiotics are often combined with antifungal medications, as there is a risk of developing candidiasis. Nystatin, Fluconazole, Fucis are taken in combination with them.
• Antipyretic drugs. Prescribed if the patient has heat. It is best to use medications Ibuprofen, Aspirin, Paracetamol.
• Decongestants. For this purpose, antihistamines are prescribed. Cetrin, Eden, Loratadine are considered quite effective and safe. These drugs help reduce the size of the uterus, relieve inflammation and swelling of tissues.

Treatment of endometritis with topical medications

Review of suppositories and ointments for the treatment of endometritis:

1. Hexicon. Active ingredient This drug is chlorhexidine, which is effective against bacteria, viruses and fungi. It is used to treat endometritis caused by trichomonas, gardnerella, and chlamydia. Candles are placed twice a day. One in the morning, and the second before bed.
2. Terzhinan. Combined suppositories containing Ternidazole, Neomycin, Nystatin and Perdnisolone. This drug can be considered universal, since it is effective against Staphylococcus aureus, fungi of the genus Candida, Trichomonas and gram-positive bacteria. Such a wide spectrum of action is due to the substances that make up the candles. Two suppositories per day for 10 days are enough to cure endometritis.
3. Longidaza. The drug is prescribed after an ultrasound, when the presence of adhesions and severe inflammation in the uterine cavity is confirmed. The medicine contains hyaluronic acid and mannitol. Thanks to these components, uterine swelling is reduced and adhesions are destroyed.
4. Polygynax. It is too combination drug, which contains antimicrobial and antifungal components. The suppositories contain nystatin, neomycin and polymyxin. The main advantage of the drug is that its components do not disturb the beneficial microflora of the vagina. Suppositories are used for endometritis caused by gram-positive and negative microorganisms.
5. Ginalgin. Suppositories widely used in gynecology. They contain metronidazole and chlorquinaldol. Thanks to these substances, candles are effective against fungi and bacteria. This drug used to treat acute and chronic endometritis caused by STIs.
6. Iodoxide. The suppositories contain povidone-iodine, which inhibits the growth and reproduction of pathogenic and opportunistic microorganisms. Candles have an antibacterial and antiseptic effect.
7. Klion-D. Effective candles containing metronidazole and miconazole. Accordingly, they are used for endometritis caused by fungi and bacteria, as well as protozoa.

Consequences of endometritis

Complications of endometritis:

• Spikes. Due to the inflammatory process, the layers of the endometrium are layered one on one. This may affect deeper layers in the uterus - the myometrium. This is fraught with the occurrence of adhesions and knots. Adhesions may appear in the area fallopian tubes, which prevents the egg from moving to the uterus.
• Polyps of the uterine cavity. The result of endometritis is endometrial hyperplasia. As the layers of the endometrium grow, polyps appear, which are nourished by blood vessels.
• Adenomyosis. This is the growth of the endometrium into the layers of the myometrium. Scars form in the uterine cavity, which prevents you from getting pregnant. In addition, there is constant spotting and pain during sex.
• Cysts. Due to inflammation, cysts can form on the ovaries or in the uterine cavity. This makes it difficult to get pregnant and can lead to removal of the ovary.
• Risk of miscarriage. If pregnancy does occur, then endometritis can cause premature birth or rejection of the fertilized egg.

Endometritis is a disease that is provoked by difficult childbirth and abortion, miscarriages, and various gynecological interventions. Up to 90% of cases are diagnosed in women of childbearing age. Its prevalence is continuously growing due to the use of intrauterine contraception, an increase in the number of abortions, and intrauterine medical manipulations. Chronic endometritis is most often the result of an untreated acute form of the disease.

This pathology often leads to infertility, miscarriages, unsuccessful attempts at artificial insemination, complicated pregnancy, childbirth and postpartum period. Currently, endometritis is successfully treated. Doctors prescribe complex therapy, including the use of medications and folk remedies, as well as physiotherapy.

Chronic endometritis is an inflammatory process in the uterine mucosa. The injured membrane is more susceptible to the disease, so its development is often caused by artificial and natural termination of pregnancy, intensive obstetric care, diagnostic curettage uterine cavity.

The acute form becomes chronic if treatment is not started in a timely manner, as well as non-compliance with doctor’s recommendations and reduced immunity. Symptoms become more subdued, but the disease responds less well to treatment.

