Chronic Endometritis: Symptoms and Treatments

Chronic endometritis is a persistent inflammation of the endometrium, the inner lining of the uterus. Unlike acute endometritis, which is often caused by infection following childbirth or miscarriage, chronic endometritis can persist without apparent symptoms, leading to potential complications such as infertility or chronic pelvic pain. This article delves into the symptoms, diagnosis, treatment options, and causes of chronic endometritis, providing a comprehensive understanding of this often-overlooked condition.

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What is Chronic Endometritis?

Chronic endometritis is a low-grade inflammatory condition of the endometrium. It is often asymptomatic, making it a challenging diagnosis that can be easily overlooked. The condition is characterized by the presence of plasma cells in the endometrial stroma, which are detected through histological examination, often via a biopsy.

Chronic Endometritis vs. Endometriosis

It is essential to differentiate between chronic endometritis and endometriosis. While both conditions affect the endometrial tissue, endometriosis involves the presence of endometrial-like tissue outside the uterus, leading to a different set of symptoms and complications. Understanding this distinction is crucial for accurate diagnosis and effective treatment.

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Symptoms of Chronic Endometritis

The symptoms of chronic endometritis can be subtle and nonspecific, often overlapping with other gynaecological conditions, which complicates diagnosis.

Common Symptoms

Asymptomatic Cases

Many women with chronic endometritis exhibit no symptoms, highlighting the importance of considering this condition in cases of unexplained infertility or recurrent pregnancy loss.

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Causes of Chronic Endometritis

Chronic endometritis can be caused by various factors, often involving bacterial infections.

Bacterial Infections

The most common cause is persistent bacterial infection. Bacteria such as Escherichia coli, Enterococcus faecalis, and Mycoplasma species have been implicated. Chronic endometritis may occur following childbirth, miscarriage, or gynaecological procedures if the bacteria are not completely eradicated.

Other Contributing Factors

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Diagnosing Chronic Endometritis

Accurate diagnosis of chronic endometritis is critical yet often missed due to the subtlety of symptoms.

Clinical Evaluation

A thorough clinical evaluation should include a detailed medical history and a comprehensive pelvic examination. However, due to the nonspecific nature of the symptoms, further diagnostic steps are usually necessary.

Biopsy and Histological Examination

A definitive diagnosis is typically made through an endometrial biopsy. This involves taking a tissue sample from the endometrium and examining it for the presence of plasma cells, which are indicative of chronic inflammation.

Additional Diagnostic Tools

In some cases, hysteroscopy may be performed. This procedure allows direct visualization of the uterine cavity and can help identify any structural anomalies or lesions that might suggest chronic endometritis.

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Treatment Options for Chronic Endometritis

Effective treatment of chronic endometritis requires addressing the underlying cause of the inflammation.

Antibiotic Therapy

Antibiotics are the mainstay of treatment, targeting the specific bacteria identified through culture or suspected based on clinical presentation. A broad-spectrum antibiotic may be prescribed initially, followed by a more targeted approach once specific pathogens are identified.

Surgical Intervention

In cases where chronic endometritis is associated with structural abnormalities, such as polyps or fibroids, surgical intervention may be necessary to address these underlying issues.

Monitoring and Follow-Up

Following treatment, follow-up is crucial to ensure the resolution of inflammation and to prevent recurrence. Repeat biopsies or hysteroscopies may be performed to confirm the efficacy of treatment.

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Chronic Endometritis and Infertility

The relationship between chronic endometritis and infertility is complex and multifaceted. Inflammation of the endometrium can impair embryo implantation, leading to infertility or recurrent miscarriages. Therefore, addressing chronic endometritis is a critical component of fertility management in affected individuals.