- 1 What is endometritis?
- 2 What is endometriosis?
- 3 Difference between endometritis and endometriosis
- 4 Endometritis symptoms
- 5 What causes endometritis?
- 6 Postpartum endometritis treatment
- 7 Chronic Endometritis Treatment
- 8 Antibiotics for Chronic Endometritis
- 9 Endometriosis Antibiotics
- 10 Endometritis treatment with Metronidazole (Flagyl)
- 11 Endometritis Treatment with Doxycycline
What is endometritis?
Endometritis is an inflammatory disease of the internal mucous coat of endometrium. According to the scientists, this disease is one of the main factors of the reproductive function disorder in women. The endometrium is required to attach the fertilized ovum to the uterus and for the development of a fetus. The peak of endometritis falls to the age of 25-35 during the most active sexual function. Due to the inflammatory process, the fertilized ovum is not able to attack to the uterus. But there is also a risk that the ovum dies under the influence of the pathogenic organisms, and a miscarriage happens.
The inflammatory disease is developed during an infection penetration into the mucous coat of the endometrium. The most frequent agitators of the infection are staphylococci, streptococci, or gonococci, and also E. coli.
A danger of endometritis is a fast progression. An infection may affect the fallopian tubes, deep layers of the endometrium, and induce a development of the infertility. The inflammatory process is acute on the mucous coat of the endometrium but many women do not notice the symptoms, or confuse them with other pathologies.
What is endometriosis?
Endometriosis is a pathological growth of the endometrium cells (the internal mucous coat of the uterus). The ingrowth of the endometrium cells into the tissues of the ovaries, fallopian tubes, and urinary bladder happens during this disease. The movement of the cells of the mucus happens during the menstruation.
- pain during sexual intercourse,
- pain during urination and defecation,
- excessive bleeding during the periods,
- and infertility.
The Endometriosis is often met in women at the age of 20 to 45. A cunning of the disease consists in an asymptomatic course within a long period. According to the scientists, every 5th woman in the world has Endometriosis. It is believed that the disease is developed due to the pathologies of the uterine tissue, nevertheless, the disease often affects other organs.
Endometriosis is a disease that may be detected in other organs, not necessarily genitals.
There is genital type of the disease (Endometriosis of uterine and ovaries) and extragenital type (Endometriosis of the intestine, belly-button, internal organs) depending on a site of the growth of the mucus coat.
This disease has been obscure within a long period because it is latent and rather difficult to detect it. Due to this, doctors still cannot tell the exact causes of Endometriosis. It is believed that a genetic predisposition is a base of this disease. But to activate Endometriosis, a gene mutation, or initiating agents are needed. It may be a prolonged inflammatory process on the mucous coat of the endometrium, or an infectious diseases of the genitals.
Difference between endometritis and endometriosis
The diseases of the endometrium belong to the most common gynecological pathologies. Endometrium is an internal layer of the uterine that plays an important role in the reproductive function. But it is not protected well, and this is a cause of the numerous pathologies of the endometrium.
Endometritis and Endometriosis are concordant diagnosis but they have different course and symptoms:
- Endometritis is an infectious inflammatory disease of the endometrium. It appears due to the developed pathogenic organisms on the mucous coat or in case of the hormonal imbalance.
- Endometriosis is not an inflammatory disease. Another pathological process is the key: a growth of the tissue that is similar to endometrium beyond the mucous coat of the uterine cavity.
Basic difference between endometritis and endometriosis:
The symptoms of the endometritis are obvious on the fourth day after the infection. Bleeding, lower abdominal pain, painfulness during the urination, bloody-purulent discharges may occur. It is acute or chronic.
The symptoms of the endometriosis have severe bleeding during the periods, pain during the sexual intercourse, dragging pain in the back.
- Affected region.
The endometritis affects only the external cells of the mucus of the endometrium. The endometriosis affects the entire surface of the endometrium and even deep tissues. The disease may spread outside the genitals, for example, intestine.
The endometriosis is detected by means of the ultrasound imaging and a deep diagnostic. The endometritis is easily detected during the common gynecological examination and by the blood test results.
The administration of the antibiotics gives a good result even during the neglected types of the endometriosis, and the symptoms quickly pass. To treat the endometriosis, the pharmaceutical treatment is often ineffective, and patients get a surgical intervention.
