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Treatment of endometritis with antibiotics - which drugs are effective?

Pregnant women often wonder if they are diagnosed with a disease, whether they can be given antibiotics for endometritis. Mostly during pregnancy, women are prescribed physiotherapy procedures, a course of vitamins and immuno-strengthening drugs. However, in case of severe inflammation, the doctor also recommends antibacterial therapy.

10 principles of antibiotic therapy

Treatment of endometritis with antibacterial agents is based on important principles:

  1. Preparations with a false effect are prescribed after identifying the causative agent of the pathology.
  2. Medications are taken strictly according to the plan - dosage, time mode.
  3. Identify the resistance of microbial resistance to drugs.
  4. Prescribe medications with a wide range of effects on the provocateur of inflammation.
  5. Do not take drugs without an appointment.
  6. Overdue drugs are not allowed.
  7. The effectiveness of the antibiotic taken is evaluated a couple of days after the first dose.
  8. The price issue is important.
  9. Exclude self endometritis.

The treatment is carried out under the supervision of a specialist.

Antibiotics for acute endometritis

Treatment of the acute process is carried out immediately by the following drugs:

  • intramuscularly Cefazolin,
  • Gentamicin against gram-negative bacteria,
  • Metragil against anaerobic pathogens,
  • in case of emergency care, ampicillin is administered intramuscularly to the patient.

The treatment plan is selected by the attending physician. After the results of bacterial seeding therapy may be adjusted.

How to treat

Endometritis causes a microbial infection, for this reason, measures are necessary to eliminate the provocateur. Antibacterial agents have a healing effect. The treatment regimen uses different combinations of drugs, which contributes to the enhancement of the therapeutic effect.

Piperacillin and Tazobactam Sodium

The combination of Ampicillin with Tazobactam sodium is very effective as monotherapy in 2/3 of patients. This combination has a detrimental effect on anaerobic microorganisms. But the drugs are not perfect when treating any nosocomial infections.

The drug is used in monotherapy to remove gram-negative, anaerobic and some types of gram-positive bacteria.

The antibiotic acts by combining with penicillin-binding proteins, after which it slows down the synthesis of the bacterial cell wall, inhibiting the replication of pathogenic microorganisms.

Causes provoking the development of the disease

Pathological damage to the mucous membrane of the uterus may occur as a result of penetration into the uterus through the cervical canal of various pathogens. Inflammation is provoked by exposure to viruses, fungi, mycoplasmas, streptococci, chlamydia, other pathogenic bacteria. Endometritis in its course can be acute and chronic.

An acute onset of the pathology may be triggered by gynecological interventions, for example:

  • when performing an abortion,
  • when installing the coil,
  • during diagnostic curettage of the uterus, hysteroscopy,
  • in the presence of chronic diseases of the genital organs,
  • as a result of postpartum complications, especially after cesarean section.

Against the background of reduced immunity, inflammation of the inner layer of the uterus is possible due to the presence of sexually transmitted infections or extragenital diseases, such as diabetes mellitus, abnormalities in the endocrine system, or hormonal dysfunction.

The chronic course of the disease develops as a complication or continuation of acute inflammation of the endometrium of the uterus, which has not been cured in a timely manner by medical methods. Therefore, it is extremely important to treat the chronic form of endometritis at an early stage and not bring it to the acute form of pathology.

Diagnostics

Endometritis is diagnosed in the presence of an appropriate clinical picture, when the following symptoms are observed:

  • the presence of pain in the lower abdomen,
  • urination problems,
  • the presence of vaginal discharge with a strong odor,
  • deterioration of general well-being,
  • increase in body temperature above normal
  • tachycardia may occur,
  • examination of the uterus reveals her in a state of tension, it is painful and enlarged.

Endometritis treatment

What drugs need to treat endometritis? The effectiveness of therapeutic measures taken in the diagnosis of pathology, is directly dependent on the timeliness of the start of treatment. Endometritis caused by severe postpartum complications requires treatment in a hospital setting.

Its lighter forms can be treated without the patient being hospitalized. Drugs used to treat endometritis include a number of antibiotics and antimicrobials.

Treatment of endometritis with antibiotics is based on the determination of the infectious agent and the elimination of the consequences of its negative impact on the uterine lining. In most cases, endometritis is a polymicrobial disease, that is, inflammation occurs with the participation of not one but several pathogens that enter the uterus from the vaginal microflora along the ascending pathways. Therefore, doctors use the tactics of prescribing broad-spectrum antibiotics for endometritis.

The choice of drug treatment is carried out by a gynecologist on the basis of the examination. What kind of antibiotics should be used to treat endometritis depends on the results of the tests, which determine the causative agents of infection and determine the level of sensitivity of the organism to certain antibiotics. Similar treatment tactics are performed in women with chronic endometritis. Accordingly, choose those drugs that are most effective against the identified pathogens, and to which the body exhibits greater sensitivity. Using the data of antibiogram determine how the pathological flora reacts to a number of main groups of drugs and describe the treatment regimen.

If there are signs of an acute form of endometritis, another approach to solving the problem is used. Since performing the necessary analyzes (seeding, antibiogram) takes a considerable period of time, approximately 2 to 5 days, and the state of the uterus quickly deteriorates, they try to pick up such a pair of therapeutic drugs, the mutual action of which can affect as many pathogenic microorganisms as possible, leading to development of pathology.

Timely initiated therapeutic measures with broad-spectrum antibiotics for endometritis give good results in a large percentage of sick patients.

List of recommended drugs for treatment

With therapeutic interventions, both acute and chronic forms of the disease, the use of a number of cephalosporins is recommended. Ceftriaxone with endometritis is prescribed quite often.

This antibiotic belongs to the third generation of drugs, differing in an expanded spectrum of action against pathogens. It is active against aerobes and anaerobes, as well as gram-positive and gram-negative microorganisms. Ceftriaxone is enhanced by the action of other drugs administered in parallel from the discharge of fluoroquinolones, for example, the combination of Ceftriaxone-Clindamycin preparations is considered successful.

Well inhibits the development of anaerobes that inhabit the uterine cavity and vaginal fornix with endometritis, the drug Metronidazole, which is used in complex treatment for acute endometritis. For example, doctors often use the Ampicillin – Gentamicin – Metronidazole bundle, which makes it possible to cover the field of activity of potential infectious agents as widely as possible with the mutual action of this complex of drugs.

It is important to bear in mind that the dosage, like the choice of drugs itself, depends on the severity of the process and the types of pathogens that are identified. For example, if it is revealed that chlamydia are involved in the inflammatory process, doctors prefer Doxycycline to be used.

It is necessary to pay attention to the fact that the enhanced mode of antibacterial therapy is justified in acute forms of the disease, while the chronic course needs therapy with a predominance of immunostimulants in order to activate the body’s own defense mechanisms. This is achieved using a treatment regimen that includes, in addition to a certain group of antibiotics, serious doses of immunomodulators, vitamin complexes, as well as means that promote the activation of regeneration processes in damaged tissues, for example Actovegin.

The list of antibiotics recommended in the treatment of endometritis includes:

  • ampicillin,
  • Amoxicillin
  • clindamycin,
  • gentamicin,
  • doxycycline,
  • cefoxime,
  • Ceftriaxone,
  • levofloxacin,
  • ceftazidime,
  • augmetin,
  • unazin.

