A diagnosis of chronic endometritis was made. Chronic endometritis: the importance of proper treatment of the pathology and the likelihood of pregnancy. Treatment of chronic endometritis

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

Possible consequences of inflammatory processes in the pelvic organs include miscarriage, infertility, chronic pelvic pain syndrome, and ectopic pregnancy.

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

Is it possible to get pregnant with uterine endometritis? We will tell you about the main symptoms and signs of the disease, including after childbirth, and methods of treating the disease in our review!

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

Endometritis of the uterus in women - what is it in simple 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.

When pregnancy occurs, 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, the germinal layer of the mucous membrane is involved in the inflammatory process.

Inflammation can progress and spread to the muscular layer of the uterine wall, then endometritis turns into endomyometritis or metroendometritis.

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

Pathogens enter the uterine cavity either from the appendages (descending route) or from the vagina and cervical canal (ascending route).

Normal development infectious processes prevent acidic environment vagina, local immune defense mechanisms (antibodies, immunoglobulins contained in mucus and natural vaginal microflora) and partially - anatomical features structure of the reproductive system.

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

Causes of occurrence in women and risk factors

Inflammatory processes are caused by bacteria, viruses, fungi and protozoa. Often this is a combined pathology, when several infectious agents are involved 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;
coli.

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

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

Most often, infection occurs through an ascending route. Infection is possible when two conditions coincide: open channel cervix and endometrial damage.

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

diagnostic curettage or instrumental abortion. The disease develops when complete removal functional layer of the endometrium or if sterility is violated during manipulation;
miscarriage. In case of spontaneous abortion, fragments of the fertilized egg often remain in the uterus - this is an ideal nutrient medium for the development of pathogenic microorganisms;
hysterosalpingography and hysteroscopy. Invasive diagnostic procedures– a fairly serious intervention, the basis for which is suspicion of certain diseases.
In addition to the inevitable damage to the endometrium, weakened immunity is important;
use of an intrauterine device. Infection can occur due to violations of sterility during insertion or removal of the IUD, or in case of violation of the examination technique against the background of the IUD;
unprotected sex during menstruation;
protracted labor and operative delivery.

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

There are rare cases of infection spreading from foci of chronic inflammation through the bloodstream or lymphatic system. Most often, gynecologists encounter postpartum endometritis. After spontaneous childbirth, inflammatory processes develop in approximately 20% of cases, after cesarean section - in 45%.

Classification, ICD-10 code, symptoms, treatment methods

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 we mean an inflammatory process caused by pathogenic microorganisms; nonspecific inflammatory reactions are caused by representatives of opportunistic 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?

Symptoms of 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;
the presence of concomitant pathologies;
immunity status;
provoking conditions;
patient's age.

Most severe course The disease is observed after complicated childbirth, spontaneous abortions, and during 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 of the lower abdomen, less often in the lumbar or sacral area. 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 with admixtures of blood. As the purulent process develops, the discharge has a pronounced unpleasant odor.

Postpartum endometritis may cause bleeding. Accession staphylococcal infection leads to the development of a purulent process, and 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 the circumstances. If the disease develops due to the use of an IUD, it is removed. After this, scraping is performed uterine cavity.

After curettage, the following 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 impact. If anaerobic microflora is detected, Metronidazole or Ornidazole is additionally prescribed, and vaginal sanitation is carried out according to indications.

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

As the condition eases and the inflammatory process subsides physiotherapy is prescribed. The complex of physiotherapeutic procedures includes magnetic therapy, laser therapy, and low-intensity ultrasound.

Chronic inflammation

In case of insufficient or untimely treatment acute pathology may become chronic. Clinical manifestations are mild, in approximately 40% of cases this disease is asymptomatic.

Chronic endometritis is indirectly indicated by:

abundant or very scanty discharge during menstruation;
disturbances in the duration of menstruation;
changes in the cyclicity of menstruation;
intermenstrual bleeding, mucous, mucopurulent, bloody discharge;
periodic or constant nagging pain in the lower abdomen;
recurrent 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 is 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 in the second half menstrual cycle. On days 7-11 of the cycle, hysteroscopy and endometrial biopsy are recommended.

For chronic inflammation, step-by-step treatment is used. At the first stage, broad-spectrum antibiotics are prescribed in combination with antifungal drugs and Metronidazole.

When a combined infection is detected combinations are prescribed antimicrobials and antiseptics. Chronic inflammatory processes of viral origin suggest the need to prescribe antiviral and immunomodulatory drugs.

At the second stage, the patient is prescribed antioxidant, hepatoprotective, metabolic, enzyme preparations, and 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 also manifests itself as a slowdown in uterine contractions.

When treating postpartum endometritis, the breastfeeding factor is taken into account. 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-shpu to improve the outflow of secretions from the uterine cavity, improving myometrial contractility.

Curettage may be performed to remove the contents of the uterus., vacuum aspiration or comparatively new method– enzymatic curettage.

