Endometritis: causes, symptoms and treatments. Causes of sluggish endometritis and its symptoms. Medical treatment consists of two stages

Chronic endometritis - chronic illness inflammatory, damaging the inner layer 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 a violation menstrual cycle, 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 genital organ, acute or chronic inflammation endometrium. 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.

Increased risk of progression chronic endometritis 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 is worth noting that in almost 1/3 of women, doctors cannot establish the true cause of the 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.

AT recent times 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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Answer only if you have proven medical knowledge

Diseases with similar symptoms:

Polyposis is a disease characterized by the appearance of multiple benign neoplasms in different organs. 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).

Chronic inflammation of the endometrial tissue (endometritis) is a serious medical problem. Up to 90% of all patients are patients reproductive age. Difficulties in the diagnosis and treatment of pathology are due to the latent course of the disease without a pronounced clinical picture, low information content of available diagnostic methods, absence effective prevention after uterine manipulation. Inflammation of the endometrium is common cause violations of the fertilization process.

The frequency of detection of chronic endometritis in violations of the reproductive function:

with infertility - 68%;
at unsuccessful attempts IVF - 60%;
with habitual miscarriage - up to 70%.

Endometrium is the integumentary tissue that lines the uterine cavity. The tissue has a mucous nature and is abundantly supplied with blood vessels. It partially exfoliates during menstruation, and if pregnancy occurs, it retains the fetal egg and subsequently forms the placenta. Inflammatory processes of the endometrium lead to the development of many gynecological pathologies and are difficult to treat. During many years of research, generally accepted schemes for managing patients with this diagnosis have not been developed.

If the question arose: Endometritis of the uterus - what is it? That answer in an accessible language is inflammation of its inner shell.

Inflammation of the endometrium is classified according to morphological features process: atrophic, cystic, hypertrophic. It has been proven that chronic endometritis is a consequence of the acute phase of the pathology, which has not been completely cured.

Separately, postpartum endometritis is isolated. The cause of the complication is infection of the uterine mucosa with pathogenic microorganisms: Klebsiella, Proteus, staphylococci, streptococci, enterococci and enteropathogenic Escherichia coli. Microorganisms enter the uterine cavity in the following ways:

ascending from the external genitalia;
hematogenous or lymphogenous - during the migration of microorganisms from the foci chronic infection;
intra-amniotic - with invasive interventions on the uterus during gestation (puncture of the placenta, umbilical cord, amniotic cavity).

Important to remember! AT postpartum period the woman should be under medical supervision. Even if the birth took place outside medical institution, the woman in labor is delivered to the maternity hospital.

There are risk factors for the development of postpartum inflammation of the uterine mucosa. These include: slowing down the reverse development of uterine tissues (involution), difficult childbirth, incomplete isolation of lochia, early discharge of water and a long anhydrous period, injury to the birth canal. Endometritis after childbirth often occurs as a result of surgery C-section. Pathology develops in 20% of women after operative delivery. At natural childbirth this figure is reduced to 5%.

Reasons for the development of endometritis

There are a number of reasons that provoke the development of the disease in women:

early onset of sexual activity;
focus of chronic infection in the body;
reproduction pathogenic microorganisms in the pelvic organs;
usage intrauterine device over a long period of time;
diagnostic manipulations on the uterine cavity: (curettage, hysteroscopy, aspiration biopsy);
health care in conception (insemination, IVF);
complication of the postpartum period;
artificial termination of pregnancy.

Etiology and pathogenesis

Normally, the uterine cavity is sterile. Microorganisms multiply in the vagina, which make up the normal or pathological microflora this body. If the infection migrates from the vagina through the cervix to the uterus, it develops inflammatory process. The answer to the question of what endometritis is and what it develops from implies an indication of infection of the normally sterile uterine cavity.

The main feature of pathogenesis is the undulating, aggravating nature of the disease. Are formed inflammatory infiltrates, which consist of lymphoid elements and are located around the glands and blood vessels. In the focus of inflammation, enzymes are produced that change normal structure endometrium. Intoxication with endogenous bacterial toxin leads to the development oxidative stress, to overproduction free radicals, which damage the cell membrane and increase its permeability. The phagocytic activity of neutrophils and the content of all classes of immunoglobulins in the blood serum decrease, which weakens the protective function and further aggravates the process.

Symptoms and signs of chronic endometritis

If a woman has a history of chronic endometritis, the symptoms and treatment depend on the degree of neglect of the process. The chronic course of the disease has a hidden, erased symptomatology. If a woman experiences slight discomfort and does not consult a doctor, she may not be aware that she has endometritis.

Important to remember! A woman needs to regularly undergo medical examination and examination by a gynecologist.

The main symptoms of pathology:

menstrual disorders: irregularity and soreness of "critical days", abundant and prolonged discharge, spotting in the middle of the cycle;
increased subfebrile temperature body;
weakness, fatigue;
pain during intercourse and physical activity;
purulent and putrid discharge from the genital tract.

Diagnosis of the disease

signs this disease are not specific, they are also characteristic of other pathologies of the female reproductive organs.

For differential diagnosis diseases use the following methods:

A bimanual examination reveals an increase in the uterus and the pain of the procedure itself for a woman.
Laboratory research methods. In the general analysis of blood, ESR and the specific number of leukocytes may increase. A smear from the vagina to determine the degree of purity has inflammatory character 3 or 4 degrees.
Ultrasound reveals pathological changes in the organs of the female reproductive system: changes in size and shape, the presence of infiltrates, postpartum complications in the form of pieces of the placenta.
In difficult cases, an aspiration biopsy is used, which is carried out in outpatient settings. A piece of tissue taken from the uterine cavity is sent for histochemical analysis, the result of which is necessary for the differential diagnosis of the disease and the exclusion of oncological growth.
As helper methods echography and probing are used.

Modern methods of treatment

It's important to know! For complete cure endometritis is required to reconsider their habits and lifestyle. Immunity strengthening and expansion internal reserves body will help a woman cope with the disease.

Treatment of chronic inflammation of the endometrium is a long and complex process, it takes place in several stages. Removed at stage 1 infectious agent pathologies, for this purpose, antibacterial and antimicrobial drugs are used, which are often injected locally into the uterine cavity. Further efforts are aimed at restoring the endometrium. On the final stage eliminate reproductive disorders. For these purposes, a course of metabolic and hormonal drugs is prescribed. When the disease shows physiotherapy.

After the course drug therapy shown Spa treatment, in particular, balneotherapy and mud therapy. Procedures will eliminate residual effects after the inflammatory process, activate the cellular and humoral immunity, start regeneration processes in the uterine cavity, remove nervous tension and relax the body.

Phytotherapy has a positive effect. For 2 - 3 months they use herbal tea and put microclysters. Also, with endometritis, the following are effective medicinal herbs: thyme, mint, shepherd's purse, chamomile, marshmallow, lavender, sweet clover, wormwood, upland uterus.

Important advice! Since the cause of this disease may be the multiplication of pathogenic microorganisms, her sexual partner should be tested for STDs and treated if necessary.

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. With 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 on the background chronic stage 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 - increase or lengthening of the volume menstrual flow;
spotting discharge on the eve of menstruation.

echo signs

This is what the complex is called. pathological changes, which 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 condition of the uterine cavity and inner 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 reasons for 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;
usage 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 placenta, decidua, blood clots, or gestational sac(causes of postpartum endometritis).

Exacerbation of chronic endometritis

The disease starts with acute endometritis and only then flows into a chronic form. It is characterized by less pronounced symptoms that 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

In the early stages of the disease, reproductive functions are still in a satisfactory condition. Depending on activity immune system and an 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 future mom is under constant medical supervision. If endometritis is not treated, then even the IVF procedure will not help to carry the pregnancy.

Diagnostics

When characteristic symptoms endometritis chronic form it is necessary to 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 the infectious agent;
smear from the vagina on the flora;
a blood test for the concentration of hormones;
general analysis urine.

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 characteristics organism. In general, therapy is carried out in 3 stages:

Elimination of infection of the endometrium, for which antibiotics are used a wide range actions.
Restoration of the immune system through hepatoprotective, enzymatic, metabolic, immunomodulatory and microcirculation-improving agents.
Regeneration of the structure of the endometrium. At this stage leading role physiotherapeutic methods play - 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:

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.
anti-inflammatory solutions. They provide high concentration antiseptic and antibacterial drugs in the focus 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.
metabolic drugs. In this group, aloe extract, Actovegin and vitreous body. They contribute to the regeneration of the endometrium and stimulation of local immunity.
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:

Ceftriaxone. Based on the active ingredient of the same name, it belongs to the group of cephalosporins. Active against staphylococcus and streptococcus and a number of aerobic gram-negative bacteria. The downside is a large number of adverse reactions.
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. Has few contraindications, but big list 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:

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 the long list. negative reactions.
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 of endometritis, you can use some folk remedies. The following recipes are effective:

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.
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 the doctor's recommendations when using an intrauterine device as a contraceptive;
To follow the rules intimate hygiene;
refuse abortion;
use barrier contraception in the form of condoms to avoid sexual infections;
to prevent postpartum infections.

Video

Chronic endometritis develops against the background of undertreated acute form pathology. Diagnosed quite often. Occurs most often in women childbearing age. It is characterized by periods of exacerbation and remission.

Chronic endometritis is an inflammatory process, the area of localization of which becomes the basal layer of the endometrium. Pathology is caused by the penetration of fungi, bacteria, viruses into it.

How does it manifest itself

The clinical picture is poorly expressed. Accompanying condition constant weakness attributed to fatigue, so the woman is in no hurry to see a specialist.

During the period of exacerbation, the disease manifests itself in such conditions as:

scanty / heavy menstrual flow, intermenstrual spotting, delays;
pain during frictions;
the appearance of unpleasantly smelling discharge, the presence of purulent inclusions is not excluded;
fast fatiguability;
fever, chills;
habitual miscarriage;
pain in the projection of the uterus.

There are also ultrasound signs of the disease. It:

thickening of endometrial tissues on the 5th - 8th day of the cycle reaches 6 - 7 mm at a rate of no more than 3 - 4 mm;
premature thinning of the mucosa;
the presence of hyperechoic inclusions in the lower endometrial layer;
diffuse / focal formations in the myometrium;
pathological expansion of the veins of the uterus;
violation of blood flow (determined by dopplerometry).

Symptoms

With chronic inflammation, there are no signs of an acute form. Symptoms chronic course are:

Constant, but slight increase in body temperature. The woman feels overwhelmed, tired, there is a decrease in efficiency.
Menstrual disorders. The patient notes the lengthening / shortening of the cycle, a change in the volume of menstrual flow, metrorrhagia, daubing before and after menstruation. Conditioned similar symptoms fibrosis connective tissue, which leads to disruption of cyclic processes in the endometrium, poor contractility uterus and deviation in the process of platelet aggregation.
Pain syndrome. Soreness is felt in the area of the projection of the uterus, in lumbar region. It is not excluded its development during the release of the intestine, as well as during sex.
Allocations. Vaginal leucorrhoea becomes abundant, mucous, smells unpleasant. May include purulent components.
Fertility disorders. A woman becomes incapable of bearing or cannot become pregnant at all.

How to treat chronic endometritis

The tactics of therapy depends on the current clinical picture. As a rule, with an exacerbation of the pathology, a woman is offered hospitalization.

Medical

Treatment is aimed at solving the following problems:

elimination of infection;
boosting the immune system;
normalization of the flow of metabolic processes.

Important! AT without fail prescribed oral contraceptives.

Since the cause of the chronic form of endometritis becomes bacterial infection, then the woman is prescribed antibacterial and antiviral drugs.

Read also: Signs of endometritis after childbirth: pathology therapy

During the period of exacerbation and the appearance of pronounced symptoms, the patient is prescribed 2-3 types of antibiotics. At the same time, a woman can receive two drugs intravenously, by drip or by mouth, while the third is intended for intrauterine sanitation. The drug is injected into the uterine cavity through a thin catheter.

In order to strengthen immune protection used immunostimulants. Nice results gives the use of interferon or polyoxidonium.

The final step is restoration. natural processes in endometrial tissues. To achieve the goal, a woman is assigned:

hormonal contraception;
preparations containing progesterone;
hemostatic agents.

Important! To eliminate the inflammatory process, suppositories with indomethacin and dicrofenac can be used.

Surgical

In the chronic form, surgery is practiced relatively infrequently. The indication is the presence of polyposis formations and adhesions in the uterine cavity in preparation for a planned pregnancy.

Removal is carried out using an electrocoagulator during the hysteroscopy procedure.

Treatment with folk remedies

The chronic form of inflammation can be treated with herbs.

It is necessary to combine equal volumes of pine buds, nettle and cherry leaves, sweet clover grass, wormwood, lavender, cudweed, leuzea and marshmallow roots. Grind. Take 2 tbsp. mix and boil with boiling water. Keep warm all night. Filter. Drink a third of a glass up to 5 times a day for 60 days.
1 tbsp pour dry St. John's wort with boiling water (200 ml) and simmer in a water bath with a slight boil for 15 minutes. Let cool, drain. Take 50 ml three times a day. Contraindication - arterial hypertension.
Tampons with sea buckthorn oil. Course duration - 10 days. They put tampons on all night.

Before starting treatment, be sure to consult a doctor.

Can chronic endometritis be cured?

Timely conducted diagnostic tests allow to detect the disease at an early stage, which significantly improves the prognosis for recovery.

When a pathology is detected, it is important to draw up a “correct” treatment regimen that takes into account all factors:

degree of damage to the endometrium;
activity of the ongoing process;
the presence of developed complications;
type of pathogen.

Doctors conduct a multi-stage treatment of the disease. In case of absence acute symptoms the course of therapy can be carried out on an outpatient basis, i.e. at home.

How long does it take to heal

Everything is individual and the duration of therapy depends on many factors, in particular, the degree of development of inflammation and general condition the patient's health.

It should be noted that full recovery occurs in rare cases. But timely medical care allows a woman to experience the joy of motherhood.

How does chronic endometritis develop?

The main reason for the chronicity of the disease is the lack of adequate treatment acute form of inflammation of the endometrium.

On the background of the drug therapy, there is a fading characteristic symptoms, but the inflammatory process at the same time remains not completely removed. Minor pain syndrome, menstrual disorders, pathological vaginal discharge diagnosed within a few months.

Read also: Endometritis - treatment regimen and symptoms, therapy after childbirth

Causes

The initiators of the acute form of inflammation of the lining layer of the uterus are pathological microorganisms that penetrate into its cavity from the vagina. But this is possible only if the cervical canal is opened and there is an injury to the endometrium.

Factors that cause inflammation include:

violation of asepsis rules when performing abortions / diagnostic curettages;
spontaneous miscarriage, as a result of which unremoved pieces of embryonic tissue remain in the uterine cavity - an ideal base for the reproduction of pathogenic microorganisms;
forced expansion of the cervical canal during the procedure of hysteroscopy or hysterosalpingography;
procedure for setting an intrauterine device;
frequent vaginal irrigation;
difficult prolonged childbirth;
sexual relations during menstruation.

Less common reasons are:

probing the body of the uterus;
branch " children's place» after the completion of labor by hand;
impaired immune defense;
IVF procedure and artificial insemination.

Diagnostic methods

When diagnosing the chronic form of endometritis, the gynecologist is based on the patient's complaints and the results of the gynecological examination.

The specialist fixes a slightly enlarged softened uterus. When trying to palpate the organ, the woman experiences pain. Pain is also felt during probing the vaults of the vagina, which signals the development of adnexitis.

Additionally assigned:

general blood analysis;
examination of the obtained smears;
bacteriological examination vaginal discharge;
Ultrasound of the pelvic organs;
hysteroscopy (if necessary, accompanied by diagnostic curettage).

Species (classification)

The classification of the disease is based on various factors. Depending on the type of pathogen, such forms of chronic endometritis are distinguished as:

nonspecific - development is due to the active reproduction of its own conditionally pathogenic microflora;
specific - caused by penetration pathogenic bacteria from outside.

Accompanying the disease morphological features also underpin the classification. Within the framework of this gradation, it is customary to distinguish the following types of chronic endometritis:

atrophic - characterized by atrophy of the glands;
hypertrophic - accompanied by excessive growth of the endometrium;
cystic - for the form, the growth of fibrous tissues is typical, followed by the formation of cystic formations.

Depending on the strength of the inflammatory process, there are:

moderate - signs of inflammation are present on ultrasound, there are characteristic symptoms;
sluggish - the manifestations of the disease are minimal, they are detected only during transvaginal ultrasound;
chronic inactive - it is possible to diagnose signs of inflammation only by examining endometrial cells under a microscope.

Additional classification:

according to the degree of prevalence - focal and diffuse;
according to the depth of the lesion - superficial and deep.

Do's and Don'ts

But since the disease occurs against the background of reduced immune protection, a woman is advised to review her diet to strengthen it. It is desirable to increase the content fresh vegetables and fruits to compensate for the deficiency of vitamins and microminerals.

Important! During the period of exacerbation of the disease, it is necessary to minimize any physical activity and refuse to visit baths and saunas.

Forecast

Full recovery occurs in rare cases. The main direction of treatment is the elimination of signs of the inflammatory process and the resumption of the patient's fertility. Timely therapy prevents the development of infertility.

What is chronic endometritis? A pathology in which the mucous membrane of the uterus becomes very inflamed is called endometritis. If only the surface layer of the mucosa is affected, a simple but acute form of the disease occurs. If the disease penetrates deeper and affects the basal and muscle layers - we are talking about the chronic form.

Chronic endometritis stands out as a separate pathology. Its symptoms and signs differ from the acute and subacute forms of the disease. Signs that should alert every woman are pain in the abdomen, in its lower part, and vaginal discharge. Most often, pathology is diagnosed in adulthood. The incidence rate is increasing from year to year.

AT healthy body The uterine cavity is a sterile organ without microbes and viruses. The vagina, on the contrary, is an organ in which they simply teem different kind bacteria. The cervix is the link between the vagina and the uterus. It is she who is a kind of barrier to the infection in the body. If something happens to this barrier, and inside the main female organ penetrate pathogenic microbes- Women's health problems begin. There is an inflammatory process of an acute or chronic nature.

Pathology most often affects the uterus of women who are actively sexually active. The disease may occur:

In patients who survived surgical intervention, caesarean section, abortion, birth trauma (injuries and ruptures of the perineum, vagina, cervix contribute to entry);
Those who have had diagnostic curettage, endometrial biopsy, those who have used an intrauterine device for a long time (spirals that are inside the body for a long time become potentially dangerous);
Violation of the rules of hygiene of the genital organs, frequent douching is another cause of the disease;
If a woman often uses tampons. The fact is that tampons, absorbing bloody issues become a potential source of pathology. They need to be changed every 4-6 hours, it is forbidden to use at night, before and after menstruation, as well as in hot weather;
In a state of constant stress, overwork. These conditions significantly undermine defensive forces organism, against the background of which infections of various kinds begin their attack.

But the main reason for the protracted inflammatory process is the untreated phase of acute endometritis.

In chronic endometritis, the mucous membrane becomes thinner, development occurs adhesive process polyps and cysts are formed. The transition of the disease to this form is possible when the human immune system is depleted. If the body ceases to resist the penetration of viruses and microbes, then the inflammatory process of a chronic nature begins. This condition is called autoimmune endometritis.

With this form, it is difficult to identify an infectious agent, even if a series of examinations is carried out. Approximately one third of the patients fail to identify the true cause of the pathology.

Types of chronic endometritis

Depending on the pathogen, chronic inactive endometritis is divided into:

Specific;
Non-specific.

Pathology of the first type occurs if microorganisms of chlamydia, tuberculosis, virus enter the body herpes simplex, gonorrhea, candida, ureaplasma. Often there are cases of pathology with two or three pathogens. Microorganisms such as staphylococci, streptococci and coli can sit for years in the human body, and then, under certain circumstances, lead to endometritis.

Chronic nonspecific endometritis can be caused by misuse intrauterine device, taking hormonal contraceptives.

There are also focal and proliferative endometritis (when the walls of the uterus thicken and thicken).

Symptoms

Symptoms of chronic endometritis are barely noticeable. The woman experiences slight discomfort and does not associate it with the disease. Sometimes there may be erased signs:

aching, dull pain in the lower abdomen, manifested both during physical exertion and in everyday life;
Unpleasant pain during sex;
Vaginal discharge different color and bad smell. They can be transparent, mucous, yellow-green, brown, with a protracted form of the disease - even serous-purulent;
Pain during bowel movements;
Menstrual irregularities, discharge bloody color before and after menses.

Indirect signs of endometritis: general weakness, malaise, fever.

Chronic endometritis is the cause of infertility in 10 out of 1000 women with this problem.

Echo-signs of chronic endometritis can be seen on ultrasound. These include: thickening of the uterine mucosa, the presence of adhesions, an increase in the size of the uterus.

How to identify

In confirmation of the symptoms of chronic endometritis, a number of studies are carried out:

A thorough examination by a gynecologist with a comparison of all symptoms, discharge and the condition of the uterus. Examination may show a slight compaction and an increase in the size of the uterus;
Microscopic and bacteriological examination of smears;
Blood analysis.

For a more detailed study of the causes of chronic endometritis of the uterus, ultrasound procedure and hysteroscopy. Ultrasound will show the remains of the placenta in the uterus, blood clots, tissue change. The examination will also show which other organs are involved in the inflammatory process.

When the diagnosis is fully confirmed, it is necessary to establish which bacteria or viruses the patient is infected with. For this, an additional examination is assigned:

Sowing material from the uterus. It is also carried out to determine which of the antibiotics will be most effective in the treatment;
A blood test for antibodies - allows you to determine whether the pathology is caused by viruses and which ones, if so;
A smear on the flora, which helps to determine if there is inflammation in the uterus and vagina.

To detect viruses, the doctor may prescribe serodiagnosis. As a result, antibodies to various pathogens can be determined in the blood.

Exacerbation of the chronic form

Endometritis begins with an acute form, which as a result not proper treatment can develop into chronic. Chronic sluggish endometritis can last for a very long time, without particularly disturbing the woman and without causing severe discomfort. Meanwhile, the disease develops, affecting more and more the urogenital area.

Exacerbation of chronic endometritishappens suddenly. It can be caused by pregnancy or abortion. Against the background of these phenomena, severe bleeding may open. After that, the examination will show the presence of endometritis.

Treatment

Can chronic endometritis be cured? Of course, yes, if comprehensive measures are taken. The individuality of the treatment regimen depends on the results of the examination, the severity of the disease, the presence of concomitant diseases and complications. However, the treatment of chronic endometritis is not fundamentally different. Almost all patients are prescribed:

Broad spectrum antibiotics;
Antiviral drugs;
Proteolytics;
vitamins;
Hormonal preparations;
Physiotherapy procedures.

The treatment of chronic endometritis aims to restore and improve the function of the uterine endometrium, as well as to fulfill the desire of a woman to become pregnant.

How to treat chronic endometritis? Treatment is carried out in three stages:

First of all, after establishing the source of infection, all funds are directed to its elimination. This alone will reduce discharge and relieve pain.
Then it is necessary to carry out work to restore the cells of the immune system.
On the last step in order to cure the disease completely, it is necessary to restore the structure of the endometrium and its functions.

First stage

Initially, the attending physician will prescribe antibacterial drugs, namely one of the groups: cephalosporins, nitroimidazoles, macrolides, penicillin is also used. Medicines begin to be used simultaneously with fluconazole, ketoconazole or levorin on the 10th day of the monthly cycle.

If during the examination pathogens of an anaerobic group of infections are found, then metronidazole is added to the treatment. The course of treatment with these drugs is 10 days.

Treatment of endometritis with antibiotics is mainly carried out in a hospital, since medication is prescribed intravenously, droppers are placed 2 times a day. Treatment with injections is possible.

If, nevertheless, the detected infection is of a viral nature, antiviral drugs are prescribed.

Second phase

It is possible to cure chronic endometritis faster and more efficiently if the prescribed drugs are injected into the uterine mucosa, concentrating their greatest concentration here.

Third stage

The last step on the road to recovery involves the use of physiotherapy treatments. The most popular and effective are the following:

Mud treatment;
Plasmapheresis;
laser irradiation;
Magnetotherapy;
Iontophoresis.

These procedures aim to reduce inflammatory edema mucosa, activating blood circulation, stimulating immunity. Also, women with a diagnosis of chronic endometritis can be prescribed hydrotherapy and mud therapy.

In addition, during the period of chronic endometritis disease, treatment is carried out and hormonal drugs such as Duphaston, estrogens, phytoecdysteroids. Reception lasts 3-6 months. Hormonal drugs restore the disturbed monthly cycle.

Treatment with hormonal drugs must necessarily take into account the age of the patient, the severity of the disease, as well as how disturbed the hormonal background is.

Along with traditional methods Treatments are also used with folk remedies. The disease is treated with infusions and decoctions, which can be made from such herbs as: marshmallow root, nettle leaves, sweet clover, pine buds, leaves of wormwood and blueberries.

Chronic endometritis, unlike acute, requires prolonged treatment. As a rule, it can take more than one week, and sometimes months, until complete recovery. After a course of therapy, a second examination is carried out, which will show whether the chronic inflammation of the endometrium has completely passed or not.

Complications

The infectious disease chronic endometritis is very insidious in the sense that in the absence of bright severe symptoms can lead to infertility. Even if, in the presence of an illness, a woman manages to become pregnant, there is a big threat that she simply cannot bear the baby. Complications may also develop during childbirth. But the fact is that the inflamed endometrium is simply not ready to host a fertilized egg.

Complications can also be:

The development of the adhesive process in the uterus itself;
The development of polyps and cysts of the endometrium;
The spread of pathology to the ovaries and tubes, the neck, appendages, to the intestines and pelvic organs.

For these reasons, every self-respecting woman should visit a gynecologist every six months to make sure that everything is in order. Or vice versa, to diagnose the pathology in time and start treatment in time. If a woman sees signs of chronic endometritis in herself, this is also a reason to consult a gynecologist. After proper treatment reproductive function women fully recovered.

Prevention

In general, the disease is not dangerous, since vital important organs. Prevention is essential to maintaining health. After the treatment, a woman should avoid severe physical stress, temperature fluctuations and hypothermia.

In addition, a woman should:

Limit the use of intrauterine devices;
Keep the genitals clean;
Timely cure all acute and chronic diseases urogenital area;
Neglect casual sex;
Avoid sexual contact during menstruation;
Avoid accidental pregnancy and abortion.

At the first discomfort in the field of health, you need to see a doctor.