Endometritis

Introduction

• Description: Endometritis is an acute or chronic inflammation, usually of infectious origin, of the lining of the uterus. This is a general term that is used for this condition in either nonpregnant or not recently pregnant patients; chorioamnionitis or endomyometritis are the terms commonly used for pregnant or recently pregnant patients. Acute endometritis is often characterized as an intermediate state in infections ascending from the cervix to the fallopian tubes, ovaries, and pelvis, characterized by the presence of microabscesses or neutrophils within the endometrial glands. Chronic endometritis is notable for variable numbers of plasma cells within the endometrial stroma. The clinical signs and symptoms of both are similar.

• Prevalence: 75% of patients with pelvic inflammatory disease; 40% of patients with mucopurulent cervicitis.

• Predominant Age: Reproductive age.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Aseptic inflammation of the endometrium is commonly found in users of intrauterine contraceptive devices (IUDs). Infection by organisms ascending from the cervix and lower tract are common (most often Chlamydia trachomatis, Neisseria gonorrhoeae, Ureaplasma urealyticum , and Streptococcus agalactiae ). Less common are infections by Actinomyces israelii or tuberculosis. Salpingitis is associated with a 70%–90% chance of acute endometritis. In approximately one-third of cases of chronic endometritis no cause can be established.

• Risk Factors: IUD use, intrauterine instrumentation (biopsy, hysterosalpingography), cervicitis, sexually transmitted infection (STI), retained products of conception.

Signs and Symptoms

• Asymptomatic

• Dysfunctional uterine bleeding (typically intermenstrual)

• Postcoital bleeding

• Foul-smelling cervical/vaginal discharge

• Pelvic inflammatory disease

• Chronic pelvic pain

• Tubo-ovarian abscess

• Infertility (rare cause)

Diagnostic Approach