After caesarean section

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

antibacterial;

Endometritis of the uterus in women - what is it, is it treated, in simple language the specialist will tell you in the following video:

Prevention

Maximum risk inflammatory reactions discarded when using an IUD, after an abortion or cesarean section. For the prevention of endometritis after complex gynecological procedures 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. The practice of preventive examinations increases the chances of early detection and treatment gynecological diseases.

Careful adherence is important intimate hygiene, usage barrier contraceptives, especially during sexual intercourse during menstruation.

Endometritis(N71 – ICD diagnosis code) is an inflammatory disease of the endometrium, that is, the inner layer of the uterine mucosa. It often occurs in combination with inflammation of its muscle layer - myometritis.

The endometrium changes its structure throughout the menstrual cycle, growing anew after each rejection in order to prepare a substrate for a fertilized egg. Normally, the uterine cavity, lined with the endometrium, is perfectly protected from any infection. However, when certain conditions nevertheless, the infectious pathogen penetrates into the uterus with the subsequent development of inflammation of its inner layer - acute endometritis develops.

Uterine endometritis often leads to miscarriages, infertility, IVF failures, complications during pregnancy and childbirth, and even complications in the postpartum period. Therefore, before it is carried out detailed diagnostics, it is impossible to answer the question “Is it possible to get pregnant if you have a history of endometritis.”

Inflammatory disease of the endometrium is called “endometritis.”

The number of cases of acute endometritis accounts for 2.1% of the total number of gynecological diseases, while chronic endometritis accounts for 14%. This disease, especially in its chronic form, poses a real threat to a woman’s health, even leading to the formation of incurable infertility. The most commonly diagnosed is postpartum endometritis, which develops in 5–20% of all spontaneous births, and in 40% after cesarean section.

Note! Often on a women's forum you can come across the question: “What is the difference between endometritis and?” Let’s clarify this point right away: endometritis and endometritis are completely different pathologies.Endometriosis is the formation of tissue resembling the endometrium in place of other tissues in those organs where it normally cannot exist. The definition of endometritis has already been given above.

Risks

The main reason for the formation of endometritis is damage to the structure of the endometrial layers and the penetration of an infectious agent into them. The development of the disease is greatly influenced by the reduction of barrier mechanisms of local defense that would prevent the penetration of microorganisms into the internal genital organs.

The infectious agent is spread:

Along the ascending path, that is, from the cervical canal or from the vagina;
Lymphogenous route;
By hematogenous route.

For reasons and depending on the pathogens, endometritis is divided into:

The following categories of patients are most at risk:

Having had or had an abortion.
Those who are in the period of menstruation (despite the fact that the uterus inside is a wound surface, bloody discharge washes out the secretions of the cervical canal, which leads to alkalization of the vaginal mucosa and a decrease in its protective properties). For the same reason, endometritis develops after menstruation.
Having traumatic injuries appeared:

during hysterosalpingographic examinations;
when a probe is inserted into the uterine cavity of the uterus;
during curettage of the uterus;
during hysteroscopic examinations;
with uterine biopsy, curettage;
in case of violation of the technique of the douching procedure ( mechanical damage or thermal and chemical burns).

Endometritis can occur due to improper douching technique

Wearing an intrauterine device. Spirals that remain in the uterus for a long time become a source of inflammation and contribute to the penetration of infection through the threads in an ascending manner. Endometritis is an indication for.
Those who have suffered birth ruptures complicated by wound infection.
Suffering from chronic inflammation of the cervix (cervicitis).
Having a history of bacterial vaginosis.
Having had an STD (mycoplasmosis, etc.)
Carriers of cytomegalovirus or genital virus.
“Owners” of uterine polyps or fibroids.
Violators of genital hygiene, “lovers” of spermicides.
Women who use tampons (by the way, they must be changed every 5 hours, not left overnight and not used when high temperature air).

Important! Violating the rules for using tampons often leads to the formation of toxic shock syndrome.

Those experiencing chronic stress, which weakens the body and increases the risk of infection.

Another reason for the formation of endometritis is chronic stress.

Clinic

Based on the nature of the course, it is customary to distinguish two forms of the disease - acute and chronic.

Acute endometritis

All the factors listed above contribute to its development, so a detailed history will make it much easier for the attending physician to make this diagnosis.
Symptoms of endometritis, as a rule, appear already in the first week after diagnostic procedures, childbirth (postpartum endometritis is quite common), abortion, etc.

So, patients should pay attention to following signs pathologies:

Deterioration general well-being, loss of appetite and other general symptoms.
Increase in body temperature to 39°C.
Drawing and aching pain in the lower abdomen can be expressed to a greater or lesser extent and radiate to the lumbar region and sacrum.
Discharges from unpleasant smell from the genital tract, resembling a mixture of pus and blood (purulent endometritis).
Uterine bleeding occurs extremely rarely.

The acute stage can last on average a week or a little longer. Usually, the patient can easily completely cure endometritis if the correct therapy is prescribed.

If treatment is not prescribed at all, or the patient tries to use pure treatment folk remedies, or violates the doctor’s instructions - then the most possible outcome is the process becoming chronic.

Chronic endometritis

The chronic form, as mentioned above, is often a consequence of an untreated acute form of endometritis.