The pharmaceutical industry is constantly improving the development of medicines for the treatment of gynecological diseases. One of these successful developments is considered the drug Longidase. Pathology of endometritis leads to a gradual growth in the mucous membrane of the endometrium of the connective tissue sites, the further formation of adhesions in the tissues adjacent to the focus of inflammation. This disrupts their normal operation and can lead to tubal infertility. Longidase with endometritis contributes not only to stopping the process of the occurrence of adhesions, but also due to the presence in its composition of a special enzyme that breaks down fibrous inclusions, can affect the already formed adhesions.

Longidase improves blood microcirculation, which reduces swelling and tension of uterine tissues, and also improves the penetration of antimicrobial agents into the endometrial inflammatory foci. Clinical trials of the drug with innovative properties confirm the effectiveness of Lognidase in the case of treatment of endometritis.

One of the newest drugs of a number of antibiotics is Sumamed. It was developed by a Croatian company and adopted by many domestic and foreign experts. Its active ingredient is azithromycin. Sumamed with endometritis is prescribed if the patient has a reduced sensitivity to the usual range of antibiotics.

The range of effects of Sumamed on pathogens is very wide, it is active against chlamydia, mycoplasma, ureoplasm. The ability of the drug to accumulate in the focus of inflammation favorably distinguishes it from other antibiotics.

In clinical trials, it was established that the activity of the active substance Sumamed is able to persist for up to 5-7 days after the last use of the drug. This drug is so effective that instead of a course of a conventional antibiotic lasting 7 days, Sumamed suffices to take 3 days to relieve symptoms of acute inflammation.

Endometrial uterine pathology is a serious gynecological pathology, but following the treatment regimen developed by a competent and qualified gynecologist, it can be cured without preventing the occurrence of complications.

Causes of endometritis

Modern medicine divides the disease into two main subspecies: acute and chronic endometritis. The causes of such problems in women have quite different background.

Acute endometritis usually becomes the result of infection in the uterine cavity with various instrumental manipulations. These include:

  • Production of abortion at various stages of pregnancy. It should be noted that vacuum extraction or medical abortion cause a similar condition 10 to 15 times less than the usual instrumental procedure of curettage of the uterus.
  • The widespread introduction of endoscopic techniques in gynecology into modern practice also, oddly enough, increases the number of inflammatory processes in the uterus.Hysteroscopy, although this manipulation is performed under sterile conditions of the operating room, is the cause of the development of 15% of endometritis.
  • Extremely high probability of endometrial inflammation after childbirth. Hormonal changes in the woman and failure of the immune system leads to the fact that in 12 - 15% of women after childbirth, there is inflammation of the inner layer of the uterus. It should be noted that despite the timely antiseptic, more than 30 percent of women undergoing cesarean section have a similar pathology.
  • Acute endometritis may not be associated with various interventions in the integrity of the female reproductive organ. The general background of the decrease in immune protection in the body of modern patients leads to the spread of a large number of inflammatory diseases that are sexually transmitted. Approximately 40% of them are able to provoke the penetration of bacteria or viruses into the uterus.
  • In principle, any woman's health problems will most often affect the state of her genitals. Diabetes mellitus, chronic processes in the lungs and bronchi, and gastrointestinal diseases can lead to the development of endometritis as a concomitant pathology.

Chronic endometritis is usually a complication or continuation of a poorly cured acute process in the uterus. But there are related factors:

  • Chronic endometritis is a disease of women with reduced social responsibility.
  • The lack of proper work and rest, inaccuracies in the diet, excessive alcohol abuse in 80% of cases will lead to inflammatory processes in the uterus.
  • This disease may be the result of insufficient care for women after childbirth and during breastfeeding.

Endometritis must be treated and do it in a complex. According to WHO, 60% of infertility is a consequence of endometrial inflammatory processes. It should be recalled that when carrying out in vitro fertilization, women who have problems with inflammation of the uterus walls warn that the success of the manipulation completely depends on the degree of stabilization of the inflammatory process in the organ.

We recommend reading an article on endometritis in women. From it you will learn about the causes and symptoms of the disease, methods of treatment and possible complications.

And here more about the monthly with endometritis.

Antibiotics for acute endometritis

Most often, experts are faced with an acute form of the disease. In this case, everything is decided by time. The patient is shown to conduct examinations to exclude acute surgical pathology and determine the sensitivity of the uterus flora to antimicrobial agents.

Therefore, doctors begin to treat the inflammatory process in a patient immediately, using standard drug complexes:

  • Women are prescribed cephalosporins of the second generation of action, in particular, Cefazolin 1 gram 3 times a day. The drug must be administered intramuscularly, it is recommended to combine these injections with a similar injection of 80 mg Gentamicin. The complex scheme also includes intravenous administration of Metrogil three times a day at a dosage of 0.5 gram per dose.
  • An interesting combination of banal penicillins and beta-lactam antibiotics is widely used for emergency treatment of endometritis. An example would be the simultaneous administration of the drug Unazin at a dosage of 1.5 grams up to 5 times per day and the usual, widely used Agumentina up to 5 grams in the same time period. Drugs are recommended to be administered exclusively to the patient's muscle in order to achieve a higher concentration of the drug and prolong the time of the antibiotic.
  • Many experts emphasize the need for sanitation of the uterine cavity with a solution of cephalosporins of the 1st and 2nd generations, in order to remove purulent plaque from the walls. Such recommendations can be treated differently, however, the extra violent penetration into the uterus can stimulate an existing inflammatory process. Most gynecologists recommend not to carry out an instrumental revision of the uterus without special need.

In modern medicine, there are many schemes for the use of antibiotics for acute endometritis, and they all have the right to life. The main condition for any medical appointments is the prompt removal of inflammation and the complete safety of the treatment for the patient.

Antibiotics for chronic endometritis

In the treatment of chronic inflammation of the uterine wall, the time factor no longer matters, so doctors have enough time to determine the response of the pathological flora of the woman’s genital organ to the main groups of antibacterial agents. Before the appointment of a specific treatment of chronic endometritis, a special study is conducted - an antibiogram. It is this analysis that allows doctors to choose the right scheme for the use of antibiotics.

Most often, in the treatment of chronic forms of the disease using the same drugs that give a proven effect in acute cases. Experts recommend prescribing cephalosporin drugs, and to enhance their effect, therapy is supported by the use of fluoroquinolones.

However, in the chronic period of the disease, the rejection of antibacterial drugs plays a leading role.The basis of treatment is the restoration of the immune system of a woman, for which immunomodulators, complexes of vitamins with microelements and stimulants for the restoration of damaged tissues, in particular Actovegin, are prescribed in large doses.

Look at the endometritis video:

What is endometritis, its causes of development

Endometritis is called inflammation of the mucous membrane of the uterus, which often manifests after childbirth, abortion, or any other manipulative actions of a gynecological nature. The focus of the disease is bacteria that have entered and are attached to the mucous membrane, infections or microplasmas.

  • fever,
  • recurrent or persistent abdominal pain,
  • uncharacteristic discharge with a sharp, unpleasant odor.