There are two types of Endometritis: acute and chronic.
In case of the acute type of the disease, the symptoms are more intensive. The chronic type of Endometritis may be asymptomatic within a long period. Any infectious inflammatory process is accompanied by the increase of the body temperature. This is the first symptoms of the acute Endometritis.
As a rule, the symptoms develop in 4-5 days when the pathogenic organisms have reached the mucous coat. Other definitive symptoms also appear after the increase of the body temperature:
- Purulent uterine discharges with a bad smell;
- General fatigue;
- Acute lower abdominal pain;
- Altered defecation pattern;
- Painful urination.
The symptoms of the acute Endometritis may be confused with any infectious disease of the genitals. But unlike sexually-transmitted diseases, the body temperature goes up to 38 degrees Celsius during Endometritis, like during any other infectious disease.
The symptoms of the chronic Endometritis are less intensive. The body does not react to the increase of the body temperature to the inflammatory process. But women have other symptoms:
- Disorder of the periods (excessive bleedings);
- Purulent or bloody discharges between the periods;
- Dull lower abdominal pain;
- Pain during the sexual intercourse.
Chronic Endometritis is dangerous because many women do not pay attention to the first symptoms and postpone the gynecologist visit. The chronic type of the pathology quickly induces changes in the structure of the endometrium, and it increases a risk of the infertility development and endometriosis. When the inflammatory process affects the deep cells of the endometrium, more serious complications occur.
What causes endometritis?
The disease always appears as a result of the pathogenic organisms in the cells of the endometrium. There are usually several natural physiological barriers that prevent the infection entry. A main cause of the Endometritis is a disorder of the protective barriers of the uterine during the infection.
If we classify the endometritis as to the main causes, there are 4 groups:
- Traumas of uterus, uterine neck, vagina during labours, perineal tear.
- Mechanical, chemical affections of the mucous coat of the vagina.
- Incorrect hygiene of the genitals.
- Sexually-transmitted diseases.
Endometritis often appears due to the mechanical affections of the genitals. The wound gets the pathogenic organisms that affects the endometrium. But in 60% of cases, the disease appears because of the incorrect hygiene of the genitals and STI.
- Using tampons more than 6-7 hours (seldom tampon change);
- A long-term application of the loop;
- Poor hygiene;
- Frequent syringing;
- Seldom change of underwear;
- Using synthetical underwear.
As a rule, the female body blocks the movement of bacteria up to the uterine neck and excretes it naturally. In case of the poor hygiene, these discharges are left on the walls of the vagina, clothes, and bacteria have a chance to quickly replicate.
Moreover, endometritis often appears during the sexually-transmitted infections. At first, they affect the external genitals but if the treatment is neglected, they go up to the uterus. Therefore it is very important to follow the hygiene (especially during the periods). Women have to take the tests every year in order to detect infections: blood test and bacterial swab test.
Postpartum endometritis treatment
Endometritis may develop after miscarriages, endometrial examinations, but it is more often met after labours. The inflammation of the uterus may depend on two factors. The uterus is one, vast wound surface during the labours. As any wound, it may be inflamed under the action of the pathogenic organisms. Also, women have the immune suppression after the labours, and it just induces the inflammatory processes.
As we have said, the own microflora plays an important role as an infectious organism. The opportunistic pathogenic bacteria living in the vagina and intestine are activated during the decrease in immunity. These are hidden chronic STIs which a woman does not know about. So, do not blame a doctor during the development of the postpartum endometritis. The labours could be sterile and bacteria may enter from inside.
The diagnostics of the postpartum endometritis is not difficult during the regular examination in the maternity hospital. The inflammatory process may be detected in 3-4 days after labours. In case of the endometritis, a general blood test is taken.
If the diagnosis is confirmed, there are two options:
- If a woman is still in the maternity hospital, she is referred to the special department, where all women with the postpartum complications are kept.
- If the disease is detected after the discharge from the hospital, hospitalization is needed.
Endometritis is usually treated at home, without hospitalization. But the postpartum endometritis may have serious complications such as:
- A development of pelvic abscess and blood clots.
- A development of the contagious lining that covers the internal surface of the stomach and abdominal cavity organs;
- Destruction of the endometrium cells (as a result – infertility).
