Endometritis is inflammation of the endometrial lining inside the uterus, but inflammation may extend to other structures in the uterus. Endometritis should not be confused with endometriosis.
There are two distinct forms of endometritis: pregnancy-related and non-pregnancy-related. When endometritis is not pregnancy-related, it is known as pelvic inflammatory disease (PID).1
Endometritis may be linked with inflammation of the fallopian tubes (salpingitis), ovaries (oophoritis), and pelvic peritoneum (pelvic peritonitis). Pelvic inflammatory disease is any combination of these ‘itis’s’, which may be accompanied by a fever and lower abdominal pain.2
Endometritis is either chronic or acute. In acute endometritis, neutrophils can be found within the endometrial glands, whereas in chronic endometritis, there are plasma cells and lymphocytes in the endometrial stroma.3,4
Invasive gynaecological procedures and pelvic inflammatory disease are the most common precursors to acute endometritis, and in those giving birth, postpartum infection is the most common cause.
Chronic endometritis in those giving birth is usually caused by remnants of delivery remaining. In those without a pregnancy, chronic endometritis is typically linked with an infection and possibly with older versions of an intrauterine device (IUD).
Symptoms of endometritis
- Fever
- Lower abdominal pain
- Foul smelling labour discharge (lochia)
- Abnormal vaginal bleeding
- Abnormal vaginal discharge
- Painful sex (dyspareunia)
- Painful urination (dysuria)
- Feeling tired and a bit unwell
- Tender uterus
Bacteria most commonly associated with endometritis
- Ureaplasma urealyticum
- Peptostreptococcus
- Gardnerella vaginalis
- Bacteroides bivius
- Group B Streptococcus
- Chlamydia – associated with late-onset postpartum endometritis, and may be asymptomatic
- Enterococcus – sometimes found in those who have had cephalosporin prophylaxis
Endometritis usually has two or three organisms that contribute to it, typically from vaginal flora.5,6 Herpes and tuberculosis are rare causes.
Who gets endometritis?
Anyone with a uterus can get endometritis, but it’s more common in those who have babies. Those having cesarean deliveries are more at risk than those with vaginal births.7 Long labour, manual placental removal and older ages are more at risk.
The risk is increased if the normal cervical plug is missing (for example, due to an infection like bacterial vaginosis (BV)). Those who douche and have unprotected sex with multiple partners are at a greater risk.
Treatment for endometritis
Treatment is antibiotics, and almost 90 per cent of the time, they work within 72 hours.7 Endometritis can be a cause of a labouring mother’s death due to sepsis, but it’s uncommon now. Endometritis is not associated with further negative outcomes if treated promptly.
What else could it be?
Endometritis could be mistaken for appendicitis or pelvic inflammatory disease (PID), and in children, it could be a urinary tract infection (UTI).
References
- 1.Singh N, Sethi A. Endometritis – Diagnosis,Treatment and its impact on fertility – A Scoping Review. JBRA. Published online 2022. doi:10.5935/1518-0557.20220015
- 2.He D, Wang T, Ren W. Global burden of pelvic inflammatory disease and ectopic pregnancy from 1990 to 2019. BMC Public Health. Published online October 2, 2023. doi:10.1186/s12889-023-16663-y
- 3.Rule C, Ashley L, Bergin C. Sonographic findings in acute puerperal endometritis. Australas J Ultrason Med. Published online September 7, 2018:234-240. doi:10.1002/ajum.12112
- 4.Murtinger M, Wirleitner B, Spitzer D, Bralo H, Miglar S, Schuff M. Diagnosing chronic endometritis: when simplification fails to clarify. Human Reproduction Open. Published online January 1, 2022. doi:10.1093/hropen/hoac023
- 5.Venkatesan P. Bacterial infection linked to endometriosis. The Lancet Microbe. Published online October 2023:e768. doi:10.1016/s2666-5247(23)00221-5
- 6.Mitchell CM, Anyalechi GE, Cohen CR, Haggerty CL, Manhart LE, Hillier SL. Etiology and Diagnosis of Pelvic Inflammatory Disease: Looking Beyond Gonorrhea and Chlamydia. The Journal of Infectious Diseases. Published online August 15, 2021:S29-S35. doi:10.1093/infdis/jiab067
- 7.Cicinelli E, Resta L, Loizzi V, et al. Antibiotic therapy versus no treatment for chronic endometritis: a case-control study. Fertility and Sterility. Published online June 2021:1541-1548. doi:10.1016/j.fertnstert.2021.01.018
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