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Endometritis is an inflammation of the inner lining of the uterus or endometrium.
Endometritis is different from endometriosis, though both conditions affect the lining of the uterus. Another related condition is called endomyometritis, where inflammation happens in the inner layer of the uterus, called the myometrium.
In this article, we give an overview of endometritis, including causes, symptoms, diagnosis, and complications. We also look at its relationship with endometriosis and fertility.
Symptoms
Symptoms of endometritis may include:
- • pelvic or abdominal pain
- • vaginal bleeding or unusual discharge
- • fever or chills
- • feeling unwell or extremely fatigued
- • constipation or pain when going to the bathroom
Anyone experiencing these symptoms should see their doctor to find out the cause.
Causes
An infection of the uterine lining causes endometritis.
The cervix, which is the opening to the uterus, usually keeps bacteria out of the uterus. However, when the cervix is open, such as during childbirth or surgery, bacteria can get into the womb.
Both the bacteria normally found in the vagina and abnormal bacteria can be the cause of endometritis.
Possible risk factors for endometritis include:
- Childbirth or miscarriage. These are the most common reasons for the uterus lining to become inflamed.
- Cesarean delivery. Uterus inflammation is more common after a cesarean sectionthan a vaginal delivery, and after an unscheduled versus a scheduled cesarean.
- Sexually transmitted infections (STIs) and other bacteria. Sexually transmitted infections are passed on during sexual activity. These include chlamydia or gonorrhea, which can cause an infection in the uterus lining. It is important to always practice safe sex.
- Bacteria in the uterus. Bacteria normally found in the vagina and cervix can cause endometritis if they are found in the uterus.
- Pelvic procedures. Some surgical or medical procedures can let bacteria into the uterus. This is especially so when they are performed through the cervix or uterus, such as
- • dilation and curettage (D&C), or surgery involving the uterus
- • endometrial biopsy, where a sample of uterus lining tissue is taken
- • hysteroscopy, where a small telescope is inserted into the uterus to look for abnormalities
- • inserting an intrauterine device (IUD)
- • cesarean section
- Pelvic inflammatory disease. Pelvic inflammatory disease, or PID, is an infection in the pelvis. It is often associated with, or a cause of, endometritis. PID can be serious if not treated and requires quick medical attention and a possible stay in the hospital.
Endometritis vs. endometriosis
Endometritis is different from endometriosis, though both conditions affect the lining of the uterus.
Endometritis is where the uterus lining becomes inflamed from infection. Endometriosis is where the lining of the uterus grows outside of it, causing abdominal and pelvic pain. Endometriosis is not caused by an infection.
Endometritis is likely to be a shorter-term condition that is easier to treat than endometriosis.
Endometritis and pregnancy
Endometritis has been found to have an impact on the ability of a woman to get or stay pregnant. Inflammation of the uterus can cause scarring, which prevents an embryo from implanting and developing normally within the uterine wall.
Research published in 2016 reports that chronic endometritis can affect fertility in the following ways:
- • by stopping the fertilized egg from implanting into the uterus lining
- • by increasing the likelihood of repeated miscarriages
However, the same study reports that antibiotic treatment can lead to a significant improvement in fertility and successful pregnancies.
A study from 2018 worked with 95 women who had fertility issues. They found that over half of these women had chronic endometritis, and that antibiotic therapy improved their symptoms by more than 80 percent. With successful treatment, these women had increased pregnancy and childbirth rates.
Fertility specialists sometimes suggest that women be tested or treated for endometritis, especially with multiple failed in vitro fertilization (IVF) cycles, when the embryos were good quality, or with repeated pregnancy loss.