Undertreated acute form endometritis can eventually develop into chronic

Symptoms, in addition to a number of those inherent acute phase, may be as follows:

Irregularity of menstruation, its duration.
Significant change in the amount of discharge on “critical days.”
Increased pain during menstruation.
Change in color of menstrual discharge to brown due to the addition of a purulent component.
Changes in the color and nature of the secretion of the vagina and cervix - it becomes yellow-green and/or foamy - as opposed to the normal transparent mucus-like one.
Bleeding from the genitals can occur outside the menstrual period.

The severity of the process is determined by the depth and duration of the developed changes in the structure of the endometrium.

Diagnostics

Diagnosis of an acute process is based on:

careful collection of anamnesis;
analysis of the patient’s symptoms and complaints;
data from a gynecological examination, which reveals:
painful uterus, moderately enlarged;
in the vagina - discharge: sanguineous or serous-purulent;
general blood test data;
ultrasound data ( differential diagnosis– in particular, with a chronic form of pathology);

Ultrasound is one of the ways to diagnose endometritis

results of smear bacterioscopy.

When diagnosing chronic form shown:

Ultrasound, hysteroscopy, which reveals:

fibrous adhesions;
thickening of the uterine mucosa;
signs of hemorrhage;
sometimes – cystic growth, polyps;
in some cases - signs of inflammation of the myometrium.

diagnostic curettage;
immunocytochemical analysis (giving very accurate results);
histological examination;
bacterioscopy.

Treatment

Treatment regimen for endometritis in the acute phase

In case of acute endometritis, patients are prescribed treatment in a hospital with mandatory adherence to psychological and physical rest, as well as the following regimens:

bed,
food,
drinking,
rest and sleep patterns.

During treatment of endometritis, it is necessary to observe a rest and sleep regime

At the core drug therapy lies in the prescription of drugs aimed at stopping the impact of an infectious agent on the body and eliminating provoking factors:

Antibiotics (for example, for Trichomonas, Proteus and anaerobic infections are indicated: Ecoclave, Benzylpenicillin, Tinidazole, Gentamicin, Fazizhin, (especially with anaerobic infection), Clindamycin and Ciprofloxacin, etc., as well as their combinations (mainly with a mixed nature of the pathological microflora).
Antifungal therapy (Ointments, creams and suppositories for endometritis can be prescribed in combination with the use of oral medications (Flucostat, Terbinafine, Clotrimazole, etc.)
Antiviral (Acyclovir).
To relieve symptoms of intoxication, protein and saline solutions in volumes up to 2-2.5 l/day.
Drugs to stimulate metabolism (Riboxin, Actovegin, Wobenzym).
Vitamin therapy.
medications (Tavegil, Diphenhydramine, Suprastin) are prescribed to relieve swelling.
(Likopid, Cycloferon, T-activin).
Probiotics (Bifiform, Bifitrilak, Lactusan).
Painkillers (with great caution - Nurofen). The optimal pain reliever in in this case is local short-term application of cold.
Hirudotherapy and physiotherapy at the final stage of treatment (electrophoresis with zinc, copper, iodine; UHF, magnetic therapy)
At hormonal disorders in some cases they are shown hormonal drugs(Yarina, Utrozhestan, Duphaston) upon completion of the main therapy.

How to treat chronic endometritis

During treatment chronic endometritis Nowadays, an integrated approach is used based on:

Therapy is carried out in stages:

Eliminate the causative agent of the disease or reduce its activity as much as possible.
Restore normal condition endometrium (hormones - Progesterone in combination with Estradiol and metabolic drugs - inosine, calf blood hemoderivative, vitamins E, ascorbic acid).
As in the treatment of an acute process, drugs that restore metabolism are indicated.
Absorbable agents are also prescribed - Aloe in ampoules, Lidaza).

The effectiveness of treatment of a chronic form of the disease is judged by the following criteria:

Relief of exposure to an infectious agent;
restoration of endometrial morphology (ultrasound is performed);
absence of pathological symptoms;
normalization of the menstrual cycle;
restoration of fertility.

You can overcome the disease only by following all the recommendations and prescriptions of your doctor.

Complications

Important! Pregnant women with a history of endometritis should be under constant medical supervision!

Complications and consequences of the disease are:

, ovaries, fallopian tubes;
Adhesive disease in the pelvis (often leading to the development of infertility);
Intrauterine adhesions (synechia);
Sclerotic changes in the uterine cavity;
Irregularity of the menstrual cycle;
Cystic and polypous changes in the endometrium.

Prevention

To avoid the development of endometritis, it is necessary to avoid abortions if possible, always maintain genital hygiene (especially during menstruation), carry out timely prevention of infection after abortions and childbirth, use condoms, and regularly undergo routine gynecological examinations.

Women who prefer to use protection intrauterine devices and do not consider it necessary to change them at the right time, they risk becoming infertile. The same can be said about girls who have undergone several abortions, hysteroscopies or therapeutic and diagnostic curettages.

The reason for problems with conception often lies in the fact that the inflammatory process in the inner lining of the uterus has not subsided for many years - chronic nonspecific endometritis. It does not always manifest itself with any noticeable symptoms, and can only be detected when one of the instrumental examinations uterus. The treatment process is long and painstaking, often requiring repeated changes of medications. But, fortunately, the disease can be cured completely.

