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.

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Abdominal or pelvic pain, chills, and fever may be symptoms of endometritis.

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.

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 section than 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 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 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.

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A complete blood count, or CBC, can test for infection and may be used to rule out other causes of a person’s symptoms.

When diagnosing endometritis, a doctor will start by taking a medical history and performing a physical exam. The latter will probably include the doctor performing a pelvic exam to evaluate the internal reproductive organs. The doctor is looking for tenderness in the uterus and possible discharge from the cervix.

A doctor will often want to rule out other causes for the symptoms. This process may include:

  • Blood testing. A complete blood count, or CBC, can be used to monitor for possible infection or assess inflammatory conditions.
  • Cervical cultures. The doctor may take a swab from the cervix to look for chlamydia, gonorrhea, or other bacteria.
  • Wet mount. Discharge from the cervix may be collected and looked at under a microscope. This can help to identify other causes of an infection or inflammation.
  • Endometrial biopsy. This is a brief procedure performed in the doctor’s office, where the cervix is dilated to allow a small instrument into the uterus. The instrument takes a small sample of the endometrial lining, which is then sent to the lab for analysis.
  • Laparoscopy or hysteroscopy. These surgical procedures allow the doctor to look directly at the uterus.

Anytime someone is experiencing pelvic pain or discomfort or has unusual discharge or abnormal bleeding, they should see their doctor.

Some pelvic infections can have very serious complications, and it is important to start treatment quickly.

When doctors treat endometritis, they aim to remove the infection and inflammation from the uterus. This may involve:

  • Antibiotics. These are used to fight the bacteria causing the uterus lining inflammation. If the infection is very severe, a person may need intravenous antibiotics in the hospital.
  • Further tests. Cervical cultures or an endometrial biopsy to ensure that the infection is completely gone after finishing the course of antibiotics. If not, a different antibiotic may be needed.
  • Removing tissue. If there is any tissue left in the uterus after childbirth or a miscarriage, the surgeon may need to remove it.
  • Treating any abscesses. If an abscess forms in the abdomen from the infection, surgery or a needle aspiration will be needed to remove the infected fluid or pus.

If the infection is sexually transmitted, a woman’s sexual partner may need to be treated also.

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Before surgery, a doctor may prescribe antibiotics if a person is at risk of developing endometritis.

When a person is at risk of developing endometritis, such as before a scheduled pelvic procedure or surgery, a doctor may prescribe antibiotics to prevent this from occurring. A person must be sure to take these exactly as prescribed.

Antibiotics can also be provided after the internal procedure. It is important to take those, as ordered, as well, even if there are no symptoms of sickness or infection.

After childbirth, procedures, or surgery on the pelvis, the doctor or nurse should also provide instructions about the signs and symptoms of infection to look out for. The individual being treated must ensure that the instructions are understood and not hesitate to ask questions if necessary.

Because endometritis can also be caused by an STI, it is crucial to maintain good sexual health behaviors, especially with non-monogamous partners. These include regular screening for sexually transmitted infections and consistently using barrier contraception, such as condoms.

Endometritis, if it is left untreated, may cause the following complications:

  • infertility
  • pelvic peritonitis (general pelvic infection)
  • abscess in the pelvis or uterus
  • septicemia (bacteria in the bloodstream)
  • septic shock

The outlook for a woman with endometritis is very good, especially if she is treated with antibiotics. Seeing the doctor and starting treatment early will significantly reduce the risk of complications.