So, the postpartum endometritis needs a hospitalization. As the female body experiences a severe stress after the labours, it takes time to recover. Therefore it is not enough to have just antibacterial therapy during the postpartum endometritis.
The basic ingredients of the treatment of the postpartum endometritis are:
- Antimicrobial therapy (after getting the tests of the microbiological examination and detecting the infection agitators);
- Fluid therapy (intravenous induction of solutions to cleat the blood);
- Uterotonic therapy (the improvement of the endometrium walls and increase of the uterus tone. It is required for the fast recovery and an excretion of Lochia);
- Physiotherapeutic procedures and immune-enhancing therapy.
The main task of doctors in the treatment of the postpartum endometritis is to reduce the inflammatory process and arrest the activity of bacteria. If the infection development is prevented, the disease may be defeated at the early stage within 3-5 days.
Chronic Endometritis Treatment
Currently, doctors have not achieved consensus about the clinical picture of chronic endometritis. This disease is often latent.
According to statistics, approximately 40% of women have no symptoms of chronic endometritis. They become aggravated only with a decrease in immunity and a relapse of the infectious-inflammatory process.
But even these symptoms do not reflect the entire clinical picture of the disease. Unlike acute endometritis, the chronic form of the disease gradually affects the deep layers of the endometrium. Accordingly, treatment should be based on the full clinical picture. The deeper the endometrial tissue is damaged, the more intense the antimicrobial therapy should be.
Before starting treatment for chronic endometritis, an infectious agent must be identified.
Depending on the microflora on the endometrial mucosa, doctors may prescribe:
- antifungal drugs
- antiviral drugs
- broad-spectrum antibiotics
- systemic enzyme therapy
- physiotherapy for rapid rehabilitation
After intensive antibiotic therapy, doctors prescribe immunomodulatory and antiviral drugs.
What are immunomodulatory agents for the treatment of chronic endometritis?
Induction of production of α-interferon in blood plasma and tissues, to increase the natural protective barriers in endometrial tissues:
- Increase in immune cells that support the functioning of the immune system;
- Inhibition of viral replication enzymes.
The main goal of treating chronic endometritis is not only to stop the activity of bacteria. The main task is to create optimal conditions for the recovery of the body. Therefore, supportive therapy of chronic endometritis is much more important than the active stage of treatment and the use of antibacterial drugs.
In this connection, physiotherapeutic procedures have a huge role in general therapeutic practice.
The task of physiotherapy for endometritis is to:
- improvement of hemodynamics and microcirculation of the pelvic organs;
- stimulation of receptor function;
- acceleration of endometrial regeneration processes;
- destruction of fibrin overlays;
- increase immune defense.
For a long time, it was believed that in chronic endometritis only the prescription of hormone therapy is justified. Quite often, this disease is complicated by ovarian hypofunction and anovulation. Hormonal drugs help normalize the cycle. In addition, they are ways to maintain the function of the endometrium and the restoration of its tissues for a long time.
But now doctors are moving away from the idea of using strong hormonal drugs. They argue that it is more expedient to prescribe combined oral contraceptives with a therapeutic purpose for 3-6 months. As part of oral contraceptives a sufficient amount of female sex hormones. They restore the natural physiological processes and even normalize the microflora within the genital organs.
Antibiotics for Chronic Endometritis
Chronic endometritis penetrates deep into endometrial cells. Therefore, it is necessary to choose antibiotics that are capable of quickly and easily penetrating deep into the cell.
Most often, doctors prescribe a combination of antimicrobial mixtures:
- Macrolides with Cephalosporins III generation;
- Penicillins (with Clavulanic acid) with Macrolides;
- Fluoroquinolones with Nitroimidazoles;
- Tetracycline antibiotics with Metronidazole.
Treatment is advisable to start from the first day of menstruation. The duration of use is an average of 5-7, and sometimes up to 10 days.
If anaerobic microflora was detected during microbiological analysis, patients are prescribed antiprotozoal drugs (Metronidazole). The treatment is about 7-10 days. After the termination of a therapeutic course, surely it is necessary to hand over repeated microbiological analyzes.
Chronic endometritis can be quite insidious. Antibiotics and Metronidazole can stop most of the symptoms, but the disease will still progress. This is due to the remaining microflora in the deep layers of the mucosa. Therefore, within six months after the passage of antibacterial therapy, it is necessary to pass microbiological analyzes every month.
In addition to systemic therapy, patients are recommended to use local antimicrobials: vaginal suppositories, creams and gels.
Since the cause of endometriosis is not pathogenic microflora, the use of antibiotics is impractical. There are quite a few clinical studies that have confirmed the ineffectiveness of antibiotics for endometriosis.
Antimicrobials can only be used if endometriosis is accompanied by an infectious and inflammatory process. In this case, before the main therapy, a course of antibiotics is prescribed:
- Macrolides (Azithromycin);
- III generation cephalosporins (Cefotaxime);
- Penicillins (Augmentin).
Basic therapy for endometriosis is based on the use of:
- Hormone therapy (Antigonadotropins);
- Hormonal contraceptives (Progestogens).
But most often, hormone therapy is replaced by surgery. Surgical removal of endometrial tissue is necessary in any case. Otherwise they will grow and this will provoke a multiple formation of benign cysts.
In any case, both methods of treatment of endometriosis – medical and surgical, should not be considered as competing. Based on the clinical picture, the doctor must prescribe a combination therapy. Even surgery is not always effective, without hormonal support. The combination of medication and surgical methods increases the effectiveness of treatment and improves the prognosis for recovery. After all, in endometriosis the main objective is to achieve full restoration of endometrial tissue and reproductive function.
Endometritis treatment with Metronidazole (Flagyl)
Due to the threat of anaerobic infection of endometrial cells, additional use of Metronidazole is recommended for endometritis.
Metronidazole (Flagyl) is an antibiotic with antiprotozoal action. It has an anti-inflammatory effect and helps to quickly restore the endometrial microflora of the uterus.
In addition to the protozoa, Metronidazole (Flagyl) has a good antimicrobial effect against the following dangerous microorganisms:
- microbes capable of living without oxygen (anaerobes) – bacteroides, clostridia, peptococci, fuzobakteries;
- conditionally pathogenic microflora – gardnerella, ureaplasma, staphylococcus;
- intestinal microbes.
Conventional antibiotics are ineffective or ineffective in detecting these bacteria during microbiological analysis.
Metronidazole (Flagyl) is rarely prescribed as a mono-therapy of endometritis. It shows the best efficacy in combination with antibacterial therapy.
The complex therapeutic effect in acute endometritis involves taking Flagyl tablets in conjunction with a broad-spectrum antibiotic. The following scheme is standard – 250 mg (1 tablet) 3 times a day. The course duration is at least 10 days. Usually, subject to this scheme, the woman will not have pronounced adverse events, and the therapeutic effect will be provided.
In severe forms of endometritis, the dosage can be increased by 2 times, up to 500 mg 3 times a day.
For inpatient treatment, the doctor will prescribe a dropper with Metronidazole: intravenous administration of the drug will provide the best therapeutic effect. For intravenous administration of Metronidazole, 100 ml is sufficient 2-3 times per day.
Treatment lasts for 5 days. After this it is necessary to make a microbiological analysis (smear) and determine the microflora. If anaerobic microorganisms are still present, the therapy is repeated for another 5 days.
Endometritis Treatment with Doxycycline
Tetracycline antibiotics are among the best in treating gynecological infections. They have a wide spectrum of action and are active against most pathogens endometritis:
- gram-positive cocci,
- spore-forming bacteria,
- non-spore-forming bacteria,
- gram-negative cocci and sticks,
Doxycycline tablets is well tolerated, does not foster resistance easily, and is effective in low dosage.
When treating endometritis, it is enough to take only 100 mg of Doxycycline 2 times a day. A small dose of antibiotic does not give a strong load on the liver and it is quickly eliminated from the body.
An important feature of Doxycycline is that it interacts well with Metronidazole. Combined treatment according to the Doxycycline + Metronidazole scheme helps to completely stop the inflammatory process within 1-2 weeks.
Doxycycline has virtually no side effects and is well tolerated. But the most valuable feature of this antibiotic is that it acts against atypical microorganisms. Therefore, Doxycycline can be taken even before obtaining microbiological examination results. Almost all causative agents of endometritis are sensitive to the combination therapy of Doxycycline + Metronidazole.
Author: Dr. Eddie Louie , Infectious Diseases & Immunology, Internal Medicine, Phone: (212) 682-9202