Treatment of chronic and acute forms of metroendometritis. Treatment of chronic metroendometritis Metroendometritis oophoritis treatment standards

Chronic metroendometritis is a fairly common problem faced mainly by adult women. The disease is accompanied by the muscular layer of the uterus. Often, in the absence of therapy, severe complications are possible, in particular inflammation of the peritoneum and pelvic vessels, and even sepsis.

Chronic metroendometritis: causes of the disease

In most cases, it occurs as a result of improper treatment of the acute form of the disease. Nevertheless, chronic metroendometritis can be an independent, primary disease.

The most common cause of the inflammatory process is a bacterial infection. It can be chlamydia, gonococci and other sexually transmitted microorganisms. But in addition, activation of opportunistic microflora is possible, which is associated with a local or general decrease in immune defense.

Risk factors include abortion and other gynecological procedures. Chronic metroendometritis often occurs as a postpartum complication. Sometimes the disease appears after the removal of polyps or tumors of the uterus. In any case, it is extremely important to notice and consult a doctor in time.

Chronic metroendometritis: main signs

Unfortunately, the chronic form of this disease is often accompanied by inexpressive symptoms, which greatly complicates the diagnosis process. Some patients complain of pulling pains in the groin, which either appear or disappear altogether. Sometimes there is the appearance of abundant mucous or purulent discharge.

As already mentioned, the disease is dangerous to health. The fact is that the infection can spread by affecting neighboring organs. In the absence of therapy, complications may occur, in particular phlebitis of the pelvic vessels, as well as inflammation of the peritoneum. Since the inflammatory process penetrates into the muscular layer of the uterus, as the disease develops, the muscle tissue is replaced by connective tissue elements - the organ becomes denser, increases in size and loses its main functions.

Chronic metroendometritis: treatment and diagnosis

Of course, in order to make a final diagnosis, the doctor will need test results. For example, in a blood test, you can notice an increase in the level of leukocytes. A vaginal smear with further laboratory culture helps to determine the type of pathogen. Informative is the ultrasound examination of the reproductive system.

As for therapy, in this case, antibacterial agents are used, including antibiotics from the penicillin series. In addition, patients are prescribed vitamins (ascorbic and folic acid, B vitamins) and immunomodulatory drugs - this helps to activate the body's defense system and speed up the treatment process.

Physiotherapy is also considered essential. It has been proven that UHF procedures and infrared irradiation have a positive effect on the state of the reproductive system and effectively eliminate the inflammatory process.

Treatment of chronic inflammation is a long process. Here, proper nutrition, exposure to fresh air, physiotherapy exercises, which normalize blood circulation and eliminate fluid stagnation, will be important. Doctors also recommend physiotherapy and spa treatment.

Metroendometritis is an infectious gynecological disease accompanied by inflammation of the muscular layer (myometrium) and mucous membrane (endometrium) of the uterus. The disease develops against the background of penetration into the uterine cavity of infection from the fallopian tubes, vagina or cervical canal.

General statistics on the frequency of development of metroendometritis does not exist. But according to the observation of gynecologists in the postpartum period, the number of women with such a disease ranges from 3 to 8%, and with complicated childbirth it increases to 20%. Timely untreated metroendometritis can lead to a purulent-septic process, and later to uterine infertility. That is why pathology is on a par with other serious gynecological diseases.

After the infection has entered the uterine cavity, inflammation of the mucous membrane begins to develop - endometritis. The damaged mucosa eventually loses its ability to retain pathogenic microorganisms, and they begin to penetrate deeper. As a result, the infection enters the muscular layer of the uterus, causing an inflammatory disease such as metritis. At this stage, the clinical manifestations of metroendometritis become pronounced.

In a healthy woman, the uterus is reliably protected by such physiological barriers as the endometrium, uterine glands, and cervical canal. Therefore, the risk of infection entering the cavity is minimized. The development of pathology is possible with mechanical damage to the mucous membrane and with malfunctions of the immune system. That is why metroendometritis often develops after childbirth, abortion or gynecological operations.

In addition, to promote the penetration of the infection deeper, maybe self-medication. An independent attempt to get rid of the disease leads only to relief of symptoms, but not to the destruction of the source of infection.