Reasons for the development of the inflammatory process

The cause of the development of chronic endometritis is the entry of microorganisms into the uterine cavity. In case of specific endometritis, these are “special” microorganisms: fungi (mainly yeast-like); viruses: herpes simplex, cytomegalovirus; bacteria: mainly occupying intracellular localization (chlamydia, mycoplasma).

If chronic endometritis is called nonspecific, this means that it was caused by “ordinary” flora, localized on the surface of the perineum, labia, anus and does not cause disease. These are mainly bacteria: various cocci, Escherichia coli, Proteus, Klebsiella, as well as Gardnerella, which are the causative agents of the disease called "".

The uterine cavity is normally closed from any external influences: it ends in a narrow “tube” of the cervix filled with sterile, thick and viscous secretion. Only during menstruation and childbirth does the uterus receive natural communication with the non-sterile vaginal cavity; Then germs can get into it.

Infection also occurs during the creation of an artificial connection between the uterine cavity and environment at:

hysteroscopy;
complicated childbirth;
improper douching;
abortions;
endometrial biopsy;
frequent use spermicidal creams;
caesarean section;
long-term wearing ;
large polyps in the cervical canal;
, which grows near the cervix and “opens” its canal.

Microorganisms that enter the uterus trigger an inflammatory process - acute endometritis. The process does not always have clear symptoms (this depends on the type and quantity of the pathogen), so it is not always treated and not always followed up. In this case, chronic endometritis develops. Contribute to the chronicization of the process: suppression of local or general immunity (including during irradiation of the pelvic cavity, chemotherapy, HIV infection), endocrine diseases, constant stress, untreated bacterial vaginosis, long-term use of antibiotics, changing sexual partners more than once every 3 years.

Chronic endometritis is not a contagious pathology.

Classification

We have already considered that, depending on the nature of the microflora that caused it, chronic endometritis can be specific or nonspecific. There are other classifications.

So, depending on the nature of the disease, chronic endometritis happens:

Moderate degree activity. It has subjective symptoms, is visible on ultrasound, and according to the results of a biopsy performed during hysteroscopy, changes are visible in the endometrial tissue, indicating that the inflammation is quite active.
Sluggish: manifests itself with minimal symptoms, its signs are noticeable during ultrasound examination of the uterus. A biopsy reveals changes that indicate that inflammation is still occurring, but it is inactive.
Inactive, as a stage of remission of endometritis. It usually does not manifest itself with subjective symptoms and is detected by microscopy of areas of the endometrium (during examination for the causes of infertility or before IVF).

There is also a classification of chronic endometritis, which describes the prevalence of inflammation in the endometrium itself. She divides the disease into 2 types:

The first is focal chronic endometritis, in which inflammation is observed not in the entire inner lining of the uterus, but in its individual areas.
The second is diffuse, characterized by the presence of inflammatory changes throughout the entire endometrium or most of it.

There is also a classification based on the depth of the lesion. It divides chronic endometritis into superficial, occurring only in the innermost lining of the uterus, and endomyometritis, when inflammation affects the muscular layer of the organ.

Dangers of the disease

The endometrium consists of two layers: the functional layer, which exfoliates and comes out during menstruation, and the basal layer, which is responsible for the process of restoring the functional layer. Since inflammatory changes develop precisely in the exfoliating layer, it may seem that endometritis is a “one cycle” disease: the altered part of the membrane will “come out” with menstrual blood, and everything will be over. But in reality everything is much more complicated.

Indeed, inflammation initially develops only in the functional endometrial layer. But during the same cycle he has time to “move” to the deep basal layer. As a result, menstruation passes, but inflammation remains. And in the next cycle, such a modified basal layer will be able to “grow” on itself only cells that can no longer provide good nutrition embryo, if one is formed. And the longer active inflammation continues, the more difficult it will be for the formation of the functional layer to occur.

So is pregnancy possible?

Thus, to the question of whether it is possible to become pregnant with chronic endometritis, the answer is ambiguous. Since it occurs (and inflammation of the endometrium itself does not affect the processes occurring in the ovaries), the egg can be fertilized by a sperm. But whether the embryo will be able to implant into the inflamed, often with fibrous adhesions, endometrium and be able to “hold out” there for the entire prescribed period depends on the degree of changes in it.

So, with chronic inactive endometritis, the chance of developing pregnancy is high. Whereas an active process can only lead to the development of “biochemical pregnancy”: when fertilization occurs, but the embryo cannot be implanted, and comes out with menstrual blood (the woman does not even know that the fusion of the egg and sperm has taken place).

If implantation has occurred, this does not mean that the danger has passed. The inflamed endometrium is often unable to supply developing embryo necessary nutrients. The result is the formation of developmental defects internal organs, fetal infection, miscarriage. With constant attempts to get pregnant, spontaneous abortion accompanies every pregnancy (the so-called “”).

Therefore, today, chronic endometritis is the most common cause of infertility, spontaneous miscarriages at different, but usually at early stages, as well as unsuccessful IVF attempts.

