Definition

Endomyometritis, or endometritis, is an inflammation or infection of the inner lining of the uterus, known as the endometrium. The muscular layer of the uterus, the myometrium, is often involved in this condition, hence the term endomyometritis. It can occur acutely (sudden and short-term) or chronically (long-lasting and continuous). Acute endomyometritis can occur after surgeries involving the cervix or uterus, while chronic endomyometritis typically occurs after menopause or with sexually transmitted infections (STIs) such as chlamydia or gonorrhea.

Endomyometritis is not life-threatening but can cause complications if not properly treated. It is a common infection after childbirth, often starting from chorioamnionitis and developing into endomyometritis postpartum. Endomyometritis is also common in individuals with pelvic inflammatory disease (PID). Several types of bacteria can cause PID, with STIs being a primary cause.

Causes

Endomyometritis is caused by bacterial infections in the uterus. This can result from STIs, tuberculosis, or natural vaginal bacteria. Normally, vaginal bacteria help maintain a balanced pH but can cause infections and inflammation when this balance is disrupted by childbirth or related procedures.

Risk Factor

Several factors can increase the risk of endomyometritis:

• Childbirth or Pregnancy

Common causes of endomyometritis, as labor can expose internal genital organs to external infections. Infections during pregnancy often result from urinary tract infections or premature rupture of membranes.

• Cesarean Delivery

Endomyometritis is more common after a cesarean section due to increased exposure to external infections.

• Sexual Activities with Different Sexual Partners

Increases the risk of STIs, which are common causes of endomyometritis and can lead to PID if untreated.

• Medical Procedures

Procedures involving the cervix or uterus, such as dilation and curettage (D&C), endometrial biopsy, hysteroscopy, or IUD insertion, can increase bacterial infections.

Symptoms

Symptoms of endomyometritis include:

• Fever
• Pelvic pain
• Vaginal bleeding
• Constipation or colicky abdominal pain
• Abdominal swelling
• Fatigue

Diagnosis

Your doctor will perform a physical examination to diagnose endomyometritis and may recommend the following tests:

• Cultures: From vaginal fluid to identify bacteria, especially those from STIs like chlamydia and gonorrhea, as well as trichomoniasis or bacterial vaginosis.
• Biopsy: Examination of tissue samples from the uterus under a microscope.
• Laparoscopy: To closely examine uterine abnormalities.
• Complete Blood Count: To identify infection or inflammation by measuring white blood cells and sedimentation rate.
• Microscopic Examination: Of vaginal fluid.

Management

Treatment for endomyometritis includes pain relief and antibiotics. If the infection is severe or occurs postpartum, hospitalization for IV antibiotics and bed rest may be necessary. The goal of treatment is to eliminate the infection, reduce uterine inflammation, and prevent further complications.

• Antibiotic Treatment

For severe infections, intravenous antibiotics may be required.

• Treating Your Sexual Partners

If the disease is caused by an STI, sexual partners should also receive antibiotic treatment.

• Surgical Intervention

Surgery may be needed to remove residual tissue in the uterus, especially after miscarriage or retained placenta post-delivery.

• Abscess Management

In cases where the infection leads to abscess formation, surgery or needle aspiration may be needed to drain the infected fluid or pus.

Complications

Untreated endomyometritis can lead to serious complications such as:

Infertility

PID can cause scarring in the fallopian tubes, blocking the passage of eggs and preventing fertilization.

Uterine Abscesses

Severe infections can cause abscesses, leading to further inflammation and increased risk of infection spread.

Septicemia

The infection spreading to other organs can lead to sepsis, which is life-threatening and requires immediate intensive care.

Prevention

Preventive measures include:

• Safe Sexual Practices: Using condoms and treating STIs.
• Regular STI Screening: For you and your sexual partners.
• Prophylactic Antibiotics: Administered before cesarean sections to prevent infections.
• Postpartum Check-ups: To monitor for infections after delivery. 

When to See a Doctor?

Consult a doctor if you experience symptoms of endomyometritis, especially if you have recently:

• Given birth
• Had a miscarriage
• Undergone an abortion
• Had an IUD inserted
• Had surgery on the uterus or cervix

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