Inflammation of the womb lining is called endometritis. It is usually caused by infection that has travelled up from the vagina and cervix, and it often sits within the wider picture of pelvic inflammatory disease, where the tubes and ovaries are involved as well.
There are two main forms. Acute endometritis follows childbirth, miscarriage or a procedure inside the womb and makes you feel unwell quickly. Chronic endometritis is a low grade, often silent inflammation that is mostly found during tests for infertility or repeated miscarriage.
Symptoms
- Lower abdominal or pelvic pain and tenderness
- Fever and feeling generally unwell in the acute form
- Unusual or offensive vaginal discharge
- Bleeding between periods, after sex or heavier than normal
- Pain during intercourse
- After childbirth: a tender womb, foul smelling lochia and a temperature
- Chronic form: often no symptoms beyond spotting or difficulty conceiving
Causes and risk factors
Acute infection most often follows childbirth, particularly caesarean section, prolonged labour or retained placental tissue. It can also follow miscarriage, termination, coil insertion or hysteroscopy. Outside pregnancy the usual route is a sexually transmitted infection such as chlamydia or gonorrhoea rising through the cervix, sometimes mixed with normal vaginal bacteria. Chronic endometritis is linked to persistent low level bacterial presence in the lining; tuberculosis is a rare cause in some regions.
How it is diagnosed
- Pelvic examination and swabs: Tenderness of the womb on examination and swabs for chlamydia, gonorrhoea and other organisms.
- Blood tests: White cell count and inflammatory markers support the diagnosis and show how ill you are.
- Pelvic ultrasound: Looks for retained tissue after a pregnancy, an abscess or fluid in the tubes.
- Endometrial biopsy: A small sample of lining examined for plasma cells is the standard test for the chronic form.
- Hysteroscopy: A camera view of the cavity may show a red, swollen lining with tiny polyps in chronic disease.
Treatment options
- Oral antibiotics: Mild cases outside pregnancy are treated with a combination course, usually for 14 days, covering sexually transmitted and anaerobic bacteria.
- Intravenous antibiotics: Infection after childbirth, or anyone with high fever or vomiting, is treated in hospital until the temperature has settled for 24 to 48 hours.
- Removal of retained tissue: If ultrasound shows tissue left after delivery or miscarriage, it is removed under anaesthetic.
- Partner treatment: When a sexually transmitted infection is found, partners need testing and treatment to prevent reinfection.
- Treatment of chronic endometritis: A targeted antibiotic course, often followed by a repeat biopsy before embryo transfer in fertility patients. The evidence that this improves live birth rates is moderate, not definitive.
When it is urgent
High fever, severe pelvic pain, vomiting, a fast pulse, fainting or heavy bleeding, especially in the days after a birth, miscarriage or womb procedure, can mean spreading infection or sepsis. Go to your nearest emergency department at once. Do not travel.
Travelling to Türkiye for treatment
Acute endometritis is treated where you are, and quickly. Travel has no role. The situation in which patients do travel is chronic endometritis found or suspected during fertility treatment: hysteroscopy with biopsy, antibiotic treatment and a check biopsy can be planned around an IVF cycle. Allow for the fact that results take several days and that treatment may delay embryo transfer by a cycle.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
الأسئلة المتكررة
Can endometritis affect fertility?
Yes. Untreated pelvic infection can scar the tubes, and chronic endometritis is found more often in women with failed implantation or repeated miscarriage. Treating it is reasonable, although it does not ensure a pregnancy.
Is it the same as endometriosis?
No. Endometriosis is womb-lining-like tissue growing outside the womb. Endometritis is inflammation, usually infection, of the lining itself.
Should my coil be removed?
Not always. Mild infection can often be treated with the coil in place, but it is removed if you do not improve within about 72 hours.
How quickly should I feel better?
Most people improve within 2 to 3 days of starting the right antibiotics. If you do not, you need reassessment for an abscess or retained tissue.