The course of labor and the postpartum period

The following complications diseases are pathologies of childbirth and the postpartum period. They relate to the contractility of the uterus. When inflammation from the basal layer moves to the underlying muscular layer, the uterus contracts worse during childbirth. And this is dangerous for the fetus in the development and associated consequences (mainly, this is a lesion of the central nervous system).

IN postpartum period If the myometrium fails to contract sufficiently, bleeding will develop, which can be fatal. There is also a high probability of developing postpartum metroendometritis, which requires inpatient treatment.

For non-pregnant women, chronic endometritis is also dangerous. One of them is the development of increased uterine bleeding, the cause of which lies in the disruption of restoration processes in the endometrium. The second is the development of adhesions, cysts and polyps inside the uterus.

If chronic endometritis is caused by pyogenic flora, it can be complicated by the development of inflammation of the ovaries and fallopian tubes (). This causes infertility, less often causes inflammation of the peritoneum or blood poisoning.

Symptoms

In many cases, the disease is asymptomatic. If the inflammation has moderate activity, the following signs of chronic endometritis are noted:

constant, intensifying during menstruation, aching pain in the suprapubic region or lower back;
more meager or, on the contrary, heavy menstruation;
delayed menstruation, when only fertilization occurs, but not implantation;
discharge of blood or ichor during the intermenstrual period;
pain during sexual intercourse;
purulent discharge from the vagina yellow or greenish color;
impossibility of conception;
fatigue;
increase in body temperature up to 38°C.

Diagnostics

To prescribe the correct treatment for chronic endometritis, you need to establish this diagnosis, identify the pathogens that caused it and find out the degree of activity of the process.

The diagnosis is made as follows. First of all, an examination is carried out on a chair, during which the gynecologist can detect an enlargement of the uterus and its hardening. At the same time, the doctor takes smears from the vagina and cervical canal, which show inflammatory changes in case of endometritis; mucus is collected from the cervix for bacteriological examination.

The final diagnosis is established on the basis, which involves examining the uterine cavity using a special fiber optic device. The study is carried out under anesthesia on days 7-10 of the cycle. During hysteroscopy, several sections of the endometrium are examined, and according to the results microscopic examination These places not only make the diagnosis of chronic endometritis, but also determine the degree of its activity.

The pathogen is determined by bacteriological and immunocytochemical examination of the contents of the cervical canal.

Treatment

To the question whether chronic endometritis can be treated, the answer is comforting: yes, it can be treated. The therapeutic plan is selected individually, depending on the activity of the process, its complications, the type of pathogen that caused the disease and the desire to become pregnant.

During non-exacerbation periods, treatment is carried out on an outpatient basis.

The treatment regimen consists of 2-4 stages:

Administration of antibacterial or antiviral drugs. They take those agents to which the isolated microbe is sensitive. With active bacterial endometritis, a combination of 2-3 antibiotics is administered. 1-2 antibacterial drugs can be administered in the form of systemic agents (tablets, intramuscular or intravenous injections), the third antibiotic (or antiseptic) is administered through a thin catheter directly into the uterine cavity. If the pathological process has developed due to the herpes simplex virus or cytomegalovirus, Acyclovir is prescribed. In the mycotic process they are used antifungal agents– local ( vaginal suppositories) and systemic (tablets).
Taking medications that have a stimulating effect on the immune system. These can be interferon preparations, Polyoxidonium, preparations from animal thymus.
If there are many adhesions or polyps in the uterus, and the woman is planning a pregnancy, the third stage of treatment is surgery. In this case, under the control of a hysteroscope, adhesions are dissected using an electrocoagulator loop.
Recovery natural processes in the endometrium. For this purpose, a complex of drugs is used: hormonal birth control pills(“Janine”, “Marvelon”, “Regulon”) and progesterone-based drugs (“Duphaston”, “Utrozhestan”); means that strengthen blood vessels (“Ascorutin”); hemostatic agents (Dicinone, aminocaproic acid). Enzyme preparations (Wobenzym) and metabolic agents (Hofitol, Methionine, Inosine) are prescribed. Therapy also includes anti-inflammatory drugs (Ibuprofen, Diclofenac).

Physiotherapy is mandatory for chronic endometritis. These procedures significantly increase the effectiveness of medical and surgical treatment. Used: lidase electrophoresis, UHF, magnetic therapy, ultrasound treatment. Spa therapy is also indicated: in special sanatoriums you can carry out the same physiotherapeutic procedures, as well as water and mud therapy, taking slightly alkaline mineral waters.

How to treat chronic endometritis, if it is in an inactive form, is decided by the doctor. In some cases, it is “translated” into an active form using special drugs, after which they begin a course of antibiotics in combination with immunomodulators and probiotics. Sometimes it is considered to be in remission and the woman is allowed to enter into an IVF protocol or become pregnant naturally.

For more information, read the article "".

Pregnancy after treatment of chronic endometritis can be planned only after receiving the result of a histological examination, which will show the inactivity of the process. It must be under constant medical supervision. A pregnant woman should avoid any stress and physical overload. She is prescribed progesterone medications to help maintain pregnancy, probiotics and vitamins. If the process is suspected of transitioning to an active form, the pregnant woman is hospitalized.

