Endometritis is a condition where the lining of the uterus, known as the endometrium, becomes inflamed. This inflammation is typically caused by an infection that can develop after childbirth, miscarriage, or medical procedures involving the uterus. Common symptoms include pelvic pain, abnormal vaginal bleeding, fever, and foul-smelling discharge. If left untreated, endometritis can lead to serious complications such as infertility, chronic pelvic pain, and pelvic inflammatory disease (PID). 

Endometritis is a type of uterine infection that results in inflammation of the endometrium. The infection usually originates from bacteria entering the uterus through the cervix. Endometritis is often associated with recent pregnancy, miscarriage, or gynecologic procedures, and is most commonly caused by bacteria normally found in the vagina. Prompt recognition and treatment are essential to reduce the risk of complications. 

There are two main types of endometritis that differ in how quickly they develop and the way they present. 

Acute Endometritis 

• This type typically occurs suddenly after childbirth, miscarriage, or an abortion. 

• Symptoms include pelvic pain, fever, and heavy vaginal discharge. 

• It requires immediate attention due to its rapid onset and severe presentation. 

Chronic Endometritis 

• This form develops more slowly and may persist for weeks or months. 

• It is often identified during infertility evaluations or after repeated pregnancy losses. 

• Symptoms may be milder and more subtle than acute endometritis. 

Endometritis is primarily caused by a bacterial infection. It develops when the natural defenses of the uterus are disrupted, allowing bacteria to enter and multiply. 

Common Causes 

• Childbirth, especially cesarean delivery 

• Miscarriage or abortion 

• Uterine procedures such as dilation and curettage (D&C) or insertion of an intrauterine device (IUD) 

• Sexually transmitted infections like chlamydia and gonorrhea 

• In rare cases, tuberculosis leading to chronic endometritis 

Certain risk factors increase the likelihood of developing this condition. 

• Cesarean delivery or prolonged labor 

• Multiple vaginal exams during labor 

• Manual removal of the placenta 

• Retained products of conception 

• Intrauterine procedures or IUD use 

• History of STIs or bacterial vaginosis 

• Immunocompromised status 

Symptoms can vary depending on whether the infection is acute or chronic. 

Acute Endometritis 

• Fever 

• Pelvic or lower abdominal pain 

• Foul-smelling vaginal discharge 

• Heavy or prolonged vaginal bleeding 

• General discomfort or fatigue 

Chronic Endometritis 

• Irregular menstrual bleeding 

• Chronic pelvic pain 

• Infertility or recurrent miscarriage 

• Persistent vaginal discharge 

Normally, the cervix and cervical mucus form a natural barrier that helps keep bacteria out of the uterus. During childbirth, miscarriage, or certain medical procedures, this barrier can be disrupted. When this happens, bacteria from the vagina or cervix can travel into the uterus and cause an infection. The immune response to these bacteria triggers inflammation, which can damage the uterine lining and result in pain, fever, or abnormal bleeding. In rare cases, untreated chronic infections such as tuberculosis can spread to other areas of the pelvis. 

Diagnosis involves a combination of clinical evaluation, laboratory testing, and sometimes imaging. 

• Physical exam and medical history: A pelvic exam may reveal uterine tenderness or abnormal discharge. 

• Blood tests: Elevated white blood cell counts often indicate infection. 

• Cultures: Vaginal and cervical swabs help identify the causative bacteria. 

• Imaging: Ultrasound may be used to look for retained tissue in the uterus. 

• Endometrial biopsy or hysteroscopy: In chronic cases, these procedures help detect long-term inflammation. 

Treatment focuses on eliminating the infection and managing symptoms. Most cases respond well to antibiotics, particularly when diagnosed early. 

Antibiotic Therapy 

• Broad-spectrum antibiotics are used to target the most common bacteria. 

• Postpartum or post-abortion infections often require intravenous (IV) antibiotics. 

• Patients may later switch to oral antibiotics for a 10–14-day course. 

• Chronic cases may be treated with doxycycline. 

• Tuberculosis-related endometritis requires a full course of anti-tubercular therapy. 

Surgical Management 

• If retained products of conception are present, dilation and curettage (D&C) may be necessary. 

• Severe cases with complications such as abscesses may require surgical drainage or hysterectomy. 

Supportive Care 

• Pain and fever management with medications 

• IV fluids for hydration 

• Close monitoring for systemic infection or sepsis 

Without treatment, endometritis can lead to severe complications. 

• Pelvic inflammatory disease (PID) 

• Infertility 

• Chronic pelvic pain 

• Formation of intrauterine adhesions (Asherman’s syndrome) 

• Septicemia or, in rare cases, septic shock 

Endometritis can often be prevented with proper medical care and attention to risk factors. 

• Prophylactic antibiotics before cesarean deliveries 

• Sterile techniques during childbirth and gynecologic procedures 

• Timely treatment of bacterial vaginosis and STIs 

• Avoiding unnecessary uterine procedures 

• Ensuring safe abortion practices 

The outlook is generally positive with timely and appropriate treatment. 

• Acute infections typically resolve within days of starting antibiotics. 

• Delayed diagnosis or chronic cases may cause long-term reproductive issues. 

• Follow-up care is important for women with a history of severe or recurrent infections. 

Endometritis is a potentially serious but treatable condition that affects the uterine lining. Prompt medical attention is vital to avoid long-term complications, especially when symptoms follow childbirth, miscarriage, or uterine procedures. With early diagnosis and proper treatment, most women recover fully and maintain reproductive health. 

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