Disprove or confirm the diagnosis can only be a doctor after the mandatory research of the uterus. We are talking about the examination by a gynecologist, the study of vaginal smears, as well as an ultrasound examination of the pelvic organs. If necessary, other types of examinations can be prescribed by the attending physician. Effective treatment of endometritis is necessarily carried out in a comprehensive format. It is aimed at the anti-inflammatory and analgesic effect, as well as the removal of the affected tissues of the organ surgically.

Endometritis is a consequence of various infectious pathogens entering the uterus. As a rule, this occurs through the vagina at the time of gynecological manipulations without preserving the conditions of sterility. This applies to childbirth, abortion, hysteroscopy (examination of organs through the introduction of the optical system), as well as curettage of the uterus for diagnostic purposes (curettage).

For postpartum endometritis is characteristic manifestation for 2-4 days. The increased risk of disease are:

  • prolonged generic activity of the body,
  • caesarean section
  • recurrent bleeding after the birth,
  • delay in the uterine cavity of the particles of the placenta.

Suspect the disease should be if the woman has bacterial vaginosis or any other sexually transmitted diseases.

In the absence of proper treatment, endometritis, as a rule, becomes chronic. A dangerous complication of the disease is inflammation of the uterus, which leads to infertility.

Types of drugs depending on the form of the disease

Inflammatory lesions of the internal membranes of the uterus are recommended to be carried out comprehensively, taking into account the characteristics (form) of the existing disease: acute or chronic endometritis. Moreover, among the drugs is the main antibiotic. The whole treatment regimen depends on the nature of its impact.

Antibacterial agents in chronic form

It is possible to cure the disease only after an antibiogram, which allows you to select the most effective antibiotics, and also assign a scheme for their use.

One of the most common treatments is based on Kefzola with Clindamycin. The first drug can be replaced by cefotaxime. In order to restore the affected areas of the mucosa, Metronidazole may be administered. Actovegin, vitamin complexes and immunomodulators are also contributing to the restoration of tissue and immunity.

Ceftriaxone and Longidase for endometritis

Ceftriaxone is one of the most common treatments for inflammation. It is relevant, as in acute endometritis, and for the chronic form of the disease. The drug belongs to the third generation of cephalosporins and has a wider range of effects. For maximum effectiveness, Clindamycin may additionally be administered.

Longiditis with endometritis helps to improve blood microcirculation, which leads to the elimination of uterine muscle swelling, as well as reducing their tone. The drug provides more effective penetration of therapeutic antimicrobial substances to the sites of organ damage.

Is antibiotic treatment acceptable during pregnancy?

Patients often find out about the chronic form of endometritis during pregnancy.

Treatment of the disease is allowed during pregnancy, if it is carried out under the supervision of a physician, and vitamin complex, physiotherapy procedures and drugs aimed at improving immunity are used for therapy.

The use of antibiotics is possible only under the condition that the benefit to the patient significantly exceeds the risk of disease or impairment in the development of the fetus.

And how to do without antibiotics

Treatment of endometritis necessarily carried out in a complex and in a hospital. This is due to increased intoxication of the body due to the release of toxins into the blood.

If endometritis therapy is carried out without the use of antibiotics, it is necessary to ensure:

  • the withdrawal of toxic substances from the blood and the affected areas of the uterus, which is carried out by infusion of Albumin, Ringer or Reopoliglukina in combination with a 5% glucose solution,
  • consumption of vitamin complexes, in particular vitamin C, which has an antioxidant effect on the body,
  • to increase nonspecific immunity can be administered injections of timalin.

In any case, the treatment of endometritis is carried out under the close supervision of a physician and the exact implementation of all his prescriptions. Only in this case, you can count on a successful recovery.

What is endometritis

From Latin, endometritis speaks of a pathological process in the uterine membrane, which is made up of glandular and integumentary epithelium, while the endometrium is responsible for transporting nutrients and oxygen to the fetus. If inflammation begins in the upper layer of the uterus, it is endometritis - the symptoms and treatment will depend on the depth of penetration of the process. In the case when deep tissues are affected, a specialist can make another diagnosis - endomyometritis.

At the initial stage, it is difficult to determine the disease, since it proceeds with almost no symptoms - the characteristic signs of endometritis will appear only in women who have suffered childbirth or have been subjected to manipulations by the gynecologist during the examination. The main symptom is the appearance of pathological secretions: they have an unpleasant smell, look like a ichor or serous-purulent clots. In case of chronic endometritis, problems with menstruation will be added (duration, blood volume).

Chronic

The severity of symptoms of a chronic form is weaker than during exacerbation; the cause of inflammation is no longer childbirth, but long-term structural changes in the endometrial layers. In chronic inflammation, there is a risk of cystic formations and the difficulty of gestation. The symptoms of chronic endometritis include:

  • failure of the menstrual cycle and irregular blood flow (with very equal probability very poor or abundant discharge is observed),
  • uterine bleeding,
  • lower abdominal pain
  • discomfort during intercourse.

If a woman encounters postpartum endometritis, even without knowing the list of symptoms, she will understand that an inflammatory process is taking place inside: endometritis develops already after 3 days from the moment of surgical intervention with subsequent infection, will be expressed in:

  • vaginal serous secretions,
  • raising the temperature to 39 degrees
  • pulling pains in the lower abdomen,
  • loss of appetite
  • purulent discharge (late symptom, when not carried out timely diagnosis).

Endometritis echo signs

If a doctor prescribes an ultrasound scan to detect infective inflammation of the endometrium, he will evaluate the pathological changes in the tissues. This method of testing shows the maximum efficiency in case of chronic endometritis: among the characteristic symptoms that can be noticed during the examination, there is an increase in the uterus and thickening of its walls. In acute inflammation, only pus accumulation can be observed.

Additionally, sluggish endometritis can manifest itself:

  • endometrial thickening or thinning,
  • cavities in the mucosa,
  • gas accumulations in the uterus,
  • focal fibrosis, atrophic sites.

Inflammation in the upper layers of the endometrium occurs when pathogenic microorganisms enter the uterus, but necessarily in combination with the weakening of the barrier mechanisms of protection, since it is difficult to infect the internal genital organs. Doctors identify 3 ways to start endometritis:

  • ascending uterus infection,
  • through blood,
  • through lymph.

Mostly, the pattern of infection of the endometrium is as follows: something damages the uterine membrane, a bacterium or a virus penetrates the upper endometrial tissue and begins its activity. The causative agent of infection can be a whole list of microorganisms: from streptococci, staphylococci and gonococci to Escherichia coli, chlamydia and trichomonads. Experts identify several risk factors against which endometritis can develop:

  • The use of intrauterine contraceptives in the form of a spiral and vaginal spermicides provoke nonspecific endometritis - the symptoms and treatment regimen are similar to those described for a specific chronic form.
  • Frequent vaginal douching, failure to comply with the rules of intimate hygiene.
  • Use tampons during menstrual cycles.
  • Sex during menstruation.
  • Problems with immunity due to infectious diseases, stress, fatigue.
  • Damage to the inner layer of the uterus, its cervix, vagina or perineum during childbirth, especially with cesarean section (referred to as complications of the postpartum period).