- Uterine bleeding (intermenstrual)

Endometritis is an inflammatory disease inner surface uterus.

Main generally accepted classification divides endometritis into acute and chronic.

General information about acute endometritis

Acute endometritis most often occurs after abortion, childbirth (postpartum endometritis) or diagnostic uterine curettage. The presence of blood, remains of decidual tissue, and fertilized egg promotes the growth of microbial flora, characterized by diversity.

There is an increasing role of chlamydial and genital herpetic infections.

According to the etiological principle, everything endometritis divided into specific and nonspecific.

Specific ones include tuberculosis, gonorrheal endometritis, as well as damage to the uterine mucosa by actinomycosis.

In turn, bacterial endometritis is divided into tuberculosis, gonorrheal, chlamydial and actinomycosis of the mucous membrane of the uterine body.

An important role is played by the state of the immune, nervous, endocrine and other systems of the body, which contribute to the development of low-symptomatic, erased forms of inflammatory processes.

Treatment

As a rule, treatment of endometritis is carried out in a hospital and only under the supervision of a doctor. Self-medication can lead to further spread of infection and cause infertility. In cases where the cause of endometritis is the remains of the fertilized egg after an unsuccessful abortion or parts of the placenta after childbirth, these elements are removed and the uterus is washed with aseptic solutions.

Since the main cause of the development of the disease is a microbial infection, the treatment complex necessarily includes antibiotics, in accordance with the sensitivity of the pathogen to them, or broad-spectrum antibiotics.

Typically, various combinations of drugs are used, for example metronidazole (Metrogyl) intravenously and gentamicin intramuscularly. This helps to achieve greater effectiveness in cases where the disease is caused by several types of microorganisms.

III generation cephalosporins are successfully used in the treatment of severe forms of endometritis: ceftazidime, ceftriaxone, cefoperazone, etc., as well as imipenem/cilastatin and meropenem, which have an ultra-wide spectrum of antimicrobial action. Due to their high efficiency and low toxicity, these drugs help replace combinations of several antibiotics. The duration of therapy is determined by the severity of the patient’s condition and continues until complete victory over the causative agent of the disease.

Besides antibacterial drugs, if necessary, a set of other therapeutic measures is prescribed: painkillers, antispasmodics and hemostatic drugs, intravenous drip administration of solutions that accelerate the removal of toxins from the body.

When treating endometritis, it is very important to increase the body's resistance. Prescribe vitamins, drugs that normalize cellular metabolism, increase immunity - interferon drugs (kipferon or viferon), as well as injections of normal human immunoglobulin.

One of the leading places in complex therapy belongs to procedures that promote the activation of blood circulation in the pelvic organs, stimulating their function. Magnetic therapy, pulsed ultrasound, electrophoresis with iodine and zinc, UHF heating, mud therapy, paraffin and ozokerite applications on the lower abdomen are used.

After a course of anti-inflammatory therapy, it is recommended to take oral contraceptives for several months. They have antioxidant and anti-inflammatory properties and help normalize the menstrual cycle. In addition, the woman avoids unwanted pregnancy, and therefore abortion, which can lead to an exacerbation of the process.

In most cases timely treatment leads to good results, which helps to avoid complications of pregnancy and childbirth.

Prevention

Prevention of endometritis in women with high risk development of the disease (for example, after cesarean section) includes taking antibacterial drugs.

Prevention, after treatment, is based on maintaining sterility during uterine manipulations, childbirth, abortion, and maintaining sexual hygiene. Regular monitoring by a gynecologist is mandatory ( preventive examinations at least 2 times a year) to promptly identify inflammatory infections. It is important to strengthen the immune system.

On our website you will find everything you wanted to know about the treatment of endometrial hyperplasia.

Chronic endometritis

The frequency of chronic endometritis varies widely - from 0.2 to 67%, averaging 14%. IN last years There is a tendency towards an increase in the frequency of chronic endometritis, which may be due to the widespread use of intrauterine contraceptives, an increase in the number of abortions and various intrauterine manipulations, including endoscopic methods research.

As a rule, chronic endometritis occurs as a result of acute postpartum or post-abortion endometritis that is not fully cured; often its development is facilitated by repeated intrauterine interventions due to uterine bleeding. Rarely, the cause of chronic endometritis can be the remaining parts of the bones after the termination of a long pregnancy or suture material after a cesarean section. At the same time, the occurrence of chronic endometritis cannot be ruled out without acute stage inflammation.

If the role of the microbial factor in acute endometritis is obvious, then the question of its role in maintaining the chronicity of the inflammatory process remains uncertain. Often, the course of chronic inflammatory diseases can be aggravated by the manifestation of dysbiosis due to the negative side effects of drugs and superinfection (autoinfection with opportunistic microbes).

Most chronic endometritis occurs latently and has no clinical manifestations of infection. When using conventional bacteriological methods, it is not always possible to identify the infectious agent. To detect it, it is necessary to use a more subtle immunocytochemical method.

