Endometritis. Postpartum endometritis - treatment and symptoms. Homemade suppositories to treat symptoms of endometritis

Endometritis is inflammatory process in the tissues that line internal cavity uterus. The cause of the disease is the penetration into the uterine cavity of various infectious agents - fungi, bacteria and viruses. Often, endometritis occurs against the background of a general decrease in immunity.

At the beginning, the pathological process affects only the endometrium, but due to the special structure of the tissues, the inflammatory process quickly goes deep and affects the muscle tissue.

If left untreated, endometritis leads to adhesions inside the uterus and in the abdominal cavity, and can also cause inflammation in other areas. internal organs. In the absence of proper therapy, endometritis is often the cause of infertility, and may also be accompanied by the appearance of cysts.

Most often, endometritis affects women of reproductive age. If you suspect a disease, you should consult a gynecologist.

Types of endometritis

The form of endometritis is distinguished:

• spicy;
• chronic.

Symptoms, terms and methods of treatment in each of the cases are different. At the same time, chronic endometritis always develops against the background of an undertreated or acute disease without clearly expressed signs.

Causes of endometritis

The main cause of the inflammatory process is the entry of pathogenic viruses and bacteria into the uterine cavity, which, against the background of a decrease in immunity or a violation of the integrity of the endometrium, affect the mucous membrane of the uterine cavity.

Pathogenic microorganisms, infections and viruses can enter the uterus both ascending (through the cervical canal of the cervix) and downward path(from fallopian tubes, inflamed appendix, etc.).

Most common cause inflammation in the endometrium is mechanical damage inner lining of the uterus caused by naturally or surgical intervention. These include:

• abortions, including spontaneous ones;
• C-section;
• various gynecological manipulations in the uterine cavity;
• childbirth.

In all these cases, the endometrium lining the uterine cavity exfoliates from it in large pieces, exposing significant areas of the unprotected walls of the organ. Bacteria and infections transmitted through surgical instruments either naturally, are in favorable environment for their reproduction.

An acute form of endometritis, which, in addition to the classic picture of symptoms, is accompanied by purulent secretions from the vagina cause sexually transmitted diseases such as gonorrhea or chlamydia.

Also cause inflammation can:

• tuberculosis microbacteria;
• coli;
• protozoal infection;
• diphtheria bacillus;
• group B streptococci, etc.

The risks of endometritis are also present during normal menstruation. Blood, which, together with endometrial cells, is removed from the uterine cavity, has specific influence to the cervical canal. It temporarily changes the acidic environment of the uterine mucosa to an alkaline one, and after that it protective functions are significantly reduced. With improper hygiene, sexual intercourse and frequent use of tampons, the risk of bacteria entering the uterine cavity increases significantly.

For example, a tampon left in the vagina for more than 6 hours or overnight is a potential source of many bacteria that multiply rapidly in a warm and humid environment.

Intrauterine devices can also be a source of infection, incorrectly installed or in the uterus for more than the required period, they cause damage to the endometrium and can provoke an inflammatory process.

During endometritis, a woman may feel:

• pulling pains in the lower abdomen, radiating to the anus;
• general weakness;
• headache;
• repressed emotional condition or abrupt shifts moods.

Objective signs of endometritis

To the signs acute form endometritis include:

• increased body temperature, accompanied by chills and subsequent fever;
• nausea and vomiting;
• unusual vaginal discharge (with bad smell, with an admixture of pus, blood);
• soreness of the uterus on palpation, and its enlarged size.

With a chronic inflammatory process in the endometrium, the signs are less pronounced. The temperature may appear only occasionally for several days, but it is not high and can be easily confused with other ailments. Only a gynecologist can detect a disease with the help of a survey, examination, laboratory and instrumental research. Also, with endometritis, violations are often observed menstrual cycle- discharge changes character, they can become scarce or, on the contrary, abundant. Significantly increased period blood secretions after the end of the menstruation. Throughout the cycle, there are weak drawing pains lower abdomen.

With prolonged chronic endometritis, secondary infertility may occur.

In acute form from the moment of infection of the endometrium pathogenic bacteria and viruses before the clinical manifestations of the disease takes from 1.5 to 4 days. The fastest way to manifest itself is endometritis, provoked by surgical interventions. In chronic endometritis, the process can take several months.

Diagnosis of endometritis

Diagnostic methods

When a patient contacts a gynecologist, the first thing to do is to study the history of the disease, find out the number of pregnancies and childbirth, abortions and spontaneous miscarriages.

Gynecological examination is the next mandatory diagnostic item. On palpation, the doctor determines the size of the uterus, how different they are from the norm, and monitors the soreness of the reaction to the manipulations performed. Also during the examination, the doctor evaluates the nature of the vaginal discharge.

Acute endometritis is characterized by a sharply increased size of the uterus and severe pain. In chronic endometritis - the pain is weak, the uterus is slightly enlarged.

Laboratory diagnostics. The patient must submit general analysis blood. Increased rates leukocytes in the blood are the main marker of the presence of an inflammatory process in the body. Also, the number of leukocytes is counted in a smear from the vaginal mucosa and cervical canal.

To determine the type of bacteria that caused the inflammatory process, bacteriological examination of the vaginal microflora allows.

Chronic endometritis is much more difficult to determine, sometimes repeated sampling of material for bacteriological culture is required.