After scraping

A separate category are cases of endometritis with cureturing of the mucous membrane - this includes not only cases of abortion or the consequences of miscarriage, or missed abortion, when the doctor needs to completely clean the uterus. Even curettage during gynecological examination can be the cause of damage to the endometrium - for testing for oncology, for uterine bleeding. Even an examination of the uterus during hysteroscopy can cause endometritis.

Endometritis and childbearing

If this gynecological disease occurs in a chronic form, pregnancy does not threaten anything (provided the physician is able to correctly draw up a therapy regimen) - a woman can be cured and even prevent infection of the fetus, but this should be done at an early stage of pregnancy. In later periods, endometrial inflammation is a common cause of miscarriage of a child.

Hormone therapy

Of particular importance is the use of hormone-based drugs for pregnant women: doctors prescribe estrogen sources to preserve the fetus. In other cases, such drugs are required for the chronic form of inflammation - here, for serious hormonal disorders, the following scheme is used:

  • Divigel - used in the first half of the cycle, externally on the skin of the lower abdomen, provokes endometrial hyperplasia. Like all hormonal drugs, has a lot of contraindications. The recommended dosage is 1 g per day.
  • Utrozhestan - for the second half of the cycle, oral administration and vaginal administration is possible. Based on progesterone, you need to drink 1 capsule in the morning and evening. Vaginal use is discussed with the doctor.

Physiotherapy

After a course of therapy to help relieve acute symptoms, physiotherapy is recommended for women, especially if we are talking about chronic endometritis. Predominantly, doctors resort to inpatient treatment, during which they do:

  • electrophoresis using copper and zinc,
  • magnetic therapy - anti-inflammatory effect,
  • UHF - short (15 minutes) high-frequency electric field irradiation procedures.

Folk remedies

If there are no infectious diseases in the patients' history and endometritis is nonspecific, you can use traditional medicine. Mostly it is the reception of decoctions (100 ml 3 r / day) and douching them (30 ml). Treatment lasts 2-3 months. According to reviews, the symptoms of the disease relieve such fitosbory:

  • Leaves of mint, eucalyptus, bearberry and coltsfoot 1: 1: 1: 1, 2 tbsp. l collection of 500 ml of boiling water. Insist hour.
  • Chamomile flowers, mint grass, thyme and motherwort (equal ratio) are also taken in the amount of 2 tbsp. L., poured 0.5 liters of boiling water, insist half an hour.

Prevention

It is not necessary to ask how to treat uterine endometritis, if the risk factors are cut off: avoid abortions, be observed by a gynecologist to prevent genital pathology. Additionally should:

  • remember intimate hygiene,
  • avoid sexual contact during menstruation,
  • use barrier contraceptives,
  • time to stop the development of genital infections so that they do not affect the uterus mucosa.

Causes and Symptoms of Endometritis

The endometrium is normally well protected from pathogenic organisms by the mucous membrane of the cervical canal.

Intrauterine procedures create favorable conditions for the development of microorganisms that cause endometritis. Increase the risk and childbirth, proceeding against the background of immune and hormonal changes. The causes of acute pathology are:

  • menstruation and intrauterine devices,
  • intravaginal tampons,
  • infectious diseases of the genitourinary system,
  • constant stress, reduced immunity.

With undertreated acute process, disregard of recommendations, self-treatment develops chronic endometritis.

Errors of therapy lead to such complications as adhesions and cysts, inflammation of the appendages, infertility. Therefore, it is necessary to consult a specialist when the first signs of the disease appear, including:

  • chills,
  • temperature increase up to 38-40 ° С
  • uterine discharge,
  • aching pain in the lower abdomen,
  • general weakness.

Symptoms characteristic of an acute process require urgent administration of antimicrobial and anti-inflammatory drugs, which will destroy the pathogenic microflora in the uterine cavity.

Chronic endometritis is asymptomatic at first. Further appear:

  • low-grade fever
  • pulling pains in the lower abdomen,
  • fast fatiguability,
  • uterine bleeding,

  • menstrual disorders,
  • lack of pregnancy.

The appearance of these signs is a "bell" to consult a gynecologist. This is the only way to prevent complications.

Principles of treatment of endometritis

Since bacteria, viruses and even microscopic fungi cause the disease, the doctor’s first task is to determine the source of the infection. In most cases, identify staphylococci, streptococci, pathogens of venereal diseases.

Then be sure to conduct tests on the sensitivity of microflora to antibiotics, the results of which will determine the treatment strategy.

Therapy of acute inflammation begins before the results are obtained, then, if necessary, correction is carried out. If the drugs are chosen correctly, a positive trend will appear in 3-5 days.

In acute endometritis, requiring massive use of antimicrobial agents, the following treatment regimen is used in the hospital:

  1. Several antibiotics are prescribed, at least one of them is administered intravenously.
  2. Intoxication is removed using intravenous saline solutions.
  3. Increase the immune status of immunomodulators.

  4. Assign vitamins that improve the overall condition.
  5. Positive dynamics fix physiotherapy.

The chronic form is treated on an outpatient basis, prescribing monotherapy with antibiotics, hormones and drugs to restore the endometrium. With a favorable course in 10-14 days, the symptoms of the disease disappear.

Often prescribed drugs

In modern treatment regimens use antibiotics of new generations, quickly eliminating the focus of inflammation. Apply and complex antibiotics, having in the composition of other antimicrobial substances.

In the acute form of endometritis the most effective:

  1. Ceftriaxone is a new cephalosporin that kills all types of bacteria. It is used in chronic form.
  2. Clindamycin is a broad-spectrum antibiotic that is effective for staphylococcal and streptococcal infections.
  3. Unazin is a penicillin-containing drug containing ampicillin and sulbactam. The latter enhances the antimicrobial action of ampicillin. Take the tool in conjunction with Agumentina.
  4. Augmentin - amoxicillin-based medicine. Destroys bacteria that are insensitive to other antibiotics.

  5. Metronidazole is not an antibiotic, but belongs to the group of antimicrobials. Therefore, it is recommended to include it in the complex treatment of endometritis.

Antibiotic treatment of chronic endometritis begins after receiving test results. Apply broad-spectrum drugs, such as:

  • Sparfloxacin, administered in the absence of pathogen sensitivity to other antibiotics,
  • Doxycycline, to which many microorganisms are susceptible, including pathogens of sexually transmitted diseases,
  • Ertapenem, which is used in monotherapy and complex treatment of acute postpartum endometritis.

For endometritis, Cefazolin, Sumamed, Gentamicin, Levofloxacin, Lincomycin, etc. are also prescribed. If the drug is chosen correctly, it will improve after 3-4 days.

It must be remembered that outpatient treatment requires strict adherence to the dosage of drugs prescribed by the doctor and the duration of the intake.

Contraindications

At the first visit, the gynecologist, prescribing treatment, finds out that the patient has associated comorbidities, since most antibiotics have contraindications. Some of them:

  1. Ceftriaxone is not prescribed during pregnancy, kidney and liver failure.
  2. Sparfloxacin is contraindicated in bradycardia, hypokalemia, and heart rhythm disturbances.

  3. Ertapenem can not be taken with thrombophlebitis, pregnancy and lactation.
  4. Doxycycline is not prescribed during pregnancy and lactation, severe forms of liver failure.

