Signs, symptoms and sensations of a woman with chronic endometritis do not indicate the development of an inflammatory process in all cases. Sometimes (during remission, for example) there may be no alarming symptoms, but the pathology continues to develop and may make it impossible to conceive and bear a child.
Acute endometritis: causes and symptoms
Symptoms of chronic endometritis appear after an untreated acute form of the disease. In most cases (80%), chronic disease occurs in women of reproductive age and tends to spread. Acute pathology is often preceded by childbirth, abortion, curettage of the uterine cavity or other gynecological manipulations. Incomplete removal of the remains of the embryo or the accumulation of blood clots contribute to the development of infection and inflammation.
Postpartum endometritis, for example, is the most common manifestation of postpartum infection. Such a pathologyit is diagnosed in 4-20% of cases after natural childbirth, in 40% after caesarean section. This is due to large-scale hormonal changes in the woman's body and a general decrease in immunity. Also, acute endometritis can be caused by various bacteria and viruses. The unsatisfactory state of the immune, nervous or endocrine systems aggravates the course of the disease.
The acute form of gynecological disease develops three to four days after infection. Pathology is manifested by severe pain in the lower abdomen, increased heart rate, a feeling of internal trembling, chills, frequent and painful urination, the appearance of atypical discharge from the genital tract (often with an unpleasant odor). The first symptoms are a good reason to consult a gynecologist.
At the initial examination, the doctor determines a painful and moderately enlarged uterus, purulent or sanious discharge. The acute stage lasts from a week to ten days. With adequate and timely therapy, the disease ends in a cure. Otherwise, the problem leads to chronic endometritis.
Causes and risk factors for chronic endometritis
Chronic endometritis (ICD - N71), as a rule, is a consequence of an incompletely cured acute disease that arose after intrauterine manipulations, childbirth or abortion. In most cases, the cause is the penetration into the uterine cavity of pathogenic or opportunistic microorganisms. Under normal conditions, protection is provided by the immune system and monthlymenstrual bleeding. But these natural mechanisms do not always work properly.
Risk factors that lead to an exacerbation of the disease are a woman's age over 35 years, the presence of other chronic foci of infection and concomitant diseases of the genitourinary system, a history of abortion and childbirth, mechanical trauma to the uterus. Significantly increase the risk of disease gynecological surgery and manipulation, the presence of chronic inflammation in the cervix and ovaries, polyps in the uterine cavity. Very often endometritis provokes the installation of an intrauterine device.
Risk factors also include sexually transmitted diseases, the presence of fibroids, genital herpes or cytomegalovirus, long-term imbalance and candidiasis. Reduced immunity and the presence of autoimmune diseases negatively affect. Pathogenic microorganisms lead to the development of chronic endometritis: cytomegalovirus, gonococci, mycobacterium tuberculosis, ureaplasma, chlamydia, mycoplasma, genital or herpes simplex virus.
Classification depending on the course of the disease
Chronic endometritis can be specific or non-specific, depending on the nature of the microflora that caused the disease. The disease can manifest itself in a moderate degree. At the same time, there are subjective symptoms of chronic endometritis, the pathology is visible according to the results of a biopsy, ultrasound and examination show changes that confirm that inflammation is active.
Slow formendometritis is manifested by minimal symptoms. Signs of the disease are visible on ultrasound. A biopsy can determine changes that indicate inflammation, but it is inactive. At the stage of remission, the disease does not manifest itself with specific symptoms, it is detected by microscopy of altered areas of the endometrium. Often, chronic endometritis is diagnosed before IVF or during an examination for infertility.
There is a classification that describes the prevalence of inflammation in the endometrium. With focal chronic endometritis, the inflammatory process does not spread throughout the entire lining of the uterus, but only in certain areas. The diffuse type of the disease is characterized by the presence of inflammation in most of the endometrium or completely in the uterine cavity. According to the depth of the lesion, chronic superficial endometritis (only in the inner lining of the uterus) and a disease when inflammation affects the muscle layer are divided.
Clinical manifestations of the disease
With exacerbations of chronic endometritis, the symptoms will recur. The disease will be present in the body and worsen from time to time. The main symptom of chronic endometritis is uterine bleeding of varying severity. They can appear before, before and after menstruation, as well as in the intermenstrual period. Bleeding may be scanty or profuse. This symptom is explained by the inferiority of the uterine layer, which should normally be restored after the next menstruation.
Common symptomsexacerbations of chronic endometritis are slightly elevated body temperature, periodic aching pains in the lower abdomen, thickening of the uterus and soreness of the organ, soreness during gynecological examination or sexual contact, the appearance of atypical vaginal discharge. In the presence of concomitant infections, a more pronounced clinical picture is formed.
Diagnosis of a gynecological disease
Chronic nonspecific endometritis or a specific gynecologist can diagnose after examination, familiarization with the results of a smear on the flora from the vagina and cervix, ultrasound. During the examination on the gynecological chair, the doctor can determine the increase in the uterus and pain on palpation, areas of compaction. Smears from the cervix and vagina can determine inflammatory changes. Biological material is collected for bacteriological examination.
Then the patient is assigned an ultrasound. One procedure is carried out in the first half of the cycle, the second - in the second phase. Such a diagnosis shows only signs of a chronic disease: thickening, adhesions of the endometrium, cysts or polyps in the cavity of the organ. The final diagnosis can be made on the basis of hysteroscopy.
The procedure involves examining the cavity of an organ using a special device. The study is performed approximately on the seventh day of the menstrual cycle under general anesthesia. During the procedure, several sections of the endometrium are taken for a biopsy. According to the results of the study, a diagnosis is made, and the degree of activity of the inflammatoryprocess. The causative agent can be accurately determined by analyzing the mucus from the cervix.
