Inflammation of the uterine lining or endometritis

Endometritis is an inflammation of the lining of the uterus (endometrium), usually caused by intrauterine infections; it is different from endometriosis.

This condition is the most common cause of fever after childbirth (cesarean section or natural birth).

Endometritis is often associated with other serious disorders, such as inflammation of the fallopian tubes (salpingitis), ovary (oophoritis) and peritoneum (peritonitis).



The uterus is an important female reproductive organ; it consists of the body and neck of the uterus and this is where the fetus develops during pregnancy. The lining of the mucosal lining of the uterus is called the endometrium.

Endometritis can be acute or chronic

Acute endometritis Inflammation in the puerperium (endometritis
puerperalis): caused by an infection that develops during or after birth; it is the most common form of acute endometritis.
The puerperium is the period of time that the female body needs to regress the pregnancy and birth-related changes, which is usually 40-50 days.
Inflammation outside the puerperium: due to the infection of the organs of the small pelvis (pelvic inflammatory disease) or other invasive gynaecological procedures.

Chronic endometritis Gonococcal infections are usually not found in chronic endometritis
, unlike other bacteria, such as Mycoplasma spp.

Birth or abortion: After an abortion or birth, residual substances can remain in the uterine cavity and promote inflammation.
Outside the puerperium: in connection with chronic infections, such as chlamydiosis, gonorrhea, bacterial vaginosis, or through the insertion of an IUD.

Bacteria that can provoke inflammation of the uterine lining include:

  • Ureaplasmas
  • Staph
  • Streptococcus
  • Escherichia coli
  • Gardnerella vaginalis

Atrophic, chronic endometritis can be a senile disorder that occurs after menopause, when the mucosa atrophies, that is, when it loses volume and atrophies.
This phenomenon makes the regeneration of the superficial mucosa after the menstrual phase difficult.

What are the causes of endometritis?

Infections are among the most common causes and can be caused by one of the following diseases:

    • Amniotic fluid: can be infected before or at birth. If the child excretes his first stool (called meconium or infant fat) before birth, the risk of infection increases.
  • Infection of the organs of the small pelvis: the infection of any female organ.
  • Tissue remnants: after birth or miscarriage, remnants of placenta or other tissues can be found in the uterine cavity and cause infection.
  • Sexually transmitted diseases: also known as sexually transmitted diseases.
    You can become infected through sexual contact with your infected partner.
    Further information on sexually transmitted diseases can be provided by the doctor.

Who belongs to the risk groups of endometritis?

Bacteria are naturally present in every female vagina.
If this natural mixture of bacteria changes throughout life, the risk of endometritis increases.
The probability of this increases after the following events:

Risk factors outside the puerperium:

  • insertion of the spiral (intrauterine device, IUD for short),
  • lack of normal mucosal layer in the cervix,
  • menstrual flow in the uterine cavity,
  • vaginal irrigation,
  • unprotected sex
  • numerous sexual partners.

Symptoms of endometritis

When an infection occurs, certain symptoms become noticeable, including:

  • fever,
  • irritation of the uterus,
  • pain during sexual intercourse,
  • menstrual cramps (pain and disorders),
  • foul-smelling, bloody or bloodless discharge.

As infection increases, serious symptoms may occur:

The fever can rise sharply.
The discharge can increase and the pain becomes noticeably more unpleasant.
Menstrual irregularities occur along with other symptoms, such as pelvic and lower abdominal pain, back pain, and in some cases, unusual bleeding.
In case of any of these symptoms, a doctor should be consulted so that a correct diagnosis can be made, because menstrual irregularities are not caused by endometritis alone.

If endometritis remains untreated for a long time, the following complications are possible:

  • abscess formation in the uterus,
  • peritonitis,
  • infections of fallopian tubes and ovary,
  • abscess formation in the pelvic region,
  • infertility,
  • Bruising in the pelvis.

How is endometritis diagnosed?

The doctor performs a physical examination.
As part of a gynecological examination, other possible causes of the symptoms can be checked.
As a rule, one of the following examinations is performed:

Blood test:
It looks for signs of infection in the blood.

Random samples of urine, blood, and discharge can provide clues as to the cause of the infection.

Vaginal ultrasound:
This examination uses sound waves to display images of the inside of the uterus and ovaries. For this purpose, a small ultrasound head is inserted into the vagina.
The images of the uterus and ovaries are displayed on a screen.

Kurz CT. Ein Röntgengerät verwendet einen Computer, um Schnittbilder des Unterleibs erzeugen zu können. Vor dem Anfertigen der Bilder kann ein Farbstoff verabreicht werden, damit die Bilder deutlicher erkennbar sind. Der Arzt muss informiert werden, wenn in der Vergangenheit bereits allergische Reaktionen auf das Kontrastmittel aufgetreten sind.

A hysteroscopy is performed to examine the lining of the uterus.
A small instrument equipped with light and camera is inserted into the vagina and cervix.
Introducing liquid or gas can help improve visibility.
During this examination, a tissue sample can also be taken from the uterus.

The doctor takes a tissue sample from the uterus and has it examined in the laboratory.

How is endometritis treated?

Antibiotics: they are prescribed to treat or prevent an infection caused by bacteria; it is taken as directed by a doctor. Most often, azithromycin (Zithromax®) is prescribed.

A scraping is performed to remove residual tissue after childbirth or abortion.

A fine needle puncture may be performed to drain an abscess in the abdomen. The needle is inserted through the abdominal wall or vagina and with its help the pus can be removed.

Surgical intervention: Surgery may also be performed to remove pus and infected tissue if severe endometritis is present.

Prognosis for endometritis

In 90% of cases, the healing times for patients suffering from mild or moderate endometritis and treated with antibiotics are 48-72 hours.
In case of insufficient success, the situation must be reassessed.


Endometritis caused by sexually transmitted infections can be prevented in the following ways:

  • Early diagnosis and complete treatment of sexually transmitted infection, both in the patient and in all his sexual partners.
  • Protected intercourse through the use of condoms.
  • The risk of endometritis can be reduced by using sterile techniques and equipment during childbirth, abortion, IUD insertion and other gynecological procedures.
  • Shortly before surgery, antibiotics can be taken to prevent endometritis and other surgery-related infections.

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