If, in the presence of contraindications, the antibiotic is still prescribed, it is necessary to inform the attending physician about it.

Most drugs have side effects, most often these are allergic reactions. Their appearance requires correction of treatment and prescription of antihistamines.

Conclusion

Endometritis is a severe inflammatory disease that develops on the background of low immunity, which requires long-term qualified treatment. Regular visits to the gynecologist, compliance with recommended therapeutic and preventive measures, a healthy lifestyle will prevent the development of complications.

Treatment of chronic endometritis with antibiotics

Treatment of inflammation in the uterus without the use of antimicrobial drugs is absolutely meaningless and extremely ineffective. Antibiotics for acute endometritis provide quick relief from the infection and prevent the formation of a chronic recurrent process leading to infertility.

A prerequisite for successful therapy is compliance with the principles of antibiotic therapy and the use of medications recommended by the doctor. This is especially important in severe disease and in the background of the postpartum state.

Indications for taking antibacterial agents

Antimicrobial drugs will be required to identify the typical symptoms of the following diseases of the uterus:

  • endomyometritis with a high risk of spreading infection,
  • chronic endometritis, as the main causative factor of infertility.

    For each woman, the choice of drug and the selection of the mode of application is strictly individual. According to expert reviews, it is far from always enough of an antibiotic to obtain the optimal therapeutic effect.

    In some cases, the time factor is critically important: a delay in the initiation of the use of an antimicrobial agent can cause serious complications with the need to use surgical therapies.

    Selection of the complex treatment regimen

    The success of the treatment of endometritis, the speed of the disappearance of symptoms and the reduction of the risk of complications depends on the following factors:

  • medication route
  • antimicrobial dosage,
  • the duration of the use of funds
  • mandatory consideration of probable adverse events,
  • the need for a combination of several drugs.

    A typical treatment regimen for acute postpartum endometritis includes 2 antibiotics administered in the form of injections, in combination with Metronidazole. This must be done as with endometritis after natural childbirth, and after the birth of the baby by caesarean.

    It is impossible to cure acute inflammation of the inner lining of the uterus without antimicrobial agents, but it should be remembered that the inflammatory process can enter a chronic stage if the doctor's advice is not followed or the drugs are quickly refused while the general condition improves.

    The combination of several drugs

    The effectiveness of endometritis therapy will increase significantly if you add to the standard scheme of drugs that have antimicrobial and anti-inflammatory effects. This is especially important in case of complicated or postoperative pathology variants:

    Most often, the doctor will combine 2 antibiotics, or add Metronidazole to the treatment regimen. The positive effect will be when using Diclofenac rectal suppositories and the use of enzyme preparations.

    Possible complications and side effects

    Drugs with antimicrobial action have a strong and pronounced effect on the entire body of a woman. We must remember and be aware of the side effects of drugs, which include the following states:

  • allergic manifestations
  • toxic effect on the liver and kidneys,
  • intestinal lesion with dysbacteriosis formation,
  • cardiotoxicity manifested by symptoms of heart failure.

    It is unacceptable to take antibiotics on your own during pregnancy and when feeding a baby with breast milk: in both situations there is a serious danger for the baby.

    Antibacterial therapy for endometritis is carried out under the constant supervision of a physician with an individual selection of combination therapy. With strict adherence to the recommendations of a specialist and the use of effective medicines, it is possible to defeat inflammation in the uterus without consequences.

    Content

    Quite often, women have a disease called endometritis. During the diagnosis of this disease it is necessary to carefully select antibiotics and other drugs, as the result depends on their effectiveness. What is the best way to take antibiotics for this disease, you will learn from this article.

    This disease indicates an inflammatory process in the uterus, or rather the change in the endometrium. For all that, moreover, not only the first layer of the endometrium deteriorates, the disease can literally "curl" into more distant layers of the shell.

    Causes that can lead to disease

    The only cause of endometritis is the penetration of pathogens into the uterus.

    First, let's look at why this unpleasant disease can occur. For medical reasons, endometritis is most often caused by an infection that has penetrated the uterus. Infection occurs during gynecological manipulations, such as:

  • abortions
  • spiral installation
  • scraping
  • hysteroscopy
  • with chronic uterine disease.

    Uterine disease can occur even after childbirth, within four days from the birth of the baby. The emergence of this disease, primarily due to:

  • long childbirth,
  • delayed placenta
  • cesarean section
  • bleeding after childbirth,
  • bacterial vaginosis.

    If you experience any symptoms, the girl must necessarily be examined by her doctor. For many women, the sense of self-preservation is completely absent, but the disease does not forgive mistakes, so if you suspect that something is wrong with your body, be sure to go to a medical center. There, the doctor will correctly establish the diagnosis and write out antibiotics that will help to quickly get rid of this problem. It is not worth doing anything yourself, as it can lead to great complications in the form of exacerbation of the disease.

    How is the disease diagnosed

    Perhaps the most important methods of diagnosis are:

  • routine gynecological examination
  • polymerase chain reaction,
  • blood test,
  • endometrial biopsy (prescribed in particularly difficult cases).

    Ultrasound examination of the abdominal cavity.

    Due to the severity of the disease, treatment is carried out only under the supervision of doctors in the hospital. During treatment, specialists carry out cleaning of the uterus, antibacterial therapeutic actions, as well as detoxification.

    What are antibiotics, and in what cases are taken

    Perhaps everyone already understands that with this disease, antibiotics are simply very important. And they begin to take them immediately after the diagnosis is revealed, to slow down in this case is extremely dangerous, because complications can appear (for many women, it was so).

    Most often, you can see that doctors usually prescribe a broad-spectrum antibiotics, these are penicillin, macrolide, thienam. If the ailment is not yet very badly started, then the doctor can prescribe medicines, using which the girl can breastfeed the baby.

    What can take anti-inflammatory drugs

    The anti-inflammatory drugs for women include: ibuprofen, diclofenac, and aspirin. In addition to the anti-inflammatory effect of these drugs are also painkillers. However, if necessary, can be anesthetized with antispasmodics. If bleeding is observed, oxytocin is recommended to prevent it. Among the most popular antibiotics today are identified Longidase, and what it is, we learn a little lower.

    I want to warn all women: folk methods are extremely unacceptable especially for uterine diseases. This can not only lead to complications, but also to death. It is better to contact a real specialist and not risk your health !!

    What are the benefits of Longidase?

    Longidis is a kind of hyaluronidase conjugate, but it has a highly nicotic carrier called azoxymere bromide.

    Due to the fact that the chemical bond between the conjugate and azoxymere succeeded, this drug is completely protected from inhibitors, among other things, the drug retains its activity for a long period of time, it does not cause any side effects.

    With long-term use of this drug, it in no way affects the heart, kidneys, liver and other human organs. According to medical experts, this drug affects the body only in a positive way.

    According to the testimony of various studies have revealed that this drug affects the disease of the uterus only positively.

    It removes inflammation, regulates protein synthesis, and has a beneficial effect on the entire body. When a thorough study of this drug, experts found that it can cause reverse development of the tissue while it does not damage the connective tissue, in addition, it stops the growth of pathology. All this makes it possible to say that for women this drug is just a real salvation.

