Exacerbation of chronic endometritis symptoms. What is chronic endometritis: nonspecific and autoimmune

The question is whether it can be cured forever chronic endometritis sounds more and more often in the gynecologist's office. This is due to the fact that many girls do not want to pay due attention to their health, and allow a seemingly easily treatable disease to become chronic. In this case, it will not be possible to get rid of the disease without medical intervention. That is why we will consider in detail the issue of treatment of chronic endometritis.

What is chronic endometritis?

This disease is an inflammation of the endometrial layer. Diagnosing the development of such inflammation is quite difficult. Most often it occurs after an abortion or quite a long period of infertility.

Why does the disease develop?

The reasons for the development of this disease are due to the peculiarity female body. Every month, the uterus undergoes a process that allows you to conceive a child. The endometrial layer of the uterus is supplied with nutrients and reacts quite sensitively to the passage of any changes, which allows the fertilized egg to implant and develop at the proper level.

But if an inflammatory process occurs in a woman’s vagina caused by infections, it can spread to the uterus.

With low immunity, improper treatment or its absence, the infection begins to develop in the cells of the mucous membrane. At times under the influence external factors the infection can remind itself, affecting the immune system and provoking the development chronic form diseases.

If this kind of inflammation is not treated, then the formation of special tissue begins in the endometrial layer. In addition, circulatory disorders occur and the level of its sensitivity to hormonal changes. As a result of this process, the fertilized egg is not able to implant in the uterus.
In addition, the chronic form of this disease can cause:

• Difficulty conceiving.
• Insufficient duration of phase 2 of the cycle.
• Miscarriage.
• Complicated pregnancy.
• Problem childbirth.

Among the factors that provoke the development of endometritis, experts identify:

• Artificial termination of pregnancy.
• Deformation of the uterine body.
• Difficult birth.
• Postpartum complications.

Symptoms of the disease

There are quite a few symptoms that help recognize the development of this disease. These include:

• Uterine bleeding.
• Abdominal pain.
• Problematic menstruation.
• Pain during sexual intercourse.
• Copious discharge.
• Infertility.

However, quite often the disease can occur in an asymptomatic form.

How is endometritis diagnosed?

Diagnosing this disease is quite difficult. In addition, it can be detected during normal gynecological examination also very difficult.
That is why, to determine the diagnosis, experts prescribe the following studies:

• Ultrasound diagnostics. When conducting ultrasound diagnostics one can observe a certain expansion of the uterine cavity and a change in the composition of its mucous membrane. Very often, doctors prescribe 2 procedures in the first and second half of the cycle.
• Hysteroscopy. When undergoing such a study, it is possible to determine the heterogeneous thickness of the mucous layer and increased level bleeding. As a rule, the procedure is carried out on the 10th day, after completion menstrual cycle.
• Histological examination. This research method allows you to diagnose endometritis as accurately as possible. As a rule, such a study is carried out 7-10 days after the end of the menstrual cycle.

How is the disease treated?

First of all, treatment of this disease is aimed at restoring reproductive function and improvement of the endometrium.
As a rule, therapy is complex and carried out in stages:

1. At the first stage, antibacterial drugs are used for treatment. Their appointment is carried out only after the causative agent of the disease has been identified. In addition, as prescribed by a doctor, you can carry out intrauterine treatment. Quite often prescribed additional dose immunostimulants.
2. At the second stage, drug therapy is carried out to improve the state of local immunity. It may also be prescribed physiological effects, which will increase blood circulation in the organ. IN in some cases Hormone therapy is prescribed to restore ovarian function.

The full course of treatment for this disease takes about 3 months. As a rule, the effectiveness of treatment is determined only when 2/3 of the course has been completed. In most cases timely treatment the chronic form of the disease allows you to normalize reproductive function.

Is it possible to cure a chronic type of disease?

Many women are concerned about the question of whether the disease can be cured forever. The answer to this question is ambiguous. Of course, it is possible to cure chronic endometritis, but to determine exactly how much is enough therapeutic effect, it’s unlikely to work.

The thing is that an incorrect lifestyle or the influence of other factors can provoke the reverse development of the disease.

How to avoid developing endometritis?

There are no specific measures to prevent the occurrence of this disease. As a rule, the main measures are to avoid the risk factor.
To do this, you must adhere to the following recommendations:

• Avoid termination of pregnancy.
• Observe hygiene rules.
• Use condoms.
• Get examined after birth.
• Visit your gynecologist regularly.

Regular visits to the gynecologist are one of the most important measures that allows you to identify chronic endometritis as early as possible. It is best to undergo scheduled examinations once every six months. As a rule, such an examination is enough to identify the disease.

