What is endometritis or inflammation of the endometrium?

By (gynecologist) and (embryologist).
Last Update: 07/12/2023

Endometritis is an inflammation of the endometrium, the inner layer that surrounds the uterus. This condition should not be confused with endometriosis, as they are different terms.

Usually, the cause of endometritis is an infection in the uterus due to chlamydia, gonorrhea, tuberculosis or even a combination of bacteria. In addition, the risk of endometrial inflammation is higher after hysteroscopy, endometrial biopsy or prolonged childbirth.

Definition of endometritis

Endometritis is the inflammation of the mucous layer that surrounds the uterus internally, that is, the endometrium. There are two types of endometritis:

Acute endometritis
is the inflammation of the endometrium as a consequence of an infection by Chlamydias trachomatis and Neisseria gonorrhoaea, mainly.
Chronic Endometritis
patients suffering from this endometritis are often associated with fertility problems. In addition, chronic endometritis is caused by a polymicrobial infection or by many microorganisms such as Streptocuccues sp, E. Coli. Enterococcus faecalis, etc.

Approximately 24.4% of women in the premenopausal period suffer from chronic endometritis. In addition, if women have uterine polyps or fibroids, they are more likely to develop this condition.

Causes of Endometritis

The most common reason for endometritis is usually infection, but it is not the only cause of endometrial inflammation. The presence of foreign bodies or the appearance of uterine polyps can also cause endometritis.

In addition, the use of intrauterine contraceptives (IUD), as well as the presence of placental debris after childbirth would be other factors of endometrial inflammation.

Risk Factors

Although the most common causes of endometritis are those mentioned above, there are some situations in which the risk of suffering this endometrial alteration may be increased:

  • Prolonged labor.
  • After cesarean section.
  • Endometrial biopsy.
  • Hysteroscopy
  • Uterine curettage.

Another risk factor for endometritis is multiparity, endometriosis or tuberculosis.

What symptoms does endometritis cause?

The clinical manifestations of endometrial inflammation will differ depending on whether it is acute or chronic endometritis. In the case of acute endometritis, fever, pelvic pain and vaginal discharge are most common. In contrast, women with chronic endometritis may be asymptomatic and, therefore, this condition goes undetected until pregnancy is attempted.

Despite this, some of the mild signs of chronic endometritis are:

  • Discomfort in the pelvic area.
  • Abnormal bleeding.
  • Leucorrhea or vaginal discharge.
  • Abdominal swelling.

In addition, chronic endometritis is associated with an increased likelihood of repeated miscarriages and implantation failure.

How is endometritis detected?

There are different diagnostic tests for endometritis. Depending on the specialist's suspicions, he/she will decide which test is best in each case. These include the following:

Microbial culture
a sample is taken from the cervix for the possible detection of microorganisms.
Endometrial biopsy
an immunohistochemical study is performed to detect the most common markers in endometritis such as CD138. In addition, endometrial biopsy can be used for histopathological evaluation.
allows visualization of the uterine cavity, as well as possible inflammations in the area. On numerous occasions, it is possible to observe endometrial micropolyps in women suffering from endometritis.

It should be noted that in women with fertility problems it would be advisable to do a test called ALICE test, especially if they are asymptomatic patients.

is there a cure for endometritis?

Fortunately, the management of endometritis is usually uncomplicated and is usually cured after the correct treatment.

When a woman is diagnosed with endometritis, the doctor will prescribe antibiotics to treat the infection causing the endometritis and rest. Doxycycline is usually the most common antibiotic and is taken for two weeks. If the endometritis is resistant, the alternative would be to use other antibiotics such as metronidazole.

The prognosis of this alteration is good and there are usually no complications. However, if endometritis is not adequately treated, it can lead to the development of generalized pelvic infection, pelvic abscesses and infertility.

Considering undergoing a fertility treatment? By getting your individual Fertility Report your will see different clinics especially selected for you out of the pool of clinics that meet our strict quality criteria. Moreover, it will offer you a comparison between the fees and conditions each clinic offers in order for you to make a well informed choice.

FAQs from users

Is endometriosis the same as endometritis?

By Alicia Francos Pérez M.D., M.Sc. (gynecologist).

Endometrititis and endometriosis are different concepts.