    The longididase drug is loved by doctors for its effectiveness; this antibiotic can be used both after surgery and during the entire course of treatment. Longidis helps to quickly heal the scars after surgery, which is very valuable. Of course, if you do not want to take an antibiotic, you can choose another way, such as electrophoresis. But this method is not as effective and is used most often in the first stage of the disease, when it is still possible to do this way of treating the uterus.

    Longidase is the newest pharmacological agent that can actually:

  • remove the inflammatory process
  • stop the growth of unwanted connective tissue
  • cause reverse fibrosis formation.

    It turns out that this tool has a number of useful properties that are aimed exclusively at eradicating the disease. Longidase is the most powerful antibiotic today and this one has been proven for a long time. In addition to the above, this tool is widely used in such areas of medicine as:

  • surgery,
  • gynecology:
  • urology,
  • pulmonology and so on.

    Antibiotic Longidase for Endometritis

    Among the various diseases in the first place is chronic endometritis. According to various data, the prevalence of this disease is 70%, which is easily explained - it is very difficult to diagnose.

    Among other ailments of this nature, the chronic form is found very, very often and this is due primarily to the fact that girls use intrauterine contraception and very often have abortions. In 85% of cases, this malaise is detected in girls of childbearing age. This is due to the fact that such a cycle of menstruation is often disturbed in such girls, which leads to the development of infertility, or the girl simply does not wear the baby, a miscarriage occurs.

    It has long been proved that if you use this drug with hormones, it will help to quickly cure the ailment. It is recommended to use the drug rectally or vaginally, the duration of the course of 10 injections, candles for endometritis of the uterus should be entered with an interval of one day.

    An interesting fact is that when using this drug, there was not a single case, when a person got some side effect. In this regard, it can be assumed that there are simply no recommended dosages. But of course in everything you need to know when to stop and do not overdo it !!

    The effectiveness and effectiveness of this drug in the treatment of adhesions, with inflammation of the internal organs, endometritis, is confirmed by various clinical tests from leading research centers in Russia.

    The result of such studies revealed:

  • complete disappearance of pain in the abdomen,
  • does not have polyclonal activity,
  • stop bleeding,
  • reduction of pain during menstruation,
  • the disappearance of whiter,
  • improvement in pipe flow,
  • no genital deformity
  • improvement of the endometrium in all those who have completed the entire course of treatment,
  • the onset of a long-awaited pregnancy and the emergence of healthy babies.

    One of the main and significant advantages of this drug is that it is classified as a non-toxic drug: it does not have polyclonal activity, is not carcinogenic, does not affect growth, mental abilities and fetal development.

    During clinical use, no local or systemic side effects have been identified.

    Summing up, we can say that such a disease is not the end of your whole life and you can and should even fight it. Do not ever lower your hands, your health is only in your hands, so as not to suffer from this ailment, we recommend that you visit your gynecologist at least once a year, undergo a general blood test and perform an abdominal ultrasound scan. All this will protect you from this infection, but if it so happens that you already have this ailment, you do not postpone the doctor’s treatment for tomorrow, but it’s best to go to the nearest medical center for professional help. Moreover, in our century there are so many options for the prevention and treatment of this ailment. If you plan to have children, then spend a full course of therapy.

    Symptoms of endometritis

    Most often occurs after childbirth and abortion. Symptoms appear 3-4 days after infection in the uterus. In acute endometritis weakness, malaise, pain in the lower abdomen, increased heart rate, temperature rise to 38–38.5 ° C, increase and hardening of the uterus, its soreness during palpation is noted. The discharge is turbid, abundant, with a purulent odor. Uterine bleeding is possible. In severe cases, pyometra may develop (accumulation of pus in the uterus).

    With incorrect or incomplete treatment, acute endometritis can become chronic.

    Chronic form

    It occurs as a result of sexually transmitted diseases, or against the background of acute endometritis. The chronic form may be latent and have no clinical manifestations - then the diagnosis is made on the basis of laboratory research data.

    Among the most common symptoms of chronic forms of endometritis are menstrual disorders, discharge before and after menstruation, the appearance of light, scarce serous discharge, mild back pain.

    In this form of the disease, endometrial structural changes associated with malnutrition of tissues or the formation of cysts are observed. Therefore, in women with chronic endometritis, infertility or miscarriage is often encountered, because a fertilized egg can not attach to the modified uterine membrane.

    Clindamycin

    Clindamycin, used in combination with gentamicin, is part of the group of lincosamides, which are useful in treating serious skin and soft tissue infections caused by most strains of staphylococcus. It is also effective against aerobic and anaerobic streptococci, with the exception of enterococci.

    Clindamycin inhibits (inhibits) the synthesis of bacterial proteins by inhibiting the initiation of the ribosome of a bacterium. It mainly binds to the subunit of the 50S ribosome, causing a slowdown in bacterial growth.

    Gentamicin

    It is an aminoglycoside antibiotic group used against gram-negative bacteria. Gentamicin is used in combination with either clindamycin or metronidazole and ampicillin.

    There are several schemes of use, they are adjusted on the basis of creatinine clearance and changes in the volume of distribution of the drug in the body. It is administered intravenously or intramuscularly.

    Antibiotics for endometritis in women

    Endometritis treatment is prescribed after examination by a gynecologist. Endometritis therapy is aimed at preventing the chronicity of the acute process and the development of complications, the elimination of the widest possible range of pathogenic pathogens, as well as the restoration of menstrual and reproductive functions.

    All treatment of acute endometritis should be carried out in gynecological hospitals.

    Non-drug therapy includes bed rest and a lightweight diet enriched with vitamins.

    Drug therapy includes the appointment of systemic antibacterial agents with the widest possible range of antibacterial effects.

    Since inflammation of the endometrium is most often caused by gram-positive cocci, enterococci, nonsporiferous anaerobes, etc., the prescribed antibiotics should affect the entire spectrum of suspected pathogens.

    Given the frequency of occurrence of inflammatory processes caused by mixed flora, combination therapy regimens are often prescribed.

    Treatment of endometritis with metronidazole is carried out in combination with third to fourth generation cephalosporins. Since as an isolated therapy, metronidazole is ineffective.

    Also often used combinations of lincosamides and aminoglycosides of the second or third generation.

    To carry out monotherapy can be used drugs inhibitor penicillins (amoxicillin in combination with clavulanic acid) or carbapenem (drugs meropenem, imipenem and cylastin).

    Doxycycline preparations for endometritis are highly effective in the chlamydial nature of the infection. Also, macrolides are often prescribed for chlamydial endometritis.

    According to indications, fluoroquinolones (levofloxacin, sparfloxacin, ciprofloxacin, etc.) can be used.

    Doxycycline with endometritis

    Doxycycline refers to synthetic derivatives of tetracycline. The drug has the broadest spectrum of antimicrobial effects, is well absorbed by oral administration and less likely to cause side effects (than tetracycline).

    Doxycycline penetrates well into the tissue of the genital organs, therefore, it is often used in the treatment of gynecological and urological pathologies of an inflammatory nature.

    Streptococci, staphylococci, Listeria, gonococci, meningococci, Escherichia, hemophilus bacilli, mycoplasmas, chlamydia, enterococci, Proteus, some protozoa, etc. are highly sensitive to doxycycline.