In chronic endometritis, there are usually no specific macroscopic changes in the endometrium. Serous, hemorrhagic or purulent discharge may be observed on its surface. The endometrium may be thickened and produce abundant material when the walls of the uterine cavity are scraped. Fibrous adhesions are rare, which can cause partial obliteration and infertility. In such cases, when scraping the walls of the uterine cavity, little material is obtained.

Conditions that disrupt the barrier mechanisms of protection against infection in the genital tract and cause the development of the inflammatory process include:

Birth injuries of the perineum, causing gaping of the genital slit and facilitating the unhindered penetration of pathogenic microorganisms from the external genitalia into the vagina.

Prolapse of the vaginal walls.

Mechanical, chemical, thermal factors that have a damaging effect on the epithelium of the vaginal mucosa. These include violation of hygiene rules, frequent douching, introduction of chemicals. contraception in the vagina, etc. In this case, increased desquamation of the surface layer of the epithelium occurs or dystrophic changes in him. In such cases, the amount of glycogen necessary for the life of Dederlein's rods decreases, the acidity of the vaginal contents decreases, and the formation of secretory immunity factors is disrupted.

Ruptures of the cervix, causing gaping of the external os or the appearance of ectropion, while the bactericidal properties of cervical mucus are disrupted. Isthmic-cervical insufficiency (organic or traumatic) is of the same importance.

Childbirth, abortion, menstruation. In this case, cervical mucus and vaginal contents are washed away with blood, along with immune defense factors and lactic acid bacteria, and the vagina becomes alkalized. Microorganisms that freely penetrate the uterus find optimal conditions for its vital activity on an extensive wound surface.

The aggravating effect is the use of disinfectants during childbirth and abortion, which completely destroy the saprophytic autoflora of the vagina and create favorable conditions for the introduction of pathogenic microorganisms.

Intrauterine contraceptives. There is evidence of a violation of the bactericidal properties of cervical mucus, with the infection penetrating into cervical canal and the uterine cavity along the threads of intrauterine devices.

The use of Tampax tampons. By adsorbing blood, they create optimal conditions for the rapid proliferation of pathogenic microorganisms and suppression of the protective mechanisms of the vagina. The use of these tampons is especially dangerous in countries with hot climates, where in some cases it leads to the development of fulminant sepsis.

Symptoms of endometritis

Clinical signs of acute endometritis usually appear on the 3-4th day after infection.

The temperature rises, the pulse quickens, chilling, leukocytosis is detected in the blood, the leukocyte formula shifts to the left, and the ESR accelerates.
The uterus is moderately enlarged, sensitive to palpation, especially on the sides (along the large lymphatic vessels).
The discharge is serous-purulent, often sanguineous for a long time.

The acute stage of endometritis lasts 8-10 days; with proper treatment, the process ends, less often it turns into a subacute and chronic form.

Endometritis can occur in mild or abortive form, especially when using antibiotics.

Symptoms of chronic endometritis

The clinical picture of chronic endometritis largely reflects the depth and duration of changes in the uterine mucosa.

The main symptom of the disease is uterine bleeding. Midline (intermenstrual) bleeding is associated with increased endometrial vascular permeability during ovulation. This change in blood vessels is also observed in healthy women, but diapedesis of blood cells is not clinically noticeable. The reasons causing uterine bleeding include a decrease in the contractile activity of the uterus and a violation of the aggregation properties of platelets.

In addition to bleeding, this group of patients often has a change in secretory function in the form of serous or serous-purulent discharge from the genital tract.

Less striking, but quite constant, are complaints of aching pain in the lower abdomen, slight enlargement and hardening of the uterus, revealed during bimanual examination.

Chronic endometritis does not prevent conception, which occurs in the presence of ovulation. In combination with concomitant ovarian dysfunction or other genital diseases, chronic endometritis causes reproductive dysfunction - infertility and spontaneous miscarriages, including habitual ones

Diagnosis of endometritis

The diagnosis of acute endometritis is made based on the patient’s complaints, clinical picture disease, general and gynecological examination, laboratory examination data.

The echographic method is not informative enough in the diagnosis of acute endometritis; its results are assessed only in combination with clinical, anamnestic and clinical laboratory data.

A patient with acute endometritis should be treated in a hospital (!), since with untimely assistance or with insufficient treatment of endometritis, a woman may develop severe complications, such as peritonitis, which can lead to a sad outcome.

Diagnosis of chronic endometritis

Diagnosis of chronic endometritis is based on the clinical manifestations of the disease, medical history with final confirmation of the diagnosis by histological examination of endometrial scraping. To obtain maximum information, the operation of diagnostic curettage of the uterine mucosa is recommended to be performed in the first phase (8-10th day) of the menstrual cycle.

In recent years, hysteroscopy has been used to diagnose chronic endometritis.

To clarify the diagnosis, it is important to carry out ultrasound examination. The most common echographic sign of endometritis is a change in the structure of the endometrium (the appearance in the zone of the median M-echo of an area of increased echogenicity of various sizes and shapes). Quite often, the presence of gas is detected in the uterine cavity; in the basal layer of the endometrium, small (0.1-0.2 cm in diameter) clear hyperechoic formations are detected, which are areas of fibrosis, sclerosis and calcification. Expansion of the uterine cavity by up to 0.3-0.7 cm due to liquid contents is observed in 30% of patients.