Treatment methods for chronic endometritis
Often, treatment of chronic endometritis is started before IVF, because the diagnosis is made in most cases when a woman consults a doctor with a problem of infertility. Endometritis can also be detected during a routine examination. In any case, the tactics of treatment is chosen individually. It all depends on the activity of the inflammatory process and complications, the desire of the woman to become pregnant and the pathogen that caused the disease. In the acute phase, the doctor may recommend a stay in the hospital, while the chronic form of the disease is treated as an outpatient.
The treatment regimen usually consists of two to four stages. First, antibiotics are prescribed, to which the identified pathogen is sensitive. With active endometritis, they resort to the simultaneous use of several drugs (no more than three). In this case, one or two drugs are administered in the form of tablets, intramuscularly or intravenously, and the remaining drug is directly into the uterine cavity. If the pathology is caused by the herpes virus or cytomegalovirus, then Acyclovir is prescribed. With a mycotic inflammatory process, local (candles) antifungal agents and tablets are indicated.
Additionally, it is recommended to take medications that restore immunity. This is necessary to support and speedy recovery of the woman's body. Such drugs are especially important if a woman wants to become pregnant in the near future. In the presence of a large number of adhesions and polyps inthe uterine cavity and the desire to have a child, surgical intervention is prescribed. Under the control of a special camera, adhesions are dissected and pathological formations are removed.
Restoration of natural processes
Symptoms and treatment of chronic endometritis in women are interrelated at least with the need to prescribe symptomatic therapy. So, it is necessary to restore the natural processes in the endometrium. For this, an integrated approach is used. Oral contraceptives are prescribed ("Janine", "Regulon" or "Marvelon"), progesterone-based drugs ("Utrozhestan" or "Dufaston"), agents that restore blood vessels ("Ascorutin"), hemostatic agents (aminocaproic acid or "Dicynon "). Metabolic (Methionine, Hofitol or Inosine) and enzyme preparations (Wobenzym) are also usually recommended. Need anti-inflammatory drugs (Diclofenac or Ibuprofen).
Symptoms of chronic endometritis necessarily require the passage of physiotherapy. Such procedures greatly facilitate the condition of a woman, increase the effectiveness of medication and other treatment. UHF, electrophoresis, ultrasound treatment, magnetotherapy can be used. The most successful treatment is carried out in specialized sanatoriums. Additionally, the patient is prescribed water and mud therapy, as well as mineral water intake.
The treatment regimen is chosen by the doctor depending on the characteristics of the course of the disease, the clinical picture, the age and desire of the patientget pregnant. Sometimes a gynecologist may recommend "transferring" the disease to an acute form in order to quickly stop the inflammatory process with antibiotics in combination with probiotics and immunomodulators. In some cases, the doctor may consider chronic endometritis as remission and allow the woman to undergo artificial insemination or pregnancy in a natural way.
Chronic endometritis and pregnancy
The inflammatory process leads to a decrease in the area of he althy endometrium, which is necessary for the successful attachment of the egg and its further development. Normally, the mucous membrane grows in the second phase of the cycle to provide the possible fetus with all the necessary nutrients. The difficulty of pregnancy with endometritis is that after a single inflammation, intrauterine adhesions or seals usually remain. The endometrium begins to function incorrectly, the menstrual cycle is disrupted, which leads to the inability to conceive a child or early miscarriages.
But not always the disease is an obstacle to conception. If a woman becomes pregnant with chronic endometritis, then an abortion is not done. In most patients with this diagnosis, pregnancy is terminated even before the delay, so they do not know about its onset. If the embryo is preserved, then it is necessary to register as soon as possible so that the doctor can monitor the condition of the woman, and, if necessary, promptly prescribe the necessary drugs and help maintain the pregnancy.
At the same timeendometrial dysfunction is one of the main causes of problems with conception and miscarriage. At the same time, the possibility of conception and the normal progression of pregnancy is not excluded. Chronic endometritis can be treated in advance so that after conception you do not have to worry about saving the child. True, the course of treatment is quite long. After chronic endometritis, you can become pregnant only after a few months. The doctor will tell you the exact dates.
The course of childbirth and the postpartum period
Complications of chronic endometritis are manifested not only in problems with conception and miscarriage. Autoimmune chronic endometritis affects the general condition of a woman, and any pathological process in the body can lead to serious consequences during childbirth and in the postpartum period. This applies to the contractile activity of the uterus. When inflammation passes to the muscle layer, the organ contracts worse during labor. For the fetus, this is dangerous due to hypoxia and damage to the central nervous system.
In the postpartum period, symptoms of chronic endometritis in women may reappear, and treatment will need to be continued. In addition, the development of increased uterine bleeding is possible. The cause of the pathology lies in the violation of the recovery processes. Also, adhesions, cysts and polyps can form inside the organ. If a certain flora is found, then the disease can be complicated by inflammation of the ovaries or fallopian tubes. This can cause inflammation of the peritoneum or blood poisoning, and also causes infertility.
Complications and preventiongynecological disease
Endometrium is an important functional layer that ensures the normal course of pregnancy. Endometritis entails severe complications of pregnancy. There may be a threat of miscarriage, postpartum hemorrhage and placental insufficiency. Therefore, the management of pregnancy in a woman with endometritis should be carried out with increased attention. Complications of the inflammatory process are adhesions and disturbed cycles, polyps and cysts. In severe cases, peritonitis may occur.
To avoid chronic endometritis, you need to avoid abortion, carefully observe hygiene measures, prevent infections after abortion and childbirth, use barrier contraception to prevent sexually transmitted diseases. Detection of infections in the early stages and adequate treatment in most cases give a positive prognosis for future pregnancies and childbirth.