    The drug is contraindicated in children under eight years of age, pregnant women, patients with individual intolerance to tetracyclines, as well as to persons with severe renal and hepatic dysfunctions.

    Doxycycline is prescribed at a dosage of two hundred milligrams on the first day and one hundred milligrams later. If necessary (severe infection) doxycycline can be used in a dosage of two hundred milligrams (one hundred to two times a day) throughout the course of therapy.

    The duration of treatment depends on the severity of the patient.

    As a rule, the drug is well tolerated. Most often, undesirable effects manifest themselves as nausea after taking capsules.

    Rarely, the side effects of the drug may be manifested by reactions of allergic genesis, increased intracranial pressure, dizziness, bleeding disorders, gastritis, peptic ulcers of the esophagus, etc.

    Drugs metronidazole with endometritis

    Metronidazole is a derivative of 5-nitroimidazole. It is an effective antiprotozoal and antimicrobial drug, active against Trichomonas, bacteroids, peptococci, fuzobakterii, clostridia, etc.

    With endometritis, metronidazole is prescribed only in combination with other antibiotics, since it is not effective against aerobic and facultative anaerobic microorganisms.

    The drug is contraindicated in patients with a history of leukopenia, hypersensitivity to derivatives of 5-nitroimidazoles, impaired motor coordination, organic lesions of the central nervous system (epileptic seizures).

    Also, the drug is contraindicated in patients in the first trimester of pregnancy.

    Dosages and treatment regimen depend on the severity of the patient’s condition and the etiology of the inflammatory process.

    Most often, metronidazole for endometritis is prescribed at 1000-1500 milligrams per day, divided into two or three doses.

    Side effects from the use of metronidazole can be manifested by allergic reactions, abdominal pain, increased intestinal motility, abdominal distention, diarrhea, metallic taste in the mouth, bile stasis, itchy skin, decreased white blood cell count, etc.

    Use of sparfloxacin for endometritis

    Sparfloxacin belongs to the group of fluoroquinolone antibiotics. The drug is able to exert a bactericidal effect against staphylococci, streptococci, Salmonella, Shigella, Mycobacterium tuberculosis, enterobacteria, hemophilic sticks, Klebsiell, moraxellus, etc.

    The drug is contraindicated in patients younger than eighteen years of age, persons with individual intolerance to fluoroquinolones, pregnant and lactating breasts, patients with cardiac abnormalities, patients with increased photosensitivity, as well as severe damage to the kidneys and liver.

    With caution, fluoroquinolone preparations are prescribed to patients with impaired cerebral circulation, epileptic seizures, etc.

    Sparfloxacin is prescribed for four hundred milligrams on the first day of treatment and two hundred milligrams per day in the future.

    The duration of treatment is prescribed individually and depends on the severity of the patient's condition.

    Side effects of treatment may include dizziness, tremor of the extremities, increased sensitivity to sunlight, depressive disorders, nausea, vomiting, fainting, abdominal pain, inflammation of the tendons, reactions of allergic genesis, drug-induced hepatitis, anemia, coagulation of the blood, anesthesia, anesthesia, anemia, drug-induced hepatitis, anemia, and blood clotting. and alanine aminotransferase, etc.

    Etiology of the inflammatory process in endometritis

    Acute endometritis can be caused by bacterial, viral, parasitic, mycoplasmal, fungal, protozoal, and spirochetotic agents.

    Endometritis of mixed nature, caused by associations of 3-4 pathogens (aerobic and anaerobic), is often observed.

    Inflammatory processes usually begin in the cervical canal. In the future, due to the upward spread of infection affects the entire uterine cavity.

    Causes of endometritis

    The reason for the development of endometritis is the penetration of pathogenic microorganisms into the uterus. The main risk factors contributing to the introduction of infection are:

    • non-compliance with personal hygiene,
    • the presence of sexually transmitted diseases,
    • septic criminal abortion (an abortion performed outside a medical facility),
    • sexual intercourse during menstruation,
    • frequent change of sexual partners
    • severe acute infectious diseases
    • the presence of immunodeficiencies,
    • postpartum complications (postpartum endometritis), etc.

    Ampicillin and sulbactam

    Ertapenem has bactericidal properties due to inhibition of cell wall synthesis and indirectly through the binding of penicillin-binding proteins.

    It is resistant to hydrolysis by various beta-lactamases, including penicillinase, cephalosporinase, and extended spectrum beta-lactamase. It is hydrolyzed by metal beta-lactamase.

    Piperacillin and Tazobactam Sodium

    It was found that the combination of ampicillin with sodium sulbactam (beta-lactamase inhibitor) is effective as monotherapy in 80-90% of patients. This agent acts on the microflora of the skin, intestines and anaerobic microorganisms. It is not ideal for the treatment of nosocomial infections.

    Cefotetan belongs to the second generation of cephalosporins and is used as monotherapy to provide a wide coverage of gram-negative, anaerobic and some gram-positive bacteria. They inhibit bacterial cell wall synthesis by binding to one or more penicillin-binding proteins, inhibits the final stage of peptidoglycan synthesis transpeptidation, which leads to cell wall destruction.

    Cefazolin is a first-generation cephalosporin that acts by binding to one or more penicillin-binding proteins, slows down the synthesis of the bacterial cell wall and inhibits the replication of bacteria.

    Prophylactic antibiotic use reduces the incidence of postpartum fevers in patients undergoing cesarean section. Currently, studies support the preoperative prophylactic administration of antibiotics. Monotherapy with first-generation drugs, such as cefazolin, or second-generation cephalosporins was recognized as the best choice.

    Treatment of inflammation of female appendages with antibiotics

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    Inflammation of the appendages is not a pleasant phenomenon, which is accompanied by pain in the lower abdomen, dull or aching pain in the appendages, menstrual disorders, general weakness of the body. Sometimes (in severe, advanced cases) the illness is accompanied by fever.

    But what causes the disease? As a rule, it is considered that this is a result of hypothermia, but also, this may be due to the riot of any infection that has penetrated into the body and was not timely detected.

    How can I treat a problem? For treatment, special antibiotics are prescribed for inflammation of the appendages. But what antibiotics can be used to treat inflammation of the appendages. There are several types of antibiotics that are actively used in medical practice.

    Cefazolin and ceftriaxone for inflammation

    When inflammation, doctors prescribe treatment with cefazolin, which is beta-lactam antibiotics, a group of cephalosporins, which have a broad spectrum of antimicrobial, bactericidal action.

    Treatment with these antibiotics is performed only if the inflammation of the appendages was provoked by staphylococci, gram-negative microorganisms, pneumococci, etc. This drug is inactive with respect to the simplest viruses, fungi and rickettsia, and the Indoprotective Proteus R.

    The action of this tool is reduced to the fact that it inhibits the synthesis of cell membranes of the walls of bacteria.

    Antibiotics "cefazolin" is prescribed after testing, during which the pathogen is determined. The dosage of the drug depends on the sensitivity of bacteria to its action. Treatment with these antibiotics is made when they are administered intravenously (drip or jet). Duration depends on the severity of inflammation of the appendages.

    Ceftriaxone has a bactericidal effect due to inhibition of cell membrane synthesis. In chronic inflammation of the appendages, ceftriaxone is administered intravenously (i.e. injections) once a day. The duration of treatment with the drug "Ceftriaxone" - 7 days. Further, the doctor may cancel ceftriaxone and continue treatment with other medicines.