The inflammatory process in metroendometritis can be acute, subacute and chronic. In the first case, the clinical manifestations of the disease are quite bright and appear within 3-5 days from the moment of infection. The subacute form is characterized by a more blurred clinical picture, it is more difficult to diagnose it, and most often it indicates the presence of a chronic process.

The chronic form develops when the treatment of metroendometritis was not carried out in a timely manner. Symptoms in this case are practically absent, except for the moments of exacerbation of the disease.

Causes of metroendometritis

The only reason for the development of metroendometritis in the uterine cavity is infection. In medicine, the disease is usually divided into 2 types: specific and nonspecific. In the first case, inflammation is provoked by such pathogenic microorganisms as gonococci and Trichomonas. And in the second case, the infection develops due to streptococcus, staphylococcus, Escherichia coli and a number of other microorganisms. But there are also negative factors that at some point can contribute to the development of the disease. These include:

1. Various injuries after diagnostic manipulations. Even a small wound in the uterine cavity can be an excellent breeding ground for bacteria.
2. The consequences of an abortion. During this procedure, the mucosa is removed, in place of which an open wound surface is formed. And through damaged vessels, microorganisms easily penetrate into the muscular layer of the uterus. In addition, the accumulated blood in the absence of a mucous layer becomes an ideal place for the reproduction of bacteria.
3. Introduction into the cavity of the intrauterine device. Microorganisms are able to penetrate through its threads.
4. Promiscuous sexual contacts.
5. Failure to comply with the rules of personal hygiene, especially in the postpartum period.
6. Surgical operations in the uterine cavity.
7. Polyps not removed in a timely manner. They delay uterine secretions, thereby forming a favorable environment for the reproduction of microorganisms.

Risk factors in the postpartum period are complicated prolonged labor, poor labor activity, uterine bleeding, and remnants of placental tissue in the uterine cavity. The development of metroendometritis can contribute to menstruation, endocervicitis and venous congestion in the pelvic organs.

Clinical manifestations of the disease

Symptoms of metroendometritis directly depend on the cause of its occurrence. But there are a number of common clinical manifestations. These include:

• disruption of the menstrual cycle;
• aching pain in the lower abdomen;
• symptoms of intoxication of the body (nausea, vomiting).

During a gynecological examination, the doctor reveals a change in the size and shape of the uterus. Pain on palpation may be present depending on the degree of inflammation.

The main symptoms of acute metroendometritis are severe pain in the pubic area, a sharp increase in temperature and the appearance of purulent discharge with a characteristic unpleasant odor. The acute form of the disease most often develops 3-5 days after intrauterine intervention (abortion, childbirth, installation of a spiral).

The symptoms of chronic metroendometritis include uterine bleeding, severe pain with pressure in the uterus and its significant increase in size. According to the observations of gynecologists, any violation of the reproductive function in a woman can be considered an indirect clinical manifestation of the disease. For example, inability to conceive and miscarriages.

In the chronic form of the disease, menstrual dysfunctions such as anovulatory cycle and menorrhagia are often observed. Companions of chronic metroendometritis can be cysts, intrauterine synechia, adhesions in the pelvic organs and chronic.

Diagnostic methods

In order to diagnose metroendometritis, the gynecologist first of all examines the uterus and vagina. Then the doctor writes out directions for laboratory and instrumental diagnostics:

1. A blood test to detect leukocytes and ESR (erythrocyte sedimentation rate). Their increased number directly indicates the inflammatory process in the body.
2. Ultrasound (ultrasound examination).
3. Bakposev secretions. It allows not only to identify the causative agent of the infection, but also to determine which antibiotic in the treatment will be most effective.
4. The study of a vaginal smear helps to assess the severity of the inflammatory process and the microbial composition.
5. Transvaginal ultrasound. Using this method, you can understand the state of not only the uterus, but also other organs of the small pelvis.

Additional research methods may be needed if a patient has comorbidities. If the diagnosis of metroedometritis is difficult, then the doctor resorts to laparoscopy.

Methods of treatment

Women with suspected metroendometritis are subject to urgent hospitalization. The lack of timely treatment can provoke uterine bleeding and, as a result, death.