Additional diagnostic methods

Ultrasound helps to diagnose endometritis and distinguish it from other gynecological diseases. An experienced diagnostician using an ultrasound machine can identify:

• endometrial thickness;
• the presence of adhesions;
• changes in tissue echogenicity;
• remnants of the placenta or fetal egg;
• the presence of blood clots and pus.

During an ultrasound examination, it is possible to determine the presence of the spread of the inflammatory process to other organs of the reproductive system, for example, to the ovaries.

Hysteroscopy - endoscopic method diagnostics. During the procedure, the specialist carefully examines the mucous membrane of the uterine cavity. With endometritis, the inner lining of the uterus has a bright red color and a loose structure. It bleeds at the slightest touch of the walls of the uterus. The cavity may also contain blood clots.

During hysteroscopy, at the discretion of the specialist, a biopsy (taking material for histological examination) can be performed.

Treatment of endometritis

Methods of treatment of acute endometritis

Treatment acute endometritis is always carried out in a hospital, as the patient needs bed rest and constant monitoring by medical personnel.

Without waiting for bacteriological studies, antibiotics are prescribed a wide range actions. At this stage, it is necessary to eliminate the inflammatory process, preventing the spread of infection into the thickness of the uterine wall and to other organs.

Antibiotics are administered intravenously or intramuscularly for 7-10 days.

Also, with endometritis are prescribed:

• painkillers and antipyretics;
• antibacterial drugs local action, for example, vaginal suppositories;
• means that reduce the uterus;
• vitamins.

As part of the prevention of bleeding and to reduce the pronounced pain cold is applied to the lower abdomen.

The task of specialists during the treatment of endometritis is to prevent its transformation into a chronic form and prevent the occurrence of possible complications.

After liquidation acute process physiotherapeutic procedures are prescribed, which improve blood flow in the uterus and act as a prevention of the appearance of adhesions.

Treatment of chronic endometritis

Treatment chronic inflammation endometrium - the process is longer, but the stages of treatment are similar - antibiotic therapy is mandatory, after which hormonal drugs are prescribed. They are necessary to restore the functions of the endometrium and normalize the menstrual cycle.

An important step in the treatment is the elimination of the consequences chronic disease- adhesions in the uterine cavity, blockage and deformation of the fallopian tubes, etc.

Required for treatment chronic form inflammation of the endometrium are physiotherapeutic procedures. These include:

• electrophoresis;
• impulse ultrasonic waves;
• UHF, etc.

Inflammatory process in the inner mucous layer of the uterus - the endometrium. Often combined with inflammation of the muscular layer of the uterus - endomyometritis. The endometrium is the inner functional lining of the uterus that changes its structure throughout the menstrual cycle. Each cycle, it grows and matures anew, preparing for the attachment of a fertilized egg, and is rejected if pregnancy does not occur. Normally, the uterine cavity, lined with the endometrium, is reliably protected from infection. But at certain conditions infectious pathogens easily enter the uterus and cause an inflammatory reaction of its inner layer - endometritis.

• using vaginal tampons

By absorbing spotting, tampons are the optimal environment for the development of infection. Tampons should be changed every 4-6 hours, do not use them at night, before or after your period, in hot climates. Violation of the rules for using tampons can lead to the development of toxic shock syndrome.

• chronic stress, overwork and poor hygiene.

These factors weaken the body and make it at risk infections.

Diagnosis of endometritis

Diagnosis of acute endometritis is based on the collection of an anamnesis of the disease, patient complaints, symptoms, gynecological examination, clinical analysis blood and bacterioscopic examination of smears. Women with an acute form of endometritis are treated inpatiently, because there are potential danger development of severe septic complications (parametritis, pelvioperitonitis, peritonitis).

In the diagnosis of the chronic form of endometritis, in addition to clarifying the clinical symptoms and anamnesis of the disease, a special role belongs to the curettage of the uterine mucosa for diagnostic purposes. Histological examination altered endometrium allows confirming the diagnosis of chronic endometritis. important diagnostic methods are ultrasound (ultrasound) and endoscopic (hysteroscopy) studies that allow to identify structural changes in the endometrium.

Treatment of acute endometritis

In the acute phase of endometritis, patients are shown treatment in a hospital with bed rest, mental and physical rest, an easily digestible full-fledged diet, and a drinking regimen. basis drug treatment acute endometritis is antibiotic therapy, taking into account the sensitivity of the pathogen (amoxicillin, ampicillin, clindamycin, gentamicin, kanamycin, lincomycin, etc.). With a mixed microbial flora, a combination of several antibiotics is indicated. Due to the frequent attachment of anaerobic pathogens, metronidazole is included in the treatment regimen for acute endometritis.

In order to relieve intoxication, intravenous administration of saline and protein solutions up to 2-2.5 liters per day is indicated. It is advisable to include multivitamins, antihistamines, immunomodulators, probiotics, antifungals in the treatment regimen for acute endometritis. With analgesic, anti-inflammatory and hemostatic purposes, cold is applied to the abdomen (2 hours - cold, 30 minutes - break). When subsiding acute symptoms physiotherapy, hirudotherapy (medical leeches) are prescribed.

Treatment of chronic endometritis

In the treatment of chronic endometritis, modern gynecology uses A complex approach, including antimicrobial, immunomodulatory, restorative, physiotherapy treatment. Treatment is carried out in stages. The first step is the elimination of infectious agents, followed by a course aimed at restoring the endometrium. Broad-spectrum antibiotics (sparfloxacin, doxycycline, etc.) are usually used. The recovery course is based on a combination of hormonal (estradiol plus progesterone) and metabolic therapy (hemoderivate of calf blood, inosine, vitamin C, vitamin E).