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

Causes, risk groups

Endometrial tissue has two layers. The functional layer, or outer layer, sheds at the end of menstruation. Basal - responsible for the formation of the first. The main cause of endometritis is damage to the structure of the layers and penetration of infection.

Most often, injuries occur for the following reasons:

• insertion of a probe into the uterine cavity;
• improperly performed douching procedures;
• uterine curettage procedure;
• hysteroscopic examinations;
• hysterosalpingographic examinations.

Depending on the causes and pathogens, endometritis can be specific or nonspecific. The first option is associated with the development in the uterine cavity of pathogens of chlamydia, herpes simplex virus, cytomegalovirus, HIV infection, gonorrhea, tuberculosis, mycoplasmosis, candidiasis, toxoplasmosis, sarcoidosis, etc.

Chronic nonspecific endometritis develops due to the use of intrauterine device, irradiation of the pelvic area, application hormonal drugs contraception, vaginal microflora disorders. During diagnosis, specific microorganisms are not identified.

Women are most at risk of developing endometritis:

• have had an abortion or miscarriage;
• undergone hysteroscopic and hysterosalpingographic procedures;
• undergone biopsy and curettage procedures;
• using an intrauterine device;
• suffered postpartum infectious complications;
• having chronic cervicitis(inflammation of the cervix);
• having and/or candidiasis;
• who have had sexually transmitted diseases (chlamydia, gonorrhea, mycoplasmosis, etc.);
• carriers of genital herpes or cytomegalovirus;
• having submucosal uterine fibroids or polyps.

But even with this big list risk groups, in every third woman the cause of chronic endometritis is unknown.

Symptoms and diagnosis

Depending on the depth and duration of the existence of structural disorders of the endometrium, mild, moderate and severe form diseases. Each of them will be characterized by more or less pronounced symptoms.

The main signs of chronic endometritis:

• disturbed menstrual cycle(scarcity or abundance of discharge);
• bleeding from the uterus;
• purulent discharge;
• aching pain in the lower abdomen;
• pain during intercourse.

Chronic endometritis is a disease whose symptoms are not always present in in full. In every clinical case 1-2 leading signs are determined, the rest are poorly expressed or are not observed all the time.

Diagnosis begins with a doctor's interview and examination on a gynecological chair, during which the presence of compaction and enlargement of the uterus is determined. Due to structural disorders in the endometrium, polyps and cysts sometimes grow. The disease in every 10 women causes infertility, and in every second it causes miscarriage.

To confirm or refute the diagnosis, the gynecologist prescribes a number of additional examinations:

• ultrasound examination of the uterus and its appendages;
• hysteroscopic examination;
• curettage of the uterine cavity, followed by histological analysis materials.

If these procedures confirm the presence of chronic endometritis, a number of studies are carried out to determine the infectious agents that cause inflammation:

• Sowing materials from the uterine cavity. This procedure not only identifies pathogens, but also determines the most efficient look antibiotics.
• Blood collection for analysis to detect antibodies (ELISA) to various infectious pathogens. The procedure determines the presence or absence of viruses (herpes, cytomegalovirus).
• Polymerase study chain reaction in material obtained from the uterine cavity. Bacteria and viruses that caused the disease are identified.
• Flora smear. Determines the inflammatory process in the cervix and vagina.

Additionally, it can be assigned hormonal analysis blood, especially if infertility was previously diagnosed.

Treatment

After diagnosis has been made, chronic endometritis can be cured using A complex approach. It consists of antimicrobial, metabolic, antioxidant, immunomodulatory therapy and physiotherapy.

With effective therapeutic measures The ultrasound picture of the endometrium is restored, the activity of pathogenic microflora is eliminated or reduced, the morphological structure of the tissue and fertility are restored, pain in the lower abdomen disappears, and the menstrual cycle is normalized.

Drug treatment consists of two stages:

1. Elimination of infection. For this, antibiotics are used: Ceftazidime, Ceftriaxone, Cedex, Doxycilin, etc. The dose and duration of administration depend on the degree of the disease, the results of the diagnosis. For purulent endometritis, antibiotics are prescribed together with Metronidazole. If the causative agent of the infection is a virus, then treatment is carried out with antiviral drugs and immunomodulators (Acyclovir, Viferon, Interferon, etc.). In parallel, anti-inflammatory and painkillers (Ibuprofen, Nurofen, Diclofenac, Spasmolgon, aspirin, No-shpa, etc.) can be prescribed.
2. Restoration of endometrial tissue. This stage combines the use of hormonal (Divigel, Utrozhestan) and metabolic agents (Actovegin, Hofitol, Inosine, vitamins C and E, Methionine, Wobenzym, glutamic acid). If there is uterine bleeding, then Oxytocin or aminocaproic acid solution is used. To restore the menstrual cycle, oral hormonal contraceptives are used for 3-5 months.