Treatment of acute endometritis

The main place in the treatment of acute endometritis belongs to antibiotics, the effectiveness of which is determined by the properties of the pathogen and its sensitivity to antibiotics. It is very important that the dose of antimicrobial drugs used provides them with maximum concentration at the site of inflammation. Antibiotics with the longest half-life should be used; for example, the half-life of amoxicillin is 8 hours, ampicillin is 5 hours, bacampicillin is 5 hours. Patients with severe clinical course process and the risk of its generalization, with a combination of gram-negative and gram-positive flora, if anaerobic flora is suspected, it is necessary to use various combinations of antibiotics. A combination of clindamycin and chloramphenicol is recommended; gentamicin with chloramphenicol, lincomycin or clindamycin.

If an association of microbes (streptococci, staphylococci, enterobacteria) and anaerobes (bacteroides, peptococci, peptostreptococci) is detected in patients with acute endometritis, it is recommended to begin treatment by prescribing penicillin at 20,000,000 - 30,000,000 units intramuscularly, while simultaneously prescribing aminoglycosides (kanamycin 0.5 g intravenous). m. 2 times a day or gentamicin - 1 mg/kg IM 3 times a day). If there is no clinical effect within 72 hours, clindamycin 600 mg is added to the therapy. IV 4 times a day until positive clinical dynamics are obtained. After that, penicillin and aminoglycosides are used for 5 days using oral medications.

If anaerobic flora is suspected, metronidazole is used. In severe cases, metronidazole is prescribed intravenously in a daily dose of 1-1.5 g at a rate of 5 ml/min. within 5-8 days; in less severe cases it is recommended oral administration drug in a dose of 400-500 mg. 3 times a day for 7-8 days; if indicated, the duration of administration can be increased.

For severe signs of intoxication, use infusion therapy: parenteral administration 5% glucose solution, polyglucin, rheopolyglucin, hemodez, protein preparations ( total liquids 2-2.5 l/day). If necessary, the infusion medium includes vitamins and agents that correct the acid-base state (4-5% sodium bicarbonate solution - 500-1000 ml). Application shown antihistamines(diphenhydramine, suprastin).

Physical methods of treatment include a method that has been used for a long time - cold suprapubic region. Cold, acting on the receptors of the specified area of the skin, has an analgesic, anti-inflammatory and hemostatic effect. Cold is used intermittently (after 2 hours of use, take a break for half an hour).

Treatment of chronic endometritis

For chronic endometritis it is used complex treatment, including drugs aimed at therapy concomitant diseases, restoratives, according to indications - sedatives, desensitizing drugs, vitamins. Physiotherapy plays a leading role, improving pelvic hemodynamics, stimulating reduced ovarian function and the activity of endometrial receptors.

Antibiotics can be used if signs of exacerbation of endometritis appear, including those occurring in response to physiotherapeutic procedures. During the period of remission, the prescription of antibiotics and sulfa drugs unreasonably.

A high therapeutic effect was achieved when administered medicines, including antibiotics, directly into the uterine mucosa. The method ensures the creation of a high concentration of medicinal substances in the focus of chronic inflammation.

In order to eliminate uterine bleeding, the complex of measures, in addition to hormonal hemostasis, includes a solution of γ-aminocaproic acid. The solution is injected into the uterine cavity daily, 3-5 ml. within 5-7 days.

Physiotherapy occupies a central place in the treatment of chronic endometritis; it is carried out differentially, taking into account the duration of the process, the patient’s age, and ovarian function.

For unimpaired ovarian function and a short-term illness (less than 2 years), the use of centimeter-wave microwaves or magnetic field UHF; if the process lasts more than 2 years, pulsed ultrasound or zinc electrophoresis is recommended.

In case of hypofunction of the ovaries and the duration of the endometrium for more than 2 years, microwaves in the centimeter range are preferred; the use of a magnetic field, UHF is also indicated; when the disease lasts for more than 2 years, pulsed ultrasound (preferred) or iodine electrophoresis is recommended. With a combination of chronic endometritis and salpingoophoritis for women young Pulsed ultrasound is recommended; for patients over 35 years of age, combined electrophoresis of iodine and zinc is recommended.

Physiotherapy often helps activate the hormonal function of the ovaries.

Hormonal drugs are recommended if the effect of physiotherapy is insufficient. Hormonal therapy is carried out taking into account the patient’s age, duration of the disease, concomitant pathological processes, phases of the menstrual cycle, degree of ovarian hypofunction (usually there are indications for cyclic replacement therapy: estrogens in the first phase, progesterone in the second phase).

Spa treatment (peloidotherapy, balneotherapy) is effective.

Naturally, simultaneous treatment of the sexual partner is indicated.

Galina Alekseevna asks:

Can chronic endometritis be cured?

The choice of antibiotics in the treatment of this disease is 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 antimicrobials, 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 the patient’s current condition.

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 prognosis for this disease quite favorable.