To summarize, we can say that the chronic form of the disease can be diagnosed in any woman who does not pay enough attention to her health. As a rule, chronic endometritis develops due to the lack of treatment for this disease. It can cause endometritis large number various factors, among which are both the simplest and most complex mechanical influences. In any case, the disease becomes chronic due to the lack of proper treatment.

Chronic endometritis is especially dangerous for women reproductive age, since its development becomes quite a strong obstacle to pregnancy. This is due to the fact that when the mucous membrane is inflamed, the fertilized egg cannot implant.

There are quite a few symptoms of the development of this disease; quite often it occurs in an asymptomatic form. Therefore, in order to determine its development as early as possible, it is necessary to regularly visit a gynecologist. This disease can only be diagnosed through comprehensive research. It can also be cured only through complex therapy. Most often, treatment takes about 3 months and includes several stages. The first stage is the elimination of the infection, and the second is the normalization of the endometrium and strengthening of local immunity. As for preventive measures, there are no specific actions aimed at preventing the development of this disease. The best preventative measure– elimination of factors influencing the development of this disease and regular visit gynecologist.

Content

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

What is chronic endometritis

If we speak in accessible language, then this is the name for a gynecological disease of a chronic nature that affects inner layer uterus The causative agents of infection can be bacteria or viruses. As a result of the activity of these microorganisms, endometrial rejection and growth are disrupted. The result is uterine bleeding, menstrual irregularities, and miscarriages. Endometritis is a cause of infertility. The disease can be atrophic, cystic and hypertrophic.

Symptoms

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

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

Discharge

The consistency, color and amount of discharge may vary from woman to woman. This 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, blood may be present in the discharge. Ichor on the background of the chronic stage of this disease saved long time.

Menstruation with endometritis

Another characteristic feature development of endometritis in a woman - menstrual irregularity. It can manifest itself in different ways:

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

Echosigns

That's what they call the complex pathological changes, which are found in the uterine cavity during ultrasound examination(ultrasound). Using this procedure, you can study the size and position of the reproductive organ, the condition of the uterine cavity and inner surface. Ultrasound signs of chronic endometritis are as follows:

• backward bending of the uterine body – retroversion;
• increased or decreased size of the uterus;
• decrease or increase in the thickness of the endometrium, the formation of cavities in it;
• gas accumulations;
• the appearance of areas of sclerosis, fibrosis or calcification;
• heterogeneous myometrial surface;
• adhesions in the uterine cavity, which are visualized as hyperechoic areas.

Reasons

There are many factors that can lead to endometritis becoming chronic. They are divided into specific (viruses and bacteria) and nonspecific, 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 mucous membrane;
• improperly performed douching;
• birth injuries cervical membranes;
• 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 during probing of the uterus;
• sexual intercourse during menstruation;
• remains of placenta, decidual tissue, blood clots or ovum(causes of postpartum endometritis).

Exacerbation of chronic endometritis

The disease begins with acute endometritis and only then becomes chronic. It is characterized by less severe symptoms, which do not cause discomfort to the woman, but the disease develops during this period and affects the genitourinary system. Sometimes exacerbation of endometritis occurs. It is characterized by an intensification of 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 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 expectant mother is under constant medical supervision. If endometritis is not treated, even the IVF procedure will not help pregnancy.

Diagnostics

If characteristic symptoms of chronic endometritis appear, you must immediately contact a gynecologist to confirm the diagnosis. For this purpose, the following studies are carried out:

• hysteroscopy;
• examination by palpation, ultrasound of the uterus and its appendages;
• sowing the material taken during hysteroscopy to determine the infectious agent;
• vaginal smear for flora;
• blood test for hormone concentrations;
• general urinalysis.

Treatment of chronic endometritis

Treatment for chronic endometritis can begin 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 body. In general, therapy is carried out in 3 stages:

1. Elimination of endometrial infection, 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 endometrial structure. At this stage main role physiotherapeutic methods play a role - mud therapy, magnetic therapy, laser therapy, plasmaphoresis, iontophoresis with zinc or copper. Additionally, the hormones estrogen and progesterone are prescribed.

Medicines

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

1. Broad-spectrum antibiotics. After identifying the causative agent of the infection, the doctor prescribes medications from this group. If the disease is caused 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, Dimexide, Chlorhexidine, Novocaine, Calendula, Lidaz and Longidase are used. They are used in rinsing courses of 3-5 procedures.
3. Metabolic drugs. This group includes aloe extract, Actovegin and vitreous. They promote endometrial regeneration and stimulate local immunity.
4. Hormonal drugs. Necessary for decreased 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, and therefore 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. Used for antibacterial therapy the following drugs:

1. Ceftriaxone. Based on the active substance 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 large number adverse 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. Has few contraindications, but big list side effects.