The basis of drug therapy in this case is antibacterial drugs. Before starting treatment, a study is carried out on the sensitivity of the pathogen to the antibiotic. If such a procedure is not possible, then the doctor prescribes broad-spectrum drugs. One of the most common antibiotics for metroendometritis is penicillin. If the drug is intolerant, at the discretion of the gynecologist, it is replaced with macrolides, tetracyclines or third-generation cephalosporins.

In any case, the doctor prescribes drugs individually for each patient, sometimes it can be a whole group of drugs. The course of treatment lasts an average of 10-14 days. To remove toxins and purulent accumulations, the uterine cavity is washed with antiseptics. Additionally, to strengthen the immune system, a vitamin complex is prescribed.

Non-steroidal anti-inflammatory drugs (ibuprofen, indomethacin) help to stop the inflammatory process in the uterine cavity. They not only relieve pain, but also reduce tissue swelling. After stopping the inflammatory process, the patient is prescribed physiotherapeutic procedures. These include electrophoresis, phonophoresis, paraffin and laser therapy.

Remember, the resumption of sexual activity is possible not earlier than one menstrual cycle after the end of treatment. Such a precaution is necessary for the complete restoration of the endometrium, otherwise the risk of re-infection is very high.

Forecast and prevention

Prevention of metroendometritis consists of a few simple rules. The main ones include the following points:

• No random connections.
• Compliance with the rules of intimate hygiene, especially during the menstrual cycle.
• Timely visit to the gynecologist for a preventive examination.
• Competent approach to the choice of contraceptives.
• Timely treat any pathology of the pelvic organs.
• After the establishment of the intrauterine device and in the postpartum period, visits to the doctor should be regular.
• If you experience any of these symptoms, you should immediately consult a gynecologist.

If treatment is started in a timely manner, then the chance for a complete recovery without consequences is quite large. The lack of therapy contributes to the transition of metroendometritis into a chronic form. The inflammatory process will move on, covering not only the uterus, but also neighboring organs. In this case, abscesses, thrombosis and complete infertility can hardly be avoided. That is why you should not delay visiting a gynecologist and hoping that metroendometritis will go away on its own.

Metroendometritis is a female disease that is characterized by an inflammatory process that affects the mucous membrane (endometrium) and the layer of muscle tissue (myometrium) of the uterus. Inflammation is most often infectious (streptococcal, staphylococcal, tubercular or Escherichia coli can become the cause of the infection), but sometimes it can occur after childbirth, pregnancy, which ends in miscarriage, abortion, or the establishment of a spiral that prevents conception.

Etiology and types of the disease

As already mentioned, metroendometritis occurs against the background of an infectious lesion of the uterus by pathogenic microorganisms, which cause the development of infectious processes on its mucous membrane (endometrium). Doctors distinguish two groups of pathogenic bacteria that can cause the development of the disease:

• specific (chlamydia, gonococcal bacilli, herpes infection);
• non-specific (Escherichia or streptococcal bacilli, Klebsibel).

According to this classification, metroendometritis is usually divided into specific and, accordingly, non-specific, the difference between the two subspecies of this disease lies in the symptoms and approaches to treatment (the effectiveness of antibiotic therapy directly depends on the correctly identified pathogen). It should be understood that inflammation begins to develop not only against the background of an infectious lesion of the body by pathogenic bacteria or viruses, but also due to a decrease in the activity (or complete absence) of the mechanisms for protecting the uterine cavity, which occurs as a result of the “desquamation” of the epithelial tissue of the fallopian tubes during menstruation, imbalance of the vaginal microflora, the appearance of specific immunoglobulins in the genital tract, and so on.

The ways in which microorganisms enter the uterus can also be different. According to statistics, the most common cause of acute metroendometritis is infection in the uterine cavity by ascending (from the lower genital organs) or hematogenous (through the blood) route, and chronic - by lymphogenous.

Risk factors

Predisposing factors for the development of the disease include the presence of intrauterine devices, pregnancy (during childbearing, the activity of the immune system decreases), frequent probing and diagnostic curettage of the uterine cavity, abortion. Postpartum metroendometritis often occurs due to non-compliance with the rules of personal hygiene of the genital organs or the early onset of sexual activity, which is prohibited until the uterine mucosa is completely healed (1-3 months, depending on how the pregnancy and childbirth went).

The main symptoms of the disease

Clinical manifestations of the disease depend on the nature of the inflammatory process and the cause of its development. At the very beginning of the disease, women with suspected metroendometritis (regardless of the nature of its course) complain of dull, aching pains localized in the lower abdomen, lethargy (lack of appetite, drowsiness), disruptions in the menstrual cycle (too heavy or, conversely, short menstruation, spotting in the middle of the menstrual cycle), symptoms of infectious intoxication of the body (vomiting, nausea). Subsequently, during a gynecological examination of the vagina, the doctor notes an increase in the uterus, a change in its shape (in the absence of adequate treatment, it acquires a spherical shape) and pain on palpation.

Acute metroendometritis, as a rule, develops 3-4 days after intrauterine interventions (termination of pregnancy, childbirth, installation of a spiral). It is characterized by a sharp increase in body temperature, pain in the pubic region, which can radiate to the sacrum, and the appearance of purulent bloody discharge from the vagina that has a putrid odor.

As for the symptoms that accompany chronic metroendometritis, they include uterine bleeding, a noticeable increase in the uterus and severe pain when pressing on this area. In addition, talking about chronic metroendometritis, doctors say that an indirect symptom of its manifestation is a violation of the woman's reproductive system (pregnancy failures at different times, suspicion of infertility), so it is recommended to treat this disease at the first signs of its appearance.

Diagnostic methods

Before starting the treatment of the disease, doctors carry out its diagnosis, which basically does not present any difficulty. The diagnosis is made on the basis of a gynecological examination of the uterus and vagina, ultrasound and clinical blood tests to determine the causative agent of the infection. In cases where the symptoms of metroendometritis are not clear and the doctor suspects the development of another disease accompanied by similar symptoms, the woman is diagnosed with a diagnostic curettage of the uterine cavity and a biopsy of endometrial tissue.

How to treat?

Patients with suspected metroendometritis are subject to urgent hospitalization (especially if the inflammation is acute and occurs after pregnancy), because the lack of adequate treatment of one of the symptoms of the disease, such as uterine bleeding, is fatal. Doctors prescribe bed rest, cold compresses to the lower abdomen, and a diet for patients. If an inflammatory process occurs after a pregnancy ending in a miscarriage, doctors must prescribe intrauterine lavage to a woman - washing the uterine cavity with a solution of antiseptic agents in order to remove blood clots that cause inflammation, stop the reproduction of pathogenic microorganisms, and stimulate the contractile activity of the myometrium.

Basic principles of drug therapy

Considering that metroendometritis is an infectious disease, its treatment begins with the use of antimicrobials - broad-spectrum antibiotics and sulfonamides, and drugs that relieve pain (for this purpose, doctors prescribe the use of vaginal suppositories, which include anesthetic components). When uterine bleeding occurs, ascorbic acid or Vikasol is prescribed.

Treatment of chronic metroendometritis consists of physiotherapeutic procedures: light therapy, mud therapy, electrophoresis, visits to medical-type sanatoriums.

Is therapy with folk remedies possible?

Self-treatment of this disease is extremely dangerous, since the lack of antibacterial and hemostatic (with uterine bleeding) therapy can lead to the development of serious complications, but sometimes (during periods of subsidence of the inflammatory process), doctors recommend that patients do douching with solutions of chamomile, nettle, lime blossom or sage (plants have a bacteriostatic, anti-inflammatory and hemostatic effect).

The prognosis for the treatment of the disease in most cases is favorable, but it is necessary to start therapy as early as possible, because otherwise the inflammatory process can move to the surrounding organs, which threatens to develop sepsis, or severely disrupt the contractile activity of the uterus.

The disease associated with inflammation of the mucous and muscular membrane of the uterus is called "metroendometritis". The cause of the disease is a septic infection that penetrates into the uterine cavity. It can be staphylococci, streptococci, gonococci, Escherichia coli. The acute form of the disease is accompanied by high fever, rapid pulse, cloudy discharge, swelling and soreness of the uterus.