    Taking ceftriaxone may feel unwell, nausea.

    Azithromycin and sumamed

    The antibiotic "azithromycin" in inflammation of the appendages with the active action in the focus of infection, has a bactericidal effect in high concentrations. Treatment with this drug is not prescribed if the inflammation of the appendages was provoked by gram-positive bacteria that are resistant to erotromycin.

    This medication can cure infections of the genitourinary system, such as gonorrheal non-rheumatic urethritis or cervicitis (an inflammation of the cervix). Before treating inflammation, it is necessary to determine the sensitivity of bacteria to its components. If the bacteria die under their action, then azithromycin is prescribed. The treatment is as follows: the drug should be drunk an hour before meals or 2 hours later, as a rule, these are two tablets per day in a dosage of 0.5 g.

    Antibiotics Sumamed also have a bactericidal effect in the inflammation. Sumamed is prescribed for inflammation of the urethra and for inflammation of the cervix. Sumamed is taken internally at 10 mg per 1 kg of weight once a day. To cure the disease is enough three days of taking the drug "sumamed."

    Amoxiclav and Amoxicillin

    Amoxiclav is an antibacterial drug of combined action. The composition of the drug "amoxiclav" is amoxicillin, which is an antibiotic of the penicillin group, and clavulanic acid is an inhibitor of beta-lactamase microorganisms. Amoxiclav (particularly amoxycilin) ​​is only effective against bacteria that are sensitive to it.

    Amoxiclav is prescribed in the presence of urinary tract infections, in the presence of infection of the genital organs in women.

    To cure inflammation with the drug Amoxiclav, you can, if you take a pill, as follows: you need to dissolve one pill in half a glass of water, then stir it in a glass until dissolved. You can also Amoxiclav - tablet chew and drink.

    As a rule, the daily dose of the drug taken by Amoxiclav does not exceed 375 mg, that is, you need to drink 1 tablet every 8 hours (or three times a day). It should be noted that in case of severe severe inflammation, the dose may be increased to 625 - 2000 mg per day. The maximum daily rate for adults is no more than 6000 mg.

    It is possible to treat the disease if the drug is administered intravenously, for which dissolve amoxiclav in water for injection (for 600 mg of the drug - 10 ml of water). Content is introduced slowly over 4 minutes.

    Also, the drug has the name "Amoxiclav kvitkab." Before use, read the instructions.

    Treatment can be carried out if you drink the drug "amoxicillin", which also has a bactericidal effect. Before prescribing treatment with the drug "amoxicillin" the patient passes the tests that are necessary in order to determine the degree of sensitivity of the flora that provoked the disease.

    The dosage of the drug "amoxicillin" is assigned to each patient individually, taking into account the severity of the disease and the degree of sensitivity of the pathogen. That is why, before drinking "amoxicillin", you need to consult with your doctor.

    Doxycycline - tetracycline antibiotics

    Doxycycline - is available in capsules, is active against a wide range of bacteria, has a bacteriostatic effect. Doxycycline is prescribed in cases of inflammatory diseases of the pelvic organs in women (with endometritis), with urinary tract infections with chlamydia, mycoplasmosis, syphilis, gonorrhea.

    The drug can be drunk after a meal, then drink it with plenty of water. Daily dose - 2 tablets (100 or 200 mg), which must be drunk every 12 hours.

    Also, the drug is administered intravenously, for which the contents of the ampoule are mixed with water for injection.

    Everything you need to know about chronic endometritis

    What is chronic endometritis? Pathology in which the mucous membrane of the uterus is strongly inflamed is called endometritis. If only the surface layer of the mucous membrane is affected, an uncomplicated but acute form of the disease occurs. If the disease penetrates deeper and affects the basal and muscular layers - it is already a chronic form.

    In a healthy organism, the uterine cavity is a sterile organ without microbes and viruses. The vagina, on the contrary, is an organ in which various bacteria simply swarm. The cervix is ​​the connecting link of the vagina directly to the uterus. That it is a kind of barrier in the path of infection in the body. If something happens to this barrier, and pathogenic microbes penetrate into the main female organ - problems begin in the woman's health. There is an acute or chronic inflammatory process.

    Pathology most often affects the uterus of women who are actively sexually active. The disease can occur:

  • In patients who have undergone surgery, cesarean section, abortion, birth trauma (injuries and tears of the perineum, vagina, cervix contribute to infection in the uterus),
  • At risk may also be those who had diagnostic curettage, endometrial biopsy, those who have used the intrauterine device for a long time (spirals that have been inside the body for a long time become potentially dangerous)
  • Violation of the rules of hygiene of the genital organs, frequent douching is another one of the causes of the disease,
  • If a woman often uses tampons. The fact is that tampons, absorbing bleeding, become a potential source of pathology. They need to be changed every 4-6 hours, it is forbidden to use at night, before and after menstruation, as well as in hot weather,
  • With a state of constant stress, fatigue. These conditions significantly undermine the body's defenses, against which infections of various kinds begin their attack.

    But the main cause of the prolonged inflammatory process is the undertreated phase of acute endometritis.

    In chronic endometritis, the mucous membrane becomes thinner, adhesions develop, polyps and cysts form. The transition of the disease into such a form is possible with exhaustion of the human immune system. If the body ceases to resist the penetration of viruses and microbes, it means that the inflammatory process of a chronic nature begins. This condition has a name - autoimmune endometritis.

    With this form, it is difficult to identify the infectious agent, even if a series of examinations is carried out. About a third of the cases did not succeed in identifying the true cause of the pathology.

    Types of chronic endometritis

    Depending on the pathogen, chronic inactive endometritis is divided into:

    Pathology of the first type occurs if microorganisms of chlamydia, tuberculosis, herpes simplex virus, gonorrhea, candida, and ureaplasma enter the body. Often there are cases of pathology with two or three pathogens. Microorganisms such as staphylococci, streptococci, and E. coli can sit for years in the human body, and then under certain circumstances lead to the occurrence of endometritis.

    Хронический неспецифический эндометрит может быть вызван неправильным использованием внутриматочной спирали, приемом гормональных контрацептивов.

    Различают также очаговый и пролиферативный эндометрит (когда стенки матки утолщаются и уплотняются).

    Symptoms of chronic endometritis are barely noticeable. The woman has a little discomfort and does not associate it with the disease. Sometimes there may be erased signs:

  • The aching, dull pains in the lower abdomen, manifested both during physical exertion and in everyday life,
  • Unpleasant pain during sex,
  • Vaginal discharge of different colors and odor. They can be transparent, slimy, yellow-green, brown, with a protracted form of the disease - even serous-purulent,
  • Pain during stool,
  • Failures of the menstrual cycle, the selection of bloody color before and after menstruation.

    Indirect signs of endometritis: general weakness, malaise, fever.

    Chronic endometritis is the cause of infertility in 10 women out of 1000 suffering from this problem.

    The echo signs of chronic endometritis can be seen on ultrasound. These include: compaction of the uterine mucosa, the presence of adhesions, an increase in the size of the uterus.

    How to identify

    In support of the symptoms of chronic endