A Complete Guide to Endometritis

Less well known than endometriosis, endometritis also affects the endometrium. Indeed, endometritis is an infection of the uterus that affects this mucous membrane that develops on the uterine wall with each new menstrual cycle. Often associated with childbirth, which is a common factor, endometritis can occur throughout the life of a menstruating person. Although it can be treated well with appropriate antibiotics , it can become chronic and affect fertility if it is not properly managed. This is why we believe it is essential to give it visibility. Today's article is intended as a complete guide to understanding and recognizing endometritis , in order to better react to it.

What is postpartum endometritis?

Endometritis is a uterine infection that affects the endometrium (the uterine lining). It usually originates in the genitals or digestive tract and then travels up into the uterus. Symptoms typically include uterine tenderness, abdominal or pelvic pain, discomfort, and sometimes vaginal discharge. Like any infection, it can cause a high fever, which requires prompt medical attention because it reveals the severity of the infection. In cases of endometritis, antibiotic treatment is often recommended to stop the infection.

Postpartum endometritis is the term used for endometritis that develops after childbirth. Postpartum endometritis is generally acute endometritis , linked to an infection that occurred during childbirth (medical intervention during childbirth, postpartum complications).

What is the difference between chronic and acute endometritis?

Endometritis can be both acute and/or chronic, depending on the duration and nature of the infection.

Acute endometritis has two characteristics: it develops rapidly and presents an intense inflammation of the uterine lining . It usually occurs after childbirth (this is postpartum endometritis), a miscarriage , an abortion or even a surgical intervention at the genital or uterine level. This is because it is often caused by pathogenic bacteria, such as infectious agents specific to the hospital environment (nosocomial infections) or sexually transmitted infections, such as chlamydia or gonococcus.

Chronic endometritis , on the other hand, is a prolonged or recurring form of endometrial inflammation . It can develop as a result of untreated acute endometritis or recurrent infections. In some cases, chronic endometritis may be due to low-grade infections, bacterial imbalances, or other non-infectious causes. It may be asymptomatic or present with symptoms that progress very differently, making diagnosis difficult. Research tends to make chronic endometritis the main cause of embryo implantation failures in IVF and thus recommends various preliminary examinations to facilitate diagnosis and treatment in the event of a pregnancy plan.

While acute endometritis often requires immediate, multi-organism treatment with antibiotics to prevent serious complications, chronic endometritis takes time to diagnose and can be more complex to treat.

What is the difference between endometritis and endometriosis?

In recent years, we have been hearing more and more about endometriosis . If endometriosis and endometritis can be confused due to their very similar names, it is primarily because they both affect the endometrium (the uterine lining).

However, these two pathologies are very different.

Endometritis is an infection caused by germs that sensitize the endometrium, sometimes causing a more serious infection.

Endometriosis is a disease that causes the endometrium to grow outside the uterus, resulting in adhesions between organs (particularly the intestines) and severe abdominal pain. The causes of endometriosis are multifactorial (genetic, hormonal, infectious, etc.).

Also read: Coping with endometriosis after giving birth

Is endometritis serious?

Acute endometritis, if treated promptly, is not dangerous and does not jeopardize a future pregnancy—we'll discuss this in more detail later in our article. However, if the infection is left untreated, it can lead to miscarriage or ectopic pregnancy, as well as sepsis, abscesses, or septic shock. That's why it's important not to let it drag on if you feel something abnormal is happening: we've put together a list of endometritis symptoms to help you spot it better.

What are the causes and risk factors?

Endometritis, in its acute form, is often associated with childbirth and, more broadly, with medical procedures around the genital and uterine areas. However, the causes and risk factors are more numerous.

Causes of endometritis

Endometritis is most often caused by a bacterial infection: it travels up into the vagina and cervix and infects the endometrium, causing inflammation. How does this infection occur and spread? Here are the causes of endometritis.

Medical procedures affecting the genital area

The rise of bacteria causing endometritis can be linked to medical procedures such as curettage (during an abortion or miscarriage).

Postpartum complications

Endometritis, and specifically postpartum endometritis, is a common complication after childbirth. This is particularly true after a cesarean delivery or in cases of premature rupture of membranes. The new mother can then become infected by bacteria present in the hospital environment.

Sexually transmitted diseases (STDs)

Various sexually transmitted diseases and infections can cause endometritis, including chlamydia and gonorrhea. These diseases have different symptoms that can help identify them. For example, vaginal discharge can be very different when you are infected with these diseases .

Hormonal imbalance

Beyond infectious causes, other factors can cause endometritis. This is particularly the case with hormonal imbalances, especially those affecting the thickness of the endometrium. These can contribute to inflammation.

Menstruating people experience significant hormonal fluctuations every day as part of their menstrual cycle, and they can sometimes experience hormonal imbalances. Pregnancy and the postpartum period are also significant times of hormonal fluctuations.

Immune conditions

Immune system disorders can sometimes play a role in the development of endometritis. Therefore, medications that suppress the immune system, such as those used for autoimmune diseases or after organ transplants, can increase the risk of infections.

Use of an Intrauterine Device

Intrauterine contraceptive devices (formerly called IUDs) and, more broadly, any foreign body placed in the uterus can cause or aggravate inflammation.

Risk factors for endometritis

As is often the case when it comes to health, luck (genetics), age, and lifestyle can all have an impact on diseases and infections. This is also the case for endometritis. Certain practices contribute to an increased risk of developing endometritis.

Genetic

Endometritis, and more broadly the risk of developing this infection, can also be genetic. The permeability of the uterus and genital tract can thus increase the risk of contamination by germs, particularly from the digestive tract.

Age and life stage

This article focuses on women of childbearing age who are more likely to be affected by endometritis. This is because the infection is often linked to interventions in the uterine area: childbirth / cesarean delivery, abortion, miscarriage / curettage.

Menopause, an age of significant hormonal changes, can also be a risk factor for developing endometritis.

Inadequate personal hygiene

Poor hygiene, especially during menstruation, can increase the risk of infection.

Not wearing a condom

In the context of sexual relations outside of an exclusive and tested relationship, the absence of condom use is a significant risk factor. Indeed, as we have mentioned, many cases of endometritis are caused by sexually transmitted germs.

Smoking

Smoking has been associated with an increased risk of various infections, including endometritis.

⚡ If you are currently trying to quit smoking, you should know that you can consult an addiction specialist to support you: specialized in the management and treatment of addictions, this health professional can help you find behavioral and medical solutions to relieve your pain.

Can endometritis affect my fertility?

Yes, endometritis can impact your fertility. That said, there's no need to panic: acute postpartum endometritis treated promptly will generally have no impact on your fertility down the road.

How chronic endometritis impacts fertility

As we explained earlier in this article, chronic endometritis is endometritis that lasts a long time and has varying symptoms. Typically, it's acute endometritis that's been misdiagnosed or poorly treated and recurs regularly.

However, chronic endometritis has a recognized impact on fertility. In fact, the regular infection of your endometrium by various germs makes your uterus unfavorable to embryo implantation. The latter becomes inhospitable and can lead to early miscarriages.

Chronic endometritis is a well-known problem in the IVF community, as it is a common cause of embryo implantation failure. But again, don't panic: the effects of this disease are well known, and IVF candidates are generally subjected, before the first attempts, to a hysteroscopy, a gynecological examination to observe the state of the uterine lining and identify the potential presence of endometritis. If chronic endometritis is detected, it is treated with various treatments before continuing implantation attempts.

Why you should (as much as possible) avoid worrying

In other words, yes, endometritis can have an effect on your fertility in its chronic form, but this is known and considered by health professionals.

So, don't worry:

• if you contract an acute form of endometritis , particularly postpartum endometritis: rapid treatment could limit any long-term problems;
• If you are currently trying for or planning to have a baby, the possibility of chronic endometritis will be discussed and considered. If you are concerned that your healthcare professionals may not be taking this into account, you can discuss it with them for reassurance and to be screened.

Know how to spot symptoms and warning signs

As is often the case with women's health, the symptoms of endometritis and the warning signs vary greatly in severity and frequency, making them difficult to identify. However, it is possible to identify a few.

Recurring symptoms of endometritis

Recurring symptoms of endometritis are:

• Pelvic pain: lower abdominal pain, particularly during the premenstrual period when the endometrium develops to accommodate the potentially fertilized egg, is a recurring sign of endometritis;
• Abnormal white discharge: suspicious white discharge (smelly, colored, etc.) can also be a symptom of endometritis;
• Abnormal bleeding: Metrorrhagia (vaginal bleeding outside of menstruation) and postmenopausal bleeding are another symptom of endometritis. Any vaginal bleeding, outside of menstruation or postmenopausal, requires medical consultation;
• Fever and chills: Fever is a normal reaction to an infection (the body heats up to kill bacteria). It often occurs in the last stage of the infection, when it is already well advanced. It is often necessary to seek medical help immediately.
• More generally, a change in your menstrual cycle: all the symptoms mentioned above have the particularity of being able to be confused with other menstrual disorders, including PMS, endometriosis and PCOS (with the exception of fever). Also, it is the difference with your previous cycles that will be the judge of peace to know whether or not you should worry and consult. You can use a cycle tracking application to have a clear idea of ​​your recurring symptoms. Generally speaking, if these symptoms embarrass you in your daily life, there is no hesitation: consult.

Warning signs

Warning signs that may lead you to consider that you are suffering from a uterine infection such as endometritis are:

• Uterine sensitivity: pain, sensitivity, discomfort... these elements should alert you and lead you to monitor your feelings.
• Unusual fatigue : Significant fatigue can be an indicator of infection. However, during the postpartum period, it is difficult to accurately assess fatigue: postpartum fatigue is unfortunately associated with this period of life!
• Weakness or general feeling of malaise: Do you tend to have vagal syncope, do you feel nauseous, or unwell? This may be a symptom to note.

⚡If you are a new mother, you may often experience pelvic pain and significant fatigue: these warning signs may be hidden in your daily life. Even if this seems “normal” to you, remember to discuss them with your doctor during a consultation: they will be one more piece of evidence that will help your healthcare professional make a diagnosis.

How to get diagnosed?

Although the symptoms of endometritis can be confused with different diseases, this infection remains fairly “easy” to detect thanks to different tests.

1. Consult a doctor

Let's start with the basics: If you experience one or more of the symptoms mentioned above—including unusual vaginal discharge, abnormal vaginal bleeding, and fever—see your doctor or gynecologist. They will examine you and suggest further testing, if necessary.

2. Talk about your doubts

If your medical relationship allows it (some doctors and healthcare professionals are not very comfortable with the notion of self-diagnosis), you can discuss with him your doubts about possible endometritis and present the symptoms that make you think it is possible. Your advisor will then be able to consider this infection or steer you away from it, if he considers another avenue in view of your medical profile.

3. Take the exams

If your doctor thinks that endometritis may be the cause of your symptoms, he or she will order several tests:

• A gynecological examination, called a hysteroscopy: the purpose of this examination is to assess the presence or absence of endometritis within the uterine mucosa: its appearance, location, and intensity. This makes it possible to define the conditions specific to its treatment;
• A vaginal swab can then be used to determine the infection and the germs responsible for the infection;
• A blood test may also be ordered to determine the stage of endometritis.

Can the onset of endometritis be prevented and how?

While it is not possible to control the majority of causes of endometritis (particularly bacteria within the hospital environment), it is still possible to reduce the risk of contracting endometritis by limiting the risk factors within your control.

Adopt a healthy lifestyle

Eating well, drinking water, sleeping well, not smoking, not drinking alcohol, exercising... You probably know the ins and outs of a healthy lifestyle. While it can't prevent you from contracting diseases, it can reduce many risk factors.

Protect yourself during sexual intercourse

STDs and STIs are major causes of endometritis. Asking your partner to use a male condom during sex, especially in a non-exclusive relationship or when testing has not been done, helps protect you.

🌈 In Gapianne, we have selected condoms from the My Lubie brand for you. Ultra-thin, odorless, and made from natural latex, they protect you while letting you enjoy yourself!

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Adopt good intimate hygiene

An imbalance in your vaginal flora can contribute to the growth and uptake of harmful bacteria in your cervix and then into your uterus. This is why it is essential to practice good intimate hygiene:

• by washing yourself daily with water or with an intimate soap with a pH adapted to your vulva. 🌈 At Gapianne, we particularly like Jho's soap-free intimate soap which cleanses and soothes without being harsh!

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• by eliminating douching: don't do this!
• by eliminating perfumed hygiene products: do you want to pamper your vulva, especially after childbirth that has damaged your skin? Instead, opt for oily, fragrance-free products. 🌈 At Gapianne, we have selected the Baûbo brand Balm for you to soothe your vulva without disturbing your vaginal balance!

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What natural treatments and solutions?

Treatments for endometritis depend entirely on its causes.

Most common treatment for endometritis

Generally, after diagnosis and identification of the germs that caused the endometrial infection, treatment of endometritis requires the prescription of vaginal antibiotics for several days or even weeks. The aim of these antibiotics is to get rid of the germs responsible for the infection.

Secondly, after the antibiotic treatment, a course of probiotics is prescribed or recommended to restore the vaginal flora. 🌈 At Gapianne, we have selected for you the Intestinal Flora probiotic course from the Miyé brand . Its key ingredients are a probiotic complex to restore and maintain the balance of vaginal and intestinal flora, cranberry to fight urinary tract infections and promote intimate comfort, and chicory inulin to improve digestive health during the female cycle.

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Other treatments for endometritis

If the cause of the problem is an STD , your sexual partner(s) should also be treated to prevent superinfection and the spread of the infection to other people.

In cases of postpartum endometritis following childbirth or abortion , curettage may be necessary to remove any remaining placental debris causing the infection.

If the IUD contributed to your endometritis, an emergency medical appointment will be scheduled to have it removed. With your consent and following discussions, your healthcare professional will prescribe another method of contraception.

Our advice for future pregnancies

You may have gathered by reading this article so far: there is no real solution to prevent endometritis or postpartum endometritis during a future pregnancy. The latter is mostly linked to factors beyond your control.

That being said, we can still recommend these few points to you:

• Talk to your doctor if you have had a previous infection: If you have had endometritis previously or during your previous pregnancy, you should share this information with the healthcare professional who will be monitoring you. This is important information because you may have an increased sensitivity to this disease;
• Adopt a healthy lifestyle: eat well, drink well, exercise, sleep well... all these elements can only contribute to your good health and help your body fight infections;
• Practice good intimate hygiene: clean yourself daily with water or soap with a pH that respects your vulva and vaginal flora.