Endometritis is the inflammation of the endometrium caused by different reasons such as an operation or uterine manipulation after childbirth, abortion, IUD insertion, etc.

Imagen: Endometritis vs Endometriosis

Endometriosis, on the other hand, is a proliferative disease of a benign nature, but highly damaging to the reproductive system.
Read more

Can endometritis cause complications?

By Marta Barranquero Gómez B.Sc., M.Sc. (embryologist).

It is not common, but women with endometritis or inflammation of the endometrium may have fertility problems. In addition, endometritis can lead to pelvic infection leading to pelvic abscesses, pelvic peritonitis with inflammation of the fallopian tubes, and so on.

In the rarest cases of endometritis, septic shock has occurred, but this is not common.

Why does postpartum endometritis occur?

By Marta Barranquero Gómez B.Sc., M.Sc. (embryologist).

Postpartum endometritis is caused by infection by micro-organisms that travel from the genital tract. The incidence of postpartum endometritis is higher in unscheduled caesarean deliveries than in vaginal deliveries.

Possible causes of postpartum endometritis include the following:

  • Prolonged labour.
  • Infection of the chorion or chorioamnioonitis.
  • Bacterial vaginosis.
  • Diabetes.
  • Postpartum haemorrhage.

Suggested for you

Throughout the article we have indicated that endometritis and endometriosis are different terms. Therefore, if you would like to know more information about it, we recommend you to visit the following link: What is endometriosis - Symptoms, diagnosis and treatment.

Also, if you have gone through several miscarriages and endometritis is suspected, you may be interested to know more about the following test: What is the EndomeTRIO test - Indications and price.

We make a great effort to provide you with the highest quality information.

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Amerigo Vitagliano, Carlo Saccardi, Marco Noventa, Attilio Di Spiezio Sardo, Gabriele Saccone, Ettore Cicinelli, Sara Pizzi, Alessandra Andrisani, Pietro Salvatore Litta. Effects of chronic endometritis therapy on in vitro fertilization outcome in women with repeated implantation failure: a systematic review and meta-analysis. Fertil Steril. 2018 Jul 1;110(1):103-112.e1. doi: 10.1016/j.fertnstert.2018.03.017 (View)

Jacques Ravel, Inmaculada Moreno, Carlos Simón. Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease. Am J Obstet Gynecol. 2021 Mar;224(3):251-257. doi: 10.1016/j.ajog.2020.10.019 (View)

Kotaro Kitaya, Takumi Takeuchi, Shimpei Mizuta, Hidehiko Matsubayashi, Tomomoto Ishikawa. Endometritis: new time, new concepts. Fertil Steril. 2018 Aug;110(3):344-350. doi: 10.1016/j.fertnstert.2018.04.012 (View)

Kotaro Kitaya, Tomomoto Ishikawa. Chronic endometritis: simple can be harder than complex? Fertil Steril. 2021 Jun;115(6):1443-1444. doi: 10.1016/j.fertnstert.2021.03.023 (View)

Neeta Singh, Ankita Sethi. Endometritis - Diagnosis,Treatment and its impact on fertility - A Scoping Review. JBRA Assist Reprod. 2022 Aug 4;26(3):538-546. doi: 10.5935/1518-0557.20220015 (View)

FAQs from users: 'Is endometriosis the same as endometritis?', 'Can endometritis cause complications?' and 'Why does postpartum endometritis occur?'.

Read more

Authors and contributors

 Alicia Francos Pérez
Alicia Francos Pérez
M.D., M.Sc.
Alicia Francos has a degree in Medicine from the University of Salamanca and a Master's degree in Mastology and Breast Pathology from the Autonomous University of Madrid and another Master's degree in Human Fertility from the Complutense University of Madrid. She also has a diploma in Gynaecological Endoscopic Surgery from the Université Clermont Ferrand. More information about Alicia Francos Pérez
License: 330840199
 Marta Barranquero Gómez
Marta Barranquero Gómez
B.Sc., M.Sc.
Graduated in Biochemistry and Biomedical Sciences by the University of Valencia (UV) and specialized in Assisted Reproduction by the University of Alcalá de Henares (UAH) in collaboration with Ginefiv and in Clinical Genetics by the University of Alcalá de Henares (UAH). More information about Marta Barranquero Gómez
License: 3316-CV

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