Some medications can be injected directly into the tissue of the uterus, for an active effect in the focus and a high therapeutic effect.

Chronic endometritis, as a disease associated with a disorder of tissue structure, can be cured with the help of physiotherapy. They reduce inflammation and swelling of tissue, activate blood circulation, and stimulate immunological reactions. A course of electrophoresis, UHF, pulsed ultrasound therapy, or magnetic therapy may be prescribed. Procedures with therapeutic mud and water in a sanatorium are also shown.

Since chronic long-term endometritis needs to be treated comprehensively, you should not neglect traditional methods. They are based on the preparation of herbal infusions and their use internally and in the form of microenemas. The course of treatment is 3 months, then a break is required for a couple of weeks.

General preparation scheme for all fees:

• 2 tbsp. l. pour half a liter of boiling water over the herbal mixture, leave in a thermos for 10-12 hours, strain. 1 tbsp. l. Dilute the infusion with half a liter of water and take orally throughout the day.
• On the second day, increase the concentration of the drink by adding 2 tbsp to half a liter of water. l. infusion.
• If there are no allergic or other unpleasant reactions to taking the drink, then from the third day you can drink it without diluting (in the same volume).
• After bowel movements, once a day you need to do a microenema into the rectum (50 ml of infusion). It is most effective to use a freshly prepared product.

The herbal mixture can be prepared according to the following recipes(all components in the same volume):

• birch leaves, chamomile and meadowsweet flowers, mint, thyme, celandine and geranium herbs, licorice and elecampane roots;
• leaves of fireweed and raspberry, knotweed, St. John's wort, wormwood and horsetail, rose hips and coriander, immortelle flowers;
• roots of bergenia, angelica and dandelion, knotweed grass and thyme, calendula flowers and coltsfoot leaves.

But before you start treating endometritis with folk remedies, you need to consult a doctor and learn more about the contraindications of certain components. An ideal and safe collection can be prepared by a herbalist.

Chronic endometritis in pregnant women

Chronic endometritis and pregnancy are a common combination, since women of childbearing age are susceptible to the disease. This diagnosis is dangerous during pregnancy, as it can lead to miscarriage or miscarriage. Therefore, the first thing to do is consult a doctor and strictly adhere to the treatment plan he has developed, including antibiotics.

In order to reduce the risk of miscarriage, you need to follow a number of rules:

1. The best option is to treat the disease at the stage of pregnancy planning, eliminate it completely or at least reduce the symptoms. Inflammation of the uterine cavity is accompanied by an infection that can easily be transmitted to the unborn child. And since the fetus does not have its own resistance to infection, the risk of its death is high.
2. With chronic endometritis, pregnancy occurs, but its course is accompanied by many problems. It is important to be under constant medical supervision. At the first complications, he will give a referral for hospital treatment(maintaining pregnancy).
3. During pregnancy, do not neglect recommendations for taking vitamins and biologically active additives, limiting physical and emotional stress.
4. Sluggish form requires administration hormonal drugs and antiplatelet agents, eubiotics (Lactobacterin, Bifidin, Biovestin, Acylact, etc.). Therapy that restores the endometrium is carried out in the first trimester.
5. Also, to eliminate the infection, you need to take broad-spectrum antibiotics prescribed by your doctor. The harm from these drugs is less than from infection.
6. Often, medications are prescribed that increase the amount of estrogen in the body (Estradiol, Estrofem, etc.).
7. Physiotherapeutic treatment (UHF, electrophoresis, magnetic therapy) has a positive effect on the health of a pregnant woman.

With chronic endometritis, bearing a child is possible, but it requires more effort than healthy women. Therefore, it is important to treat it already at the planning stage.

If you cannot get rid of the sluggish process in one course, you need to discuss all possible complications during pregnancy with your doctor and be determined to unconditionally follow all his recommendations (including taking antibiotics, hospital treatment).

Chronic endometritis, although a common disease, is treatable. If you strictly follow your doctor's recommendations and have a lot of patience, you can get rid of the problem forever.