Hormone therapy

The purpose of hormonal medications is to restore the normal monthly cycle. Their therapy necessarily takes into account the patient’s age and the severity of the disease. No less important is how severe the violations are hormonal levels. To restore it, the following drugs are prescribed:

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

Treatment with folk remedies

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

1. In equal proportions, take cherry and nettle leaves, pine buds, wormwood, sweet clover, dried sweet grass, lavender, marshmallow and Leuzea roots. After grinding 2 tbsp. pour 0.5 liters of boiling water over the raw materials and leave in a thermos for 12 hours. Use 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 throughout the day. Treat endometritis with this remedy for 4-6 weeks.

Prevention

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

• follow your doctor's recommendations when using an intrauterine device as contraception;
• stick to the rules intimate hygiene;
• refuse abortion;
• use barrier contraception in the form of condoms to avoid sexually transmitted infections;
• prevent postpartum infections.

Video

Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

Found an error in the text? Select it, press Ctrl + Enter and we will fix everything! Contents of the article:

Chronic endometritis in women can lead to serious problems with reproductive function and cause the development of pathological hyperplastic processes in the uterine cavity. Therefore, timely detection and treatment of chronic endometritis is very important for maintaining a woman’s health.

U healthy women, without gynecological problems, there should be no microorganisms in the uterine cavity. That is, it must be completely sterile. But the vaginal environment normally contains microflora, represented by different types of bacteria. Microorganisms cannot penetrate the uterine cavity because the cervix prevents them. But there are cases when they still enter the uterus, and an inflammatory process (chronic or acute) develops in the endometrium, known as endometritis.

In chronic endometritis, the functional and basal layers of the endometrium are involved in the inflammatory process. At severe forms The disease also affects the myometrium. Inflammatory changes lead to disruption of endometrial growth and its rejection. Because of this, problems with the cycle often arise, uterine bleeding. As a result, it is possible serious consequences: recurrent miscarriage or infertility.

In different population groups, the incidence of chronic endometritis varies wide range– from 0.2% to 66%. On average, it reaches 14%, which means the disease is quite common.

Types of chronic endometritis

According to morphological characteristics, chronic endometritis is divided into 3 types:

- Atrophic endometritis(glands atrophy, stromal fibrosis occurs, it is infiltrated with lymphoid elements).

- Cystic endometritis. Develops when glandular ducts become compressed fibrous tissue. The contents of the glands begin to thicken, which leads to the formation of cystic formations.

- Hypertrophic endometritis. This variant of the disease is associated with hyperplasia of the mucous membrane.

Classification of chronic endometritis according to ICD-10

N71.1 Chronic inflammatory diseases uterus

Etiology of chronic endometritis

In medical practice, there are quite often cases when the primary pathogen loses its influence on the inflammatory process, and further development illness associated with secondary infection. The disease is aggravated by dysbiosis resulting from drug therapy, as well as superinfection (autoinfection with opportunistic organisms).

The presence in the vagina of microbes classified as facultative anaerobic (genital mycoplasmas, Proteus spp., E.coli, S.aureus) and an increase in the number of anaerobic organisms (bacteroides, gardnerella, vibrios) can provoke the development of an ascending infectious process in the endometrium.

What microorganisms are the main causative agents of chronic endometritis?

When examining patients diagnosed with chronic endometritis, it was revealed that typical specific pathogens are:

Genital herpes virus.

Treponema (the causative agent of syphilis).

Candida (a fungus that causes thrush in women).

Mycobacterium tuberculosis.

Recently, cases have become increasingly common when chronic endometritis is associated simultaneously with several (usually two or three) types of microorganisms. Some of the potential causative agents of endometritis can be present in a woman’s body for many years without making themselves known. And then, for unknown reasons, these organisms suddenly cause the development of an inflammatory process. These bacteria include, first of all, staphylococci, streptococci, and E. coli.

https://genitalhealth.ru/pics/2016/12/1481548983_9827.jpg" alt=" Symptoms of chronic endometritis" width="550">!}

A feature of chronic endometritis is that it can develop asymptomatically for a long time. Or the symptoms are so mild that the patient ignores them and does not seek help.

Clinical manifestations of endometritis are associated with depth morphological changes in the area of ​​inflammation and their duration. The main symptom of the disease is bleeding. Desquamation and regeneration of the epithelium occur incorrectly, which is why patients note spotting before and after menstruation. Median discharge with blood is due to the fact that during ovulation vascular permeability increases.

Secretory function in patients with endometritis may be impaired. This is manifested by pathological serous or serous-purulent discharge. Patients often complain of pain in the lower abdomen. The pain is usually aching in nature. Possible reproductive problems: infertility or spontaneous abortion.

The inflamed endometrium is characterized by hyperemia and sometimes necrotization. The discharge becomes scanty and purulent-mucous. Symptoms are not as pronounced as with acute form diseases, so there may be problems with diagnosis. The general condition does not suffer, body temperature is not elevated. Endometritis is characterized by menstrual irregularities (menorrhagia, metrorrhagia). This is due to the fact that the process of desquamation and repair of the endometrium occurs with disturbances. The patient's uterus is enlarged, hardened, and painful during gynecological examination.

Methods for diagnosing chronic endometritis

Study of anamnesis

The history of patients with endometritis usually includes repeated intrauterine interventions and the use of an IUD. Infertility and spontaneous abortions are also common. Many of the patients had suffered acute endometritis in the past.

Physical examination

Usually patients are in satisfactory condition. Using bimanual palpation, you can detect the compactness of the uterus and its mild enlargement, sometimes mild pain on palpation.

Laboratory tests

If chronic endometritis is suspected laboratory research samples of vaginal discharge and discharge from the cervical canal are subject to examination. You also need to do clinical analysis blood. If the diagnosis is confirmed, the patient is referred to additional diagnostics, the purpose of which is precise definition pathogen.

The type of pathogen is identified by inoculating material from the uterine cavity. This analysis not only accurately identifies the pathogenic organism, but also makes it possible to determine which antibiotics the pathogen is most sensitive to.

To find out whether there is an active viral infection in the patient’s body, they resort to the ELISA method - testing the blood for the presence of antibodies. This test can detect cytomegalovirus and herpes virus. Viruses are also well identified using PCR diagnostics samples of material taken from the uterine cavity. The same method allows you to detect the presence of pathogenic bacteria.

To identify the inflammatory process in the cervix and vagina, a smear analysis of the flora is performed.

After laboratory diagnostics, the patient is treated for all identified inflammatory processes.

Those who have reproductive problems are referred to a consultation with an endocrinologist and undergo hormonal testing.

Hysteroscopy

During hysteroscopy, chronic endometritis is manifested by hyperemia of the walls of the uterus, which are flabby and bleed easily at the slightest touch. There may also be areas of hypertrophied and edematous mucosa with a whitish or yellowish color. Hysteroscopy of the uterus is best performed in early phase proliferation, on the 1st day.

Photo of chronic endometritis

Diagnostic curettage

In order to put final diagnosis, the endometrium is scraped and the resulting material is sent for histological examination. In order for the result of the study to be as accurate as possible, curettage of the cavity must be carried out in the first phase of the cycle. During histological examination scraping, you can perform an immunohistochemical assessment of the receptor activity of the endometrium and determine its immune status.

In some cases, to obtain a more accurate idea of ​​the pathological process, they resort to the method of ultrasound examination of the pelvic area.

To identify the adhesive process in the uterine cavity and tubes, X-ray examination With contrast agent- hysterosalpingography.

Differential diagnosis of chronic endometritis

During diagnosis, endometritis must be distinguished from other gynecological pathologies that lead to miscarriage and infertility. Patients with such reproductive disorders are usually referred for examination by a geneticist and a gynecologist-endocrinologist.

Pregnancy and chronic endometritis

Unfortunately, this inflammatory disease often becomes a serious obstacle to motherhood. Patients with endometritis face infertility and spontaneous interruption pregnancy.

Carrying a pregnancy to term becomes impossible due to the fact that the fertilized egg fails to implant into the endometrium, which is susceptible to inflammation. And if implantation does occur, the embryo begins to be rejected and the pregnancy is terminated. If a patient experiences two or more miscarriages/miscarriages in a row, then we can talk about recurrent miscarriage. A successful IVF procedure in such patients will be impossible.

But infertility in similar cases is not a sentence. Chances of carrying and giving birth healthy child significantly increase after adequate treatment of chronic endometritis.

Treatment of chronic endometritis

The course of therapy is prescribed to the patient based on the diagnostic results. The standard regimen involves drug treatment (taking antiviral or antibacterial drugs). Medicines that normalize microcirculation, vitamins, and proteolytics are also prescribed. They often resort to physiotherapy, and in some cases, hormone treatment is prescribed.

Therapy for endometritis is aimed at increasing the regenerative properties of the endometrium, normalizing the menstrual cycle and eliminating reproductive problems.

Non-drug methods of treating chronic endometritis

Physiotherapy improves hemodynamics, normalizes the function of the endometrium and ovaries, increases immunological reactivity. Most commonly prescribed are UHF, microwaves, zinc or copper electrophoresis, and pulsed ultrasound.

Mud procedures have a good effect, radon waters, paraffin, and ozokerite are useful. Great benefit brings sanatorium treatment.

Drug therapy for chronic endometritis

Courses of drug therapy involve taking drugs to treat concomitant diseases, as well as general strengthening medications. Some patients are prescribed vitamins, sedatives and desensitizing agents.

If it has been identified bacterial infection, then in mandatory antibiotics are prescribed. But there is no single scheme for all cases, since different types bacteria are sensitive to various antibiotics. A treatment plan for a specific patient is developed taking into account the underlying cause of chronic endometritis.

If the patient has been diagnosed with genital herpes, you will need antiviral therapy. In such cases, it is also indicated, as well as means that help improve immunity.
If the smear revealed thrush or bacterial vaginosis, these infections must be treated.

Good results can be achieved by introducing drugs (including antibiotics) into the uterine mucosa.

Gonovaccinotherapy is the introduction of microbial bodies into the patient’s body, the total dosage for the entire course is 2 ml of gonovaccine. If ovarian hypofunction is detected, cyclic hormone therapy is prescribed. During menstruation, it is recommended to take broad-spectrum antibacterial drugs. In case of bleeding, hemostatic therapy is carried out.

Hormonal therapy for chronic endometritis

Since chronic endometritis is not just an inflammatory process, but also a pathology of endometrial growth and rejection, many patients are prescribed hormonal agents. First of all, the technique shown oral contraceptives. The course of such therapy usually lasts from three months to six months. After treatment, women's cycle returns to normal, and they may become pregnant (against the background of withdrawal syndrome).

Surgery for chronic endometritis

Surgical treatment of chronic endometritis is indicated if the patient has intrauterine synechiae (they are diagnosed using hysteroscopy).

We must not forget that a successful result is possible only with integrated approach to treatment. Biological and pharmacological methods are combined with physiotherapy and balneotherapy.

Prognosis for chronic endometritis

If the diagnosis is made accurately and adequate treatment is started in a timely manner, the prognosis is favorable.

Consequences of chronic endometritis

Most often, complications of chronic endometritis are hyperplastic processes with the formation of:

Endometrial and cervical canal polyps,

Endometriosis,

Adhesions (intrauterine synechiae),

Adhesive processes in pipes,

Endocervicitis,

Erosion,

Infertility,

Miscarriage.

Prevention of chronic endometritis

One of the complications of endometritis is adhesions in the uterine cavity (synechia). They are dangerous because they can lead to infertility. To prevent their formation, the patient is prescribed proteolytic treatment (Longidaza, Wobenzym). The same drugs can be used to destroy existing synechiae.

To improve local metabolic processes and normalize microcirculation, vitamin preparations, laser therapy, and electrophoresis are prescribed.

Planning pregnancy after treatment of chronic endometritis

When the course of therapy is completed, the patient is sent for re-examination. It involves a pelvic ultrasound, vaginal smear, endometrial biopsy, hormonal tests (if there are cycle disorders).

If the examination shows that the endometrium has been restored and there are no signs of inflammation, the patient can plan a pregnancy.

Inflammatory diseases of the female reproductive system are a common gynecological problem.

In approximately 40% of cases of secondary infertility, the cause is chronic endometritis.

More often, the disease is a consequence of untreated acute endometritis caused by trauma, infection of the endometrium during childbirth, abortion, and intrauterine interventions.

The asymptomatic course of the chronic inflammatory process greatly complicates diagnosis. Often, pathology is detected by chance, during a preventive examination.

Reasons

Chronic endometritis is an inflammation of the basal layer of the endometrium which is caused by a bacterial, fungal, viral or protozoal infection.

In the background chronic inflammation the physiological cycle of development and rejection of the functional layer of the endometrium is disrupted, which manifested by menstrual irregularities.

With chronic endometritis, uterine bleeding, recurrent miscarriage, and infertility may occur.

Prerequisites for the development of the inflammatory process may be trauma to the uterine mucosa, the presence of an infectious agent.

Inflammation begins and proceeds acutely and becomes chronic. In this case, clinical manifestations subside, the influence of infection is reduced to a minimum.

Depending on the nature of the pathogen, inflammatory reactions may be specific or nonspecific.

Specific endometritis cause pathogenic microorganisms penetrating into the uterine cavity from the overlying or underlying parts of the reproductive system.

Chronic nonspecific endometritis are caused by representatives of opportunistic flora that normally live in the vagina, on the surface of the skin, and the mucous membrane of the rectum.

This disease can develop against the background of an intrauterine device, HIV, or the use of hormonal drugs.

More often, the chronic form of the disease occurs when mycoplasma infection, coli, some strains of human papillomavirus.

Provoking factors:

• intrauterine interventions, medical abortion, curettage of the uterine cavity, biopsy, embryo transfer, hysteroscopy;
• complicated childbirth;
• introduction of an intrauterine device, its prolonged use;
• vaginitis, cervicitis, cervical erosion without treatment;
• surgical treatment of diseases of the pelvic organs;
• sexually transmitted diseases.

In approximately 30% of cases, the cause of the disease cannot be determined.

Infection of the injured uterine cavity leads to the development of an acute inflammatory process; when the disease passes into the chronic stage, the role of infection sharply decreases.

Physiological and structural disorders predominate at this stage, leading to disorders of the menstrual cycle and reproductive function.

According to the course of the disease, they are distinguished:

1. Often relapsing form.
2. Chronic inflammation in a phase of stable remission.
3. Exacerbation.

Depending on the morphological changes of the endometrium, there are:

• hypertrophic;
• atrophic;
• cystic endometritis.

Atrophic type changes lead to depletion and fibrosis of the mucous membrane. It is this form of pathology that most often leads to uterine infertility.

For hypertrophic endometritis the functional layer of the endometrium grows excessively; the cystic variation is characterized by fibrosis and the formation of cystic cavities.

The ICD-10 code for chronic endometritis is N71.9.

More about endometritis and methods of its treatment:

How to identify: symptoms, signs, pain, discharge

Symptoms of the disease are nonspecific and mild, so many women don't take them seriously.

Manifestations of malaise are sometimes attributed to the consequences of overwork, inappropriate posture during intimate contact, and diseases not associated with lesions of the reproductive system.

In chronic endometritis the following are observed:

• menstrual irregularities (scanty or too heavy discharge during menstruation, spotting during the intermenstrual period, delayed menstruation);
• , appearing against the background of physical activity, before menstruation;
• discomfort or pain during sexual intercourse;
• purulent or mucous discharge with an unpleasant odor;
• general weakness, increased fatigue;
• increased body temperature in the evenings, at night;
• chills;
• miscarriage.

With mild chronic endometritis, there may be no subjective complaints at all. The disease is detected during an examination for infertility.

Outside of exacerbations, a woman may be bothered by the following symptoms:

• discomfort or pulling sensations in the lower abdomen before menstruation;
• irregular periods;
• heavy discharge after menstruation.

Pain in chronic endometritis is usually aching or pulling, tolerable, sharp sensations may appear during intimacy.

Color, consistency, amount of discharge vary greatly, they can be brown, greenish-yellow, mucous or purulent.

Why it’s dangerous: possible consequences, complications

The most common complication inflammatory diseases reproductive organs — infertility.

If pregnancy does occur, chronic endometritis is a prerequisite for its complicated course.

Against the background of pathology possible high or low water levels, disturbances of fetoplacental blood flow, intrauterine infection of the fetus.

Inflammatory processes in the uterus are risk factors for the development of other pathologies:

• ectopic pregnancy;
• endometrioid disease;
• hyperplastic diseases of the endometrium;
• inflammatory and purulent-inflammatory diseases of the pelvic organs;
• tumors and

Diagnostics

If you suspect possible lesions reproductive organs you need to contact a gynecologist.

The earlier the disease is detected, the higher the chances of successful treatment and restoration of reproductive function.

To diagnose chronic endometritis, the following are carried out:

• microscopic examination of a vaginal smear;
• bacterial culture from the endocervix;
• determination of hormonal activity of the ovaries;
• Ultrasound of the uterus and appendages.

According to indications, they can be prescribed hysteroscopic examination, endometrial biopsy.

Ultrasound reveals pronounced changes in endometrial thickness and blood vessels uterus, expansion of the uterine cavity, adhesions, cords and other connective tissue formations.

Methods for diagnosing endometritis:

Treatment regimen

Therapy for chronic endometritis is carried out in several stages with periodic monitoring of the effectiveness of treatment.

IN complex therapy includes:

1. Elimination of infection.
2. Strengthening the immune system.
3. Normalization of metabolic processes.
4. Treatment with hormonal drugs.

More often, gynecologists are faced with chronic inflammation of bacterial origin.

Drugs

The course of treatment begins with antibacterial drugs; treatment of chronic endometritis with antibiotics is more often used Metronidazole, Cefotaxime, Amikacin.

Antibiotics are administered intravenously, using droppers. Infusions are carried out 2 times a day. Amikacin is used as an intramuscular injection.

To normalize the menstrual cycle for patients prescribe contraceptives.

The drug is selected individually, taking into account age, general condition health and other characteristics of the body. Minimum course duration hormone therapy- 3 months.

After hormonal treatment prescribed for pregnancy Utrozhestan or other progestin drug. Among the more common methods of strengthening immune defense- use of immunostimulating drugs in the form of vaginal or rectal suppositories.

To restore normal metabolic processes in the endometrium, the patient is prescribed course of antioxidant and metabolic drugs, vitamin therapy.

Additionally, physiotherapeutic treatment is prescribed; the complex of procedures may include: phonophoresis, laser therapy, magnetic therapy, electrophoresis.

The greatest effect is observed after a course of electrophoresis with copper and zinc ions and microwave therapy.

The effectiveness of treatment is assessed according to several criteria:

1. Removal of the infectious agent.
2. Normalization of the menstrual cycle.
3. Elimination of symptoms of inflammation.
4. Restoring fertility.

How to cure with folk remedies

Inflammation of the uterus can be treated with herbal infusions.

To prepare the collection, take pine buds, cherry leaves, nettles, sweet clover grass, wormwood, lavender, cudweed, Leuzea roots, and marshmallows in equal parts.

Plant materials are crushed and mixed. Brew two tablespoons of the mixture in 0.5 liters of boiling water and leave in a thermos for at least 12 hours. Take a third of a glass 3-5 times a day. The course of treatment is 2 months.

In equal parts, take chamomile flowers, viburnum bark, mint, motherwort, thyme, shepherd's purse, and mantle leaves, chop and mix. Prepare and take the infusion according to the scheme indicated above.

For maximum effect two courses of treatment with different preparations must be carried out sequentially.

For endometritis You can take a decoction of St. John's wort. 1 tbsp. Pour a glass of boiling water over the chopped herbs and boil for 15 minutes. Strain the cooled broth, take a quarter glass three times a day.

St. John's wort is contraindicated in cases of exacerbation of inflammation, as well as in patients suffering from hypertension.

Can be used to treat inflammation tampons with sea buckthorn oil.

Used in a course for 10 days. It is better to coordinate treatment with traditional methods with your doctor.

At correct use funds traditional medicine noticeable improvement occurs approximately a week after the start of treatment.

The patient is worth be patient and complete the entire recommended course.

Is it possible to get pregnant: pregnancy before and after recovery

One of the most pressing symptoms of chronic endometritis is reproductive dysfunction, which may manifest itself as inability to conceive or miscarriage.

IVF attempts in such patients often end unsuccessfully. In the early stages of a chronic inflammatory process, pregnancy is possible, but in most cases it occurs with complications.

After treatment, chances of getting pregnant and giving birth healthy baby increase significantly.

Inflammatory processes in the uterus are incompatible with IVF.

If chronic endometritis is detected, before IVF, both a course of treatment according to the standard regimen and mandatory prevention of post-inflammatory complications are prescribed.

After treatment, the chances of a successful embryo transfer increase, but it is impossible to guarantee the success of the procedure in advance.

When pregnancy occurs the expectant mother is under close medical supervision and regularly undergoes preventive therapy to prevent complications.

Enhanced medical supervision is also required when pregnancy occurs against the background of endometritis. There is no treatment for the pathology at this time; therapy is aimed at maintaining the pregnancy.

What to do to prevent the disease

The chronic inflammatory process in most cases is preceded by an exacerbation of endometritis.

Among preventive measures, timely and correct treatment of inflammatory diseases of the reproductive system.

The risk of developing the disease is reduced by strictly following the doctor’s recommendations when using an intrauterine device, preparing for diagnostic and medical procedures in the uterine cavity.

Important compliance with the rules of intimate hygiene and hygiene of sexual life.

Patients with chronic endometritis rarely achieve full recovery. But the course of treatment helps to achieve a state in which it is possible to conceive, carry and give birth to a healthy child.

Endometritis is an inflammatory process in the tissues lining internal cavity uterus The cause of the disease is the penetration of various infectious agents- fungi, bacteria and viruses. Endometritis often 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 deeper and affects muscle tissue.

If endometritis is not treated, it leads to adhesions inside the uterus and in abdominal cavity, and can also cause inflammation in others internal organs. In the absence of proper therapy, endometritis is often the cause of infertility, and can also be accompanied by the appearance of cysts.

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

Types of endometritis

Endometritis is classified according to its form:

• spicy;
• chronic.

Symptoms, timing and treatment methods are different in each case. At the same time, chronic endometritis always develops against the background of untreated or proceeded without obvious pronounced signs acute diseases.

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 decreased immunity or disruption of the integrity of the endometrium, affect the mucous membrane of the uterine cavity.

Pathogenic microorganisms, infections and viruses can enter the uterus either ascendingly (through cervical canal cervix), and along the descending path (from fallopian tubes, inflamed appendix, etc.).

Most common cause the occurrence of an inflammatory process in the endometrium is mechanical damage lining of the uterus caused by naturally or surgery. These include:

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

In all of these cases, the endometrium lining the uterine cavity peels off from it in large pieces, exposing large areas of unprotected walls of the organ. Bacteria and infections that fall on them, brought through surgical instruments or naturally, they find themselves in a favorable environment for their reproduction.

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

Inflammation can also be caused by:

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

There are also risks of endometritis during normal menstruation. Blood, which, together with endometrial cells, is removed from the uterine cavity, has a specific effect on 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 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, which multiply at high speed in a warm and humid environment.

Intrauterine devices can also be a source of infection if they are not installed correctly or are located in the uterus more required period, they cause damage to the endometrium and can provoke an inflammatory process.

During endometritis, a woman may feel:

• nagging pain in the lower abdomen, radiating to the anus;
• general weakness;
• headaches;
• depressed emotional state or sudden changes moods.

Objective signs of endometritis

Signs of acute endometritis include:

• increased body temperature, accompanied by chills and subsequent fever;
• nausea and vomiting;
• unusual vaginal discharge (with an unpleasant odor, mixed with pus, blood);
• soreness of the uterus on palpation, and its increased 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 low and can be easily confused with other ailments. Only a gynecologist can detect the disease through a survey, examination, laboratory and instrumental studies. Also, with endometritis, menstrual irregularities are often observed - the discharge changes in character, it can become scanty or, on the contrary, abundant. The period of blood discharge after the end of menstruation itself increases significantly. Throughout the entire cycle there are weak nagging pain lower abdomen.

With long-term chronic endometritis, secondary infertility may occur.

In the acute form, from the moment of infection of the endometrium by pathogenic bacteria and viruses to the clinical manifestations of the disease, it takes from 1.5 to 4 days. Endometritis caused by surgical interventions manifests itself most quickly. With chronic endometritis, the process can last for several months.

Diagnosis of endometritis

Diagnostic methods

When a patient contacts her, the gynecologist first examines the history of the disease, finds out the number of pregnancies and births, abortions and spontaneous miscarriages.

A gynecological examination is the next mandatory diagnostic point. During palpation, the doctor determines the size of the uterus, how different they are from the norm, and monitors the pain of the reaction to the manipulations performed. Also during the examination, the doctor assesses the nature of vaginal discharge.

Acute endometritis is characterized by sharply increased size of the uterus and pronounced painful sensations. In chronic endometritis, the pain is mild, the uterus is slightly enlarged.

Laboratory diagnostics. The patient must undergo a general blood test. Increased performance 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 mucous membrane of the vagina and cervical canal.

The type of bacteria that caused the inflammatory process can be determined by bacteriological examination of the vaginal microflora.

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

Additional diagnostic methods

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

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

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

Hysteroscopy is an endoscopic diagnostic method. During the procedure, a specialist carefully examines the mucous membrane of the uterine cavity. For endometritis inner shell The uterus has a bright red color and a loose structure. It bleeds at the slightest touch to the walls of the uterus. The cavity may also contain blood clots.

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

Treatment of endometritis

Treatment methods for acute endometritis

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

Without waiting to receive bacteriological research broad-spectrum antibiotics are prescribed. 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 prescribed for endometritis are:

• painkillers and antipyretics;
• antibacterial drugs local action, for example, vaginal suppositories;
• uterine contractants;
• vitamins.

To prevent bleeding and to reduce severe painful sensations 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 that improve blood flow in the uterus and prevent the appearance of adhesions.

Treatment of chronic endometritis

Treatment of chronic inflammation of the endometrium is a longer process, but the stages of treatment are similar - it must be carried out antibacterial therapy, after which they are appointed hormonal drugs. They are necessary to restore endometrial function and normalize the menstrual cycle.

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

Physiotherapeutic procedures are mandatory as part of the treatment of chronic inflammation of the endometrium. These include:

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