Sometimes the inflammation spreads to the peritoneum and appendages, and sepsis may develop. The acute form of the disease requires immediate hospitalization. Treatment of the chronic course of the disease is carried out on an outpatient basis. Physiotherapy is usually used: electrophoresis, exposure to mud. Vitamins, hormonal and antiallergic drugs are also prescribed. For the treatment of chronic metroendometritis, folk remedies can also be used. There are a great many of them, and we will get acquainted with some of them.

1. In case of illness, douching of the vagina is carried out with a simple home remedy - an infusion of chamomile flowers and goose cinquefoil. This collection relieves inflammation and stops uterine bleeding. To prepare the infusion, herbs are mixed in equal proportions and take 1 tablespoon of the mixture, which is poured with one liter of boiling water.

2. The healing properties of a decoction of the collection of chamomile and linden flowers have been known for a long time. Plants are taken in a ratio of 3:2. Then 4 tablespoons of raw materials are brewed with a glass of boiling water. How to infuse - used externally for vaginal irrigation.

3. Very good results in treatment are given by douching with an infusion from a collection of medicinal plants, which includes: oak bark, chamomile flowers, nettle leaf, bird's mountaineer grass. They need to be taken in the following quantitative ratio: 1:3:3:5. All herbal ingredients are mixed and two tablespoons of the mixture are taken. This part of the collection is poured with one liter of boiling water and allowed to brew. Strained herbal extract can also be used for vaginal tampons.

4. Perfectly treats the chronic form of inflammation of the uterus collection, which includes: rosemary leaves, sage, yarrow, oak bark. In this collection, each plant is taken in one part, and the bark - two. Next, part of the collection - two spoons - is separated into a separate container and poured with one liter of boiling water. The extract is allowed to brew and used for vaginal douching and tampons. The infusion is a powerful anti-inflammatory and antiseptic.

5. Douching with an infusion of a collection of medicinal herbs, which includes: sage, black elderberry inflorescences, forest mallow flowers and oak bark, quickly relieves the inflammatory process in the uterus and stops the discharge. All plants are mixed in equal proportions. Take 7 full spoons of grass and pour 1 liter of boiling water over it. Douching is recommended twice a day.

6. Take three parts of willow bark and two parts of lime blossoms. Mix. Next, separate four tablespoons of this mixture and brew it in 250 milliliters of boiling water. After that, let the remedy brew for a quarter of an hour and then strain. Douching with this infusion is advised twice a day.

Means for oral use

With a disease of the uterus, one should be treated not only externally, but also take infusions or decoctions of herbs inside. For example, a decoction of St. John's wort has proven itself well in the treatment of metroendometritis with folk remedies. It is prepared as follows: one spoonful of raw materials is poured with 250 milliliters of boiling water. Then boil it for half an hour in a water bath, after which it is filtered and squeezed. Recommended dose: 50 milliliters three times a day.

Used for medicinal purposes with metroendometritis and plantain. It has hemostatic, anti-inflammatory, bactericidal properties. The high efficiency of the plant in restoring the mucous and muscular tissue of the uterus has long been noted.

One large spoon of grass is poured with 200 milliliters of boiling water. Let it brew for a quarter of an hour and filter. Recommended therapeutic dose: one tablespoon. It is important, when ingesting herbal infusion, to apply external medical procedures: douching, mud, tampons.

The disease will be cured if you apply alcohol tincture of calendula. It can be purchased at a pharmacy, but it is better to prepare it personally. To do this, 20 grams of plant flowers are poured with 100 milliliters of alcohol or moonshine. Let it brew for two weeks. Take orally 10 drops four times a day. This remedy restores the inflamed uterus and acts as a bactericidal drug.

3. It has high anti-inflammatory properties, improves blood circulation in the pelvis, significantly weakens or eliminates the symptoms of chronic metroendometritis collection of herbs: valerian (2 parts), cuff grass (3 parts), lemon balm leaves (2 parts) and dioica nettle (3 parts) . A mixture of herbs is mixed, take 2 tablespoons of it and pour 500 ml of boiling water. Recommended dose: 100 ml every 4 hours.

It is important to remember that the sooner the treatment of metroendometritis is started, the more chances there will be for a full recovery. To prevent the disease, you should take folk remedies, lead a healthy lifestyle, monitor your immunity and regularly visit a gynecologist.