Drugs can be injected directly into the lining of the uterus, which creates them increased concentration directly in the focus of inflammation and provides a high therapeutic effect. The relief of uterine bleeding is carried out by the appointment of hormones or a solution of aminocaproic acid (intravenously or intrauterine). An important place in the treatment of chronic endometritis is given to physiotherapy: UHF, electrophoresis of copper, zinc, lidase, iodine, pulsed ultrasound therapy, magnetotherapy. Physiotherapy treatment reduces inflammatory edema of the endometrium, activates blood circulation, stimulates immunological reactions. Patients with chronic endometritis are shown balneotherapy (mud therapy, hydrotherapy).

The effectiveness of the treatment of chronic endometritis is evaluated according to the following criteria:

• restoration of the morphological structure of the endometrium (according to the results of ultrasound)
• restoration of the menstrual cycle.
• elimination of infection
• disappearance of pathological symptoms (pain, bleeding)
• restoration of childbearing function

Complications and prevention of endometritis

The endometrium is an important functional layer of the uterus, responsible for providing normal flow pregnancy. Inflammatory diseases of the endometrium - endometritis - entail a complicated course of pregnancy: the threat of miscarriage, placental insufficiency, postpartum hemorrhage. Therefore, the management of pregnancy in a woman with endometritis should be carried out with increased attention.

The long-term consequences of endometritis are adhesive processes inside the uterus (intrauterine synechia), sclerosis of the uterine cavity, disrupted menstrual cycle, endometrial polyps and cysts. With endometritis, the ovaries and tubes may be involved in the inflammatory process, peritonitis, adhesions of the intestine and pelvic organs (adhesive disease) may develop. Adhesive disease is manifested by pain and often leads to infertility.

To avoid the occurrence of endometritis, it is necessary to prevent abortions, observe hygiene measures, especially in menstrual period, carry out prevention of postpartum and post-abortion infections, use barrier contraception(condoms) to prevent sexually transmitted infections. Early detection asymptomatic infections and their treatment in most cases gives a favorable prognosis for subsequent pregnancies and childbirth.

Endometritis is an inflammation of the mucous membrane of the uterus (endometrium), morphologically consisting of two layers - functional and basal. The first one is turned into the uterine cavity and consists of a single layer of cylindrical epithelial cells. Between them are glandular cells that produce protective mucus, and a large number of small branches of the spiral arteries. During each menstruation, the functional cell layer is destroyed and removed with blood and mucus, after which it is restored again from the cells of the basal layer in the first phase of the menstrual cycle.

Natural defense mechanisms such as anatomical features structures, protective mucus of the uterine cavity and cervical canal, containing immunoglobulins and antibodies, acidic environment vagina, microbiocinosis of these departments, local immune defense in most cases, they can prevent the development of infection in the genitals. With their disorder, in this particular case, acute or chronic endometritis develops, the manifestations of which depend on the severity of the inflammation reaction.

What it is?

Endometritis is inflammatory changes in the uterine mucosa after exposure to a septic infection or other pathogenic microorganisms. The inflammatory process in endometritis can be acute, accompanied by vivid symptoms, or it can proceed in a chronic, asymptomatic form. The development of chronic endometritis occurs due to untimely or incorrect treatment of an acute inflammatory process.

The reasons

The root cause of the formation of the disease is damage to the mucous membrane of the uterus, which contributes to the formation of the inflammatory process. But by itself, such a pathology cannot provoke endometritis. Important role this process is played by reduced immunity, non-compliance with sanitary standards when performing manipulations. In addition, the following common causes are distinguished:

• endoscopic diagnosis of the uterine cavity;
• installation intrauterine contraceptives;
• curettage of the uterine cavity;
• probing the uterine cavity;
• hysterosalpingography;
• careless douching.

Today, postpartum endometritis has become of particular importance. They are associated with the restructuring of the immune system female body. The inflammatory process very quickly affects the muscular layer of the uterus and serves as a dangerous complication. postpartum period.

Endometritis refers to polyetiological diseases, the occurrence of which is influenced by many pathogens:

• enterobacter;
• Proteus;
• chlamydia;
• group B streptococci;
• coli;
• klebsiella;
• diphtheria bacillus;
• tuberculosis mycobacterium.

Chronic endometritis occurs due to wrong therapy acute, as well as in the case when the infection settles in the tissues for a long time. The causative agents of the disease can be listed above.

Types and classification

The first and main classification is the division of endometritis into acute and chronic.

1. Acute endometritis is a problem that can even bring a woman to the operating table, and in advanced cases you can completely lose the uterus, since inflammation can lead to pelvioperitonitis.
2. Chronic endometritis is a sluggish disease, with periodic exacerbations and remissions, often associated with a cold snap and the course of the ovarian-menstrual cycle. Its treatment is long, and, most often, it is carried out in antenatal clinics, and on an outpatient basis. Only with exacerbations is hospitalization required in a specialized hospital - a gynecological department.
3. There is also an intermediate, subacute form.

The second classification is according to the nature of the inflammatory process. Endometritis is divided into:

• necrotic (with necrosis of the mucous layer);
• catarrhal (most easy stage inflammation);
• catarrhal - purulent (purulent process joins);
• purulent forms;
• gangrenous (with the addition of anaerobic flora, severe intoxication, the development of peritonitis).

The last two forms are very dangerous: the first is the development of scar tissue in the uterine cavity, even with a favorable outcome with the threat of infertility, and the second has high percent mortality even with emergency surgery.

There are other classifications - for example, postpartum endometritis, which most often develops with an unfavorable course of pregnancy in the third trimester and various obstetric benefits associated with high risk not so much for the fetus, but for the mother.

Symptoms of endometritis

Symptoms of the disease depend on many factors:

• aggressiveness of the pathogen;
• state of immunity;
• the age of the patient;
• predisposing conditions (endometritis is especially difficult against the background of the IUD, after a miscarriage or complicated childbirth);
• areas of damage to the uterine mucosa;
• the presence of concomitant gynecological pathology.

acute form

Most often occurs after childbirth and abortion. Symptoms appear 3-4 days after the infection enters the uterus. In acute endometritis, there is weakness, malaise, pain in the lower abdomen, increased heart rate, fever up to 38–38.5 ° C, enlargement and thickening of the uterus, and pain when palpated. The discharge is cloudy, copious, with a purulent smell. Possible uterine bleeding. AT severe cases pyometra (accumulation of pus in the uterus) may develop.

With improper or inadequate treatment, acute endometritis can become chronic.

Chronic form

It occurs as a result of sexually transmitted diseases, or against the background of acute endometritis. The chronic form may be latent and not have clinical manifestations - then the diagnosis is made on the basis of laboratory data.

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

1. Irregularity of menstruation, their duration.
2. A significant change in the number of discharges on "critical days".
3. Increased pain during menstruation.
4. Change in the color of menstrual flow to brown due to the addition of a purulent component.
5. Change in color and nature of the secret of the vagina and uterine cervix - it becomes yellow-green and / or foamy - as opposed to the normal transparent mucus.
6. Bleeding from the genitals can occur outside the menstrual period.

With this form of the disease, structural changes in the endometrium associated with malnutrition of tissues or the formation of cysts are observed. Therefore, in women with chronic endometritis, infertility or miscarriage is often found, since the fertilized egg cannot attach to the altered uterine lining.

Postpartum endometritis

Postpartum endometritis develops acutely in the first week after childbirth. It is most likely to occur in the case of manual examination of the uterine cavity, a long anhydrous period and after a caesarean section. According to the severity of the course, postpartum endometritis can be:

1. Mild - symptoms appear from 5 to 12 days after birth. The general condition of the woman suffers little, the body temperature rises to 37-38 degrees C. Vaginal discharge (lochia) long time are bloody. The uterus is slightly enlarged, slightly painful on palpation.
2. Moderate severity - manifestations occur on the 2-7th day of the postpartum period. Body temperature rises to 38-39 degrees C, general state women are getting worse. Disturbed by weakness, aching muscles, pain in the lower abdomen. Lochia are bloody, purulent and smell unpleasant. The uterus is enlarged, palpation causes pain.
3. Severe - signs appear 2-3 days after birth. The body temperature rises to 39-40 degrees C, the general condition of the woman suffers greatly. She is worried about severe weakness, headache, lack of appetite, sleep disturbance. Urine becomes the color of dark beer, its excretion is reduced. The pains in the lower abdomen are intense, palpation of the uterus intensifies them. Lochia purulent with a putrid odor.

Consequences of the disease

The most formidable complications of endometritis include the spread of infection: hematogenous - through the blood; lymphogenous - lymph; ascending - through the fallopian tubes and descending - the cervix, vagina.

This leads to "blood poisoning" - sepsis. Other complications include:

• chronization and outcome in chronic endometritis;
• process connection fallopian tubes and appendages - and oophoritis;
• pelvioperitonitis - as a result of pus entering the pelvic cavity;
• the formation of pyometra - the accumulation of pus in the uterine cavity, due to occlusion (obstruction of the cervix and the inability of pus to come out).

To late complications that occur with inadequate treatment include:

• violation of the menstrual cycle;
• infertility;
• constant pain in the lower abdomen.

This list of complications is not exhaustive, since the inflammatory process can be the cause of any pathology that may emerge later. Therefore, early treatment and adequate treatment play a significant role in preventing the development of severe complications.

Is pregnancy possible?

Despite the severity of the disease, endometritis does not exclude the possibility of conception and subsequent progression of pregnancy. Undoubtedly, in many cases of a chronic process, pregnancy becomes an unrealizable dream, but with the desire and certain efforts, this dream can not only be brought closer, but also realized.

Chronization of the process leads to a decrease in the area of ​​the normal, that is, healthy endometrium, which is necessary for the implantation of a fertilized egg and its support in further development. After all, it is the normally functioning uterine mucosa that is able to grow by the end of the 2nd phase of the cycle, that is, to prepare the so-called “featherbed” for receiving the future embryo and, after the introduction of the zygote, provide it with all the necessary nutrients in the initial stages of development.

Chronic endometritis does not exclude the possibility of fertilization (with existing ovulation), but pregnancy (in this case we are talking about biochemical pregnancy, when fertilization has occurred, but implantation has not yet) is interrupted at the stage of introduction of the zygote into the uterine mucosa. Most women are unaware that they have had a miscarriage for a very long time. early term, clinically it looks like a slightly late period.

But even with successful implantation, pregnancy is often interrupted in the first trimester, and miscarriages regularly recur (recurrent miscarriage). If, in spite of everything, the pregnancy continues to develop, then the process itself is accompanied by numerous complications, from the permanent threat of interruption to the birth of a child with growth retardation until his death (during pregnancy, childbirth or shortly after them).

In the case of an acute process, it is pointless to talk about pregnancy until adequate treatment has been completed. But is it possible to get pregnant with chronic endometritis? In order not to frighten women right away, the answer is positive: “yes, pregnancy is quite possible.” But what is needed for this?

First, approach pregnancy consciously, which means thinking about the problem at the planning stage. You need to visit a gynecologist and related specialists according to indications, start leading healthy lifestyle life, give up bad habits(this also applies to the spouse), take vitamins and undergo an examination. The minimum examination includes the delivery of gynecological smears, ultrasound of the small pelvis, tests for latent sexual infections, and in some cases, tests for hormones.

Upon confirmation of the diagnosis of chronic endometritis, and even more so when hidden sexual infections are detected, the gynecologist will prescribe treatment. The therapeutic course is very long, but it is important to go through it to the end. First of all, antibiotics are prescribed depending on the sensitivity of the isolated pathogen. At the second stage of endometritis treatment, physiotherapy, immunomodulators, vitamins, proteolytic drugs, and in some cases oral contraceptives. Hormonal contraceptives necessary to restore the cyclic change of the functional layer of the endometrium.

After successful treatment of endometritis future mom again undergoes an examination, in particular, an ultrasound of the small pelvis, on which she is confirmed with inactive endometritis, when the disease is in remission, and "give the go-ahead" to try to get pregnant.

Diagnosis of endometritis

In the diagnosis of endometritis, an important role is played by the collection of anamnesis - the regularity of the menstrual cycle, the presence in the history of the patient intrauterine interventions, use of intrauterine contraceptives, cases unprotected sex with a casual partner.

During a physical examination, the following signs of endometritis may be detected:

• an increase in the size of the uterus,
• organ seal,
• special sensitivity of the side walls of the organ during palpation.

AT laboratory tests the blood of patients with symptoms of acute endometritis is diagnosed with leukocytosis, an increase in the level of ESR and C-reactive protein indicating inflammation in the body. An important role in the diagnosis of acute and chronic endometritis is also played by microscopy of the vaginal smear. To confirm the signs of endometritis, ultrasound of the pelvic organs and a histological examination of the scraping of the endometrium of the uterus are additionally used.

Treatment of endometritis in acute form

The acute stage of the disease is treated in stationary conditions, while showing bed rest, absolute rest and balanced diet in compliance with the drinking regime.

The leading role in the treatment of the disease is played by antibiotic treatment(the sensitivity of the pathogen to certain antibiotics is preliminarily determined). Most often, Amoxicillin, Kanamycin, Clindamycin, Gentamicin, Ampicillin, Lincomycin, etc. are prescribed. May be observed combined treatment multiple antibiotics in cases of mixed microbial infection. Often against the backdrop of joining anaerobic infections therapy includes metronidazole.

To eliminate severe intoxication, intravenous administration of solutions of salts and proteins up to 2.5 liters per day is recommended. Treatment also includes antihistamines, antifungals, multivitamin complexes, immunomodulators, probiotics. To relieve pain and inflammation, as well as to stop bleeding, cold is applied to the stomach (two hours, half an hour break). After loosening and removing acute manifestations diseases in therapy include physiotherapy and hirudotherapy (leeches).

Treatment of chronic endometritis

Therapy of chronic endometritis does not have specific schemes, it consists of a complex medical measures aimed at eliminating the existing sluggish inflammation, restoring the proper function of the endometrium and eliminating associated complications.

1. Antibacterial therapy, by analogy with the treatment of acute inflammation, is used after bacteriological research. Infection in chronic endometritis penetrates into the underlying structures, so more effective way treatment is the introduction of antibiotics directly into the mucous layer.
2. Symptomatic therapy helps to improve blood circulation in the pelvic cavity, accelerate the healing of damaged endometrium and increase immunity.

In the presence of prolonged sluggish inflammation in the uterus against the background of improper healing of the endometrium, adhesions are formed. As a rule, they are discovered at the stage diagnostic hysteroscopy and dissect. Physiotherapy is also successfully used to treat chronic endometritis. Medicinal electrophoresis, UHF therapy, pulsed ultrasonic waves and many other methods are used. Therapeutic mud, radon baths, ozocerite, paraffin are effective.

Volume therapeutic measures in chronic endometritis always depends on the nature of menstrual and generative disorders. The restoration of a normal two-phase cycle is an indicator of the effectiveness of the ongoing hormonal correction. Combined hormonal drugs in a cyclic rhythm help eliminate hormonal dysfunction.

As a rule, infertility in chronic endometritis is associated with pathological changes in the fallopian tubes. If the infection during acute inflammation in the uterus was able to rise higher, it provokes inflammation of the uterine tubes, leading to their deformation and blockage. After appropriate treatment, the patency of the tubes is restored, and the patient has the opportunity to become pregnant.

What is the difference between endometritis and endometriosis?

Endometritis and are two individual diseases, which differ in the cause of occurrence, the mechanism of development and approaches to treatment.

Migration and proliferation of endometrial tissue in various areas is observed human body. AT normal conditions the endometrium is present only in the uterine cavity and is represented by two layers - functional and basal, which change depending on the phase of the menstrual cycle. Under the action of hormones (progesterone and estrogens), the endometrium is prepared for implantation of the embryo (the growth of the functional layer is observed, the appearance of a large number of glands, and so on). If pregnancy does not occur, the concentration of estrogens and progesterone in the blood decreases, which leads to rejection of the functional layer of the endometrium, that is, to menstruation, after which its gradual recovery begins (due to the basal layer).

With endometriosis, endometrial cells can be located in almost any organ (however, usually these are the walls of the uterus and pelvic organs - bladder, ovaries, etc.). They are subject to the same cyclical changes, as the endometrium in the uterine cavity (that is, they grow under the action of sex hormones), which will cause clinical picture diseases.

Prevention

Measures to prevent endometritis include the following:

1. Compliance with intimate hygiene.
2. Timely change intrauterine tampons.
3. Timely treatment of any infectious diseases, especially the reproductive system.
4. The practice of protected sexual intercourse will protect the uterus from the ingress of pathogenic microorganisms.
5. Prophylactic antibiotics after an abortion, caesarean section or other complex medical manipulations.
6. Mandatory full examination after childbirth will allow to bring out the endometritis on early stages which will make treatment much easier.
7. Periodic observation by a gynecologist. Also, contraceptive methods should be discussed with this specialist, especially when using intrauterine devices.

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

Chronic endometritis - chronic illness inflammatory nature affecting the inner layer of the uterus. It is caused by various infectious agents - viruses and bacteria. Such a disease is very dangerous for a woman's health, because due to its progression in the genital organ, the processes of growth and rejection of the endometrium are disrupted. This, in turn, leads to menstrual irregularities, uterine bleeding, miscarriage, and infertility. But if the pathology is diagnosed in time and cured, then the work of the female genital organs will normalize and it will be possible to become pregnant.

The uterine cavity should normally be sterile - it should not contain various infectious agents (this necessary condition for pregnancy). In the vagina, on the contrary, there are quite a lot of bacteria. Between these organs is the cervix, which prevents bacteria from the vagina from entering the uterus. If, for any reason, infectious agents penetrate the reproductive organ, acute or chronic inflammation of the endometrium immediately begins to progress. The consequences of such pathological process, if left untreated, can be deplorable.

Typically, chronic endometritis is diagnosed in women who are of reproductive age and are actively sexual life. But it is also worth noting that the pathology can begin to develop in those of the fair sex who do not have sexual intercourse.

An increased risk of progression of chronic endometritis is observed:

• after endometrial biopsy;
• after a miscarriage or medical abortion;
• after diagnostic curettage;
• in women who have installed an IUD;
• if available or ;
• in women who have already had a pregnancy, and after childbirth they had complications of an infectious nature (for example, postpartum endometritis);
• in the presence of a history of STDs:, and so on;
• in the presence of chronic inflammation of the cervix. Due to inflammation, this area cannot fully perform its functions and prevent the penetration of microbes from the vagina into the uterus;
• in the presence of polyps in the reproductive organ.

It should be noted that in almost 1/3 of women, doctors cannot establish true reason progression of chronic endometritis.

Etiology

As mentioned above, chronic endometritis is provoked by infectious agents penetrating the uterine cavity. Most often, inflammation of the endometrium occurs due to pathological activity:

• gonococci;
• treponema;
• genital herpes virus;
• fungus from the genus Candida;
• chlamydia;
• ureaplasma;
• mycoplasmas;
• Koch sticks.

Recently, doctors are increasingly diagnosing chronic endometritis in patients, which provokes not one type of microorganisms, but several.

Sometimes pathology can occur due to and. These microorganisms are classified as conditionally pathogenic, since they can live in the human body for a long time and still not cause any changes. But due to some reasons (decrease in the reactivity of the body, the presence of foci of infection, etc.), they can become more active and provoke inflammation of the endometrium.

Symptoms

Chronic endometritis is quite insidious disease, as for a long time it may not give absolutely no symptoms. Most often, the symptoms are so mild that the woman herself may not pay attention to them.

Symptoms of the disease:

• aching pain in the lower abdomen, which often occurs with physical activity, but their appearance at rest is not excluded. We can say that this is not a characteristic symptom, since it can also indicate other diseases of the female reproductive system;
• pain during sexual contact;
• vaginal discharge. They can be brown, yellow-green and transparent. Color largely depends on the causative agent of the pathology;
• cycle disturbances. This symptom worries women most of all, and it is after its manifestation that the majority go to the doctor. Periods may be absent or irregular. It is not excluded the appearance of bloody discharge from the vagina in the middle of the cycle. Pregnancy does not occur.

Signs of chronic endometritis usually appear gradually. First there is pain in the abdomen and during sex. Later, all these symptoms join. You should not hesitate and immediately go to the doctor for consultation and diagnosis, since the pathology is very dangerous and if it is not cured, then you may not get pregnant in the future.

Endometritis and pregnancy

Chronic endometritis is a pathology that can become a serious obstacle to long-awaited pregnancy. The thing is that microorganisms that have penetrated into the cavity reproductive organ cause inflammation of the endometrium. Inflamed tissues cannot serve as a "platform" for the implantation of a fertilized egg. Also, the affected endometrium can simply reject an already attached embryo. But don't immediately think that chronic endometriosis- it's a sentence. You can get pregnant, but only if you first cure the disease.

If you do not start treating the pathology in a timely manner, then the chances of a possible pregnancy are significantly reduced (up to). It will also see:

• IVF inefficiency (even with this method, pregnancy does not occur);
• habitual miscarriage. Pregnancy occurs, but the affected endometrium itself rejects the embryo.

Diagnostics

If symptoms appear that indicate a possible progression of chronic endometritis, it is necessary to contact a gynecologist as soon as possible to confirm or refute the diagnosis. To this end, the following is carried out:

• Ultrasound of the uterus and its appendages;

To clarify the cause of the development of the disease, as well as to identify the true pathogen, the following diagnostic methods are prescribed:

• sowing material that was obtained during hysteroscopy;
• PCR diagnostics;
• flora smear.

If a woman cannot become pregnant for a long time, then she is also prescribed to take a blood test to determine the concentration of hormones.

Treatment

Treatment of chronic endometritis should begin as soon as the doctor has made an accurate diagnosis. The treatment plan is developed taking into account the severity of the course of the disease and the characteristics of the patient's body. The standard treatment plan includes:

• antibiotics;
• antiviral;
• vitamins;
• proteolytics;
• means that normalize microcirculation;
• hormonal agents.

In order to reduce unpleasant symptoms, the patient is also prescribed physiotherapy. Special attention doctors give hormonal drugs, as they allow you to normalize the menstrual cycle. Accept funds for 3-6 months. It is worth noting that after stopping the medication, a woman can become pregnant. This happens against the backdrop of a "withdrawal syndrome."

Pregnancy can begin to be planned only after the woman has completed a full course of treatment for the disease and all her symptoms have disappeared. It is worth noting that after its completion, the doctor necessarily prescribes repeated examinations - a biopsy, an ultrasound scan and a smear.

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Diseases with similar symptoms:

Polyposis is a disease characterized by the appearance of multiple benign neoplasms in different bodies. Most often, polyps form in the nasal passages, in the stomach and intestines, as well as in the uterus and ovaries. There are circumstances in which these benign formations can degenerate into cancer, posing a threat to human life. In particular, this variety includes familial adenomatous polyposis (often transmitted from parents to their children).

Among the diseases in women, chronic endometritis is especially common, which develops as a result of untreated acute stage inflammation of the endometrium, i.e. the functional lining of the uterus. This very serious gynecological pathology, which may lead to dangerous complications on the organs and muscles of the peritoneum. Knowing clinical symptoms chronic endometritis, you can suspect the disease in time.

What is chronic endometritis

If you speak to accessible language, then it is called gynecological disease chronic nature that affects the inner layer of the uterus. Infections can be caused by bacteria or viruses. As a result of the activity of these microorganisms, there is a violation of the rejection and growth of the endometrium. The result is uterine bleeding, failure of the menstrual cycle, miscarriages. Endometritis is the cause of infertility. The disease can be atrophic, cystic and hypertrophic.

Symptoms

The danger of the disease lies in the fact that it can for a long time don't show yourself. If chronic inactive endometritis is manifested by symptoms, then they are not so pronounced. The main features are:

• aching pelvic pain in the lower abdomen;
• vaginal discharge yellow-green, brown or transparent, depending on the type of pathogen;
• pain during intercourse;
• violation of the phases of the menstruation cycle;
• rise in temperature to 38 degrees.

Allocations

The consistency, color, and amount of discharge may vary from woman to woman. it main feature sluggish endometritis. Patients have purulent or mucopurulent discharge. At purulent endometritis they are accompanied by an unpleasant odor. Due to the rejection of the uterine mucosa and its slow recovery, an admixture of blood may be observed in the secretions. The ichor against the background of the chronic stage of this disease persists for a long time.

Menstruation with endometritis

Another feature the development of endometritis in a woman - a violation of the menstrual cycle. It can manifest itself in different ways:

• metrorrhagia - uterine bleeding;
• hyperpolymenorrhea - an increase or lengthening of the volume of menstrual flow;
• spotting discharge on the eve of menstruation.

echo signs

This is the name of a complex of pathological changes that are found in the uterine cavity during an ultrasound examination (ultrasound). Using this procedure, you can study the size and position of the genital organ, the state of the uterine cavity and the internal surface. Ultrasound signs of chronic endometritis are as follows:

• bending the body of the uterus back - retroversion;
• enlarged or reduced size of the uterus;
• decrease or increase in the thickness of the endometrium, the formation of cavities in it;
• accumulations of gas;
• the appearance of areas of sclerosis, fibrosis or calcification;
• heterogeneous surface of the myometrium;
• adhesions in the uterine cavity, which are visualized as hyperechoic areas.

The reasons

There are many factors that can lead to endometritis flowing into a chronic form. They are divided into specific (viruses and bacteria) and non-specific, associated with endometrial injuries. In general, the causes of the development of this inflammatory disease are:

• intrauterine manipulations in the form of scraping of the mucosa;
• improper douching;
• birth trauma membranes of the cervix;
• use of intrauterine contraceptives;
• use of vaginal tampons;
• foci of sexually transmitted infections;
• reception hormonal contraceptives;
• autoimmune pathologies, decreased local immunity;
• damage to the mucosa when probing the uterus;
• sexual intercourse during menstruation;
• remnants of the placenta, decidual tissue, blood clots or fetal egg (causes of postpartum endometritis).

Exacerbation of chronic endometritis

The disease begins with acute endometritis and only then flows into a chronic form. It is characterized by less severe symptoms, which do not cause discomfort to a woman, but the ailment during this period develops and affects genitourinary system. Sometimes there is an exacerbation of endometritis. It is characterized by an increase in all the symptoms described above. Signs appear abruptly, and against their background it may even open heavy bleeding.

Is it possible to get pregnant with chronic endometritis

On the early stages reproductive functions are still in a satisfactory condition. Depending on the activity of the immune system and the infectious agent, the adequacy of therapy, pregnancy at this stage is possible, but most patients experience postpartum complications and even miscarriages. With treatment, the chances increase significantly, but after conception, the expectant mother is under the constant supervision of doctors. If endometritis is not treated, then even the IVF procedure will not help to carry the pregnancy.

Diagnostics

When characteristic symptoms chronic endometritis, you must immediately contact a gynecologist to confirm the diagnosis. To this end, the following studies are being carried out:

• hysteroscopy;
• examination by palpation, ultrasound of the uterus and its appendages;
• sowing material taken during hysteroscopy to determine infectious agent;
• smear from the vagina on the flora;
• a blood test for the concentration of hormones;
• general urine analysis.

Treatment of chronic endometritis

Therapy of chronic endometritis can be started only after confirmation of the diagnosis. The treatment regimen for the patient is prescribed by the doctor, taking into account the severity of the disease and individual features organism. In general, therapy is carried out in 3 stages:

1. Elimination of infection of the endometrium, for which broad-spectrum antibiotics are used.
2. Restoration of the immune system through hepatoprotective, enzymatic, metabolic, immunomodulatory and microcirculation-improving agents.
3. Regeneration of the structure of the endometrium. At this stage, the main role is played by physiotherapeutic methods - mud therapy, magnetotherapy, laser therapy, plasmaphoresis, iontophoresis with zinc or copper. Additionally, the hormones estrogen and progesterone are prescribed.

Medications

In the treatment of chronic endometritis, drugs from several groups are used at once. They are prescribed only by a doctor, taking into account the causative agent of the disease and the nature of the course of the pathology. These may include the following medications:

1. Broad spectrum antibiotics. After identifying the causative agent of the infection, the doctor prescribes drugs from this group. If the disease was provoked by chlamydia, then it can be treated with Doxycycline, viruses with Acyclovir, fungi with Flucostat.
2. anti-inflammatory solutions. They provide high concentration antiseptic and antibacterial drugs at the site of inflammation. For this purpose, solutions of Furacilin, Dimexidum, Chlorhexidine, Novocaine, Calendula, Lidaz and Longidaz are used. They are used in washing courses of 3-5 procedures.
3. metabolic drugs. In this group, aloe extract, Actovegin and the vitreous body stand out. They contribute to the regeneration of the endometrium and stimulation of local immunity.
4. Hormonal preparations. Necessary for reduced ovarian function to restore the cyclic change of the endometrium, eliminate intermenstrual bleeding and normalize the menstrual cycle.

Antibiotics

Treatment of chronic endometritis with antibiotics is often prescribed in the form of droppers, therefore it is carried out in a hospital. The drugs are administered intravenously 2 times a day. Treatment begins on the 1st day of menstruation and lasts about 5-10 days. For antibiotic therapy are used the following drugs:

1. Ceftriaxone. Based on the active ingredient of the same name, it belongs to the group of cephalosporins. It is active against staphylococcus and streptococcus and a number of aerobic gram-negative bacteria. The downside is a large number of side reactions.
2. Metronidazole. Belongs to the category of antibiotics with high anaerobic activity. The advantage is the release in all possible forms, even in the form of a vaginal gel. Its bioavailability is 2 times higher compared to tablets. It has few contraindications, but a large list of side effects.

hormone therapy

The goal of hormonal drugs is to restore normal monthly cycle. Their therapy necessarily takes into account the age of the patient and the severity of the disease. Equally important is how severe the violations are. hormonal background. To restore it, the following drugs are prescribed:

1. Duphaston. Active ingredient is didyrogesterone - an analogue of natural progesterone. The advantage of the drug is that it does not affect liver function and metabolic processes in the body. The downside is a large list of negative reactions.
2. Utrozhestan. Another hormonal drug based on progesterone. The medicine is very quickly absorbed already 1 hour after ingestion, stimulating the restoration of the uterine mucosa. The downside is bad reviews about taking this remedy in the form of capsules - they have many side effects.

Treatment with folk remedies

Along with drug treatment endometritis, you can use some folk remedies. The following recipes are effective:

1. In equal proportions, take cherry and nettle leaves, pine buds, wormwood grass, sweet clover, cudweed, lavender, marshmallow and leuzea roots. After grinding 2 tbsp. raw materials pour 0.5 liters of boiling water, insist in a thermos for 12 hours. Use the product 1/3 cup up to 3-5 times a day for 2 months.
2. Take 1 tbsp. chopped St. John's wort, brew a glass of boiling water and boil for 15 minutes. Cool the broth, strain and drink 1/4 tbsp. up to 3 times during the day. Treat endometritis with this remedy for 4-6 weeks.

Prevention

The main preventive measure is timely complex treatment any disease of the reproductive system. For this purpose it is necessary:

• Follow your doctor's advice when using as a contraceptive intrauterine device;
• adhere to the rules of intimate hygiene;
• refuse abortion;
• use barrier contraception in the form of condoms to avoid sexual infections;
• to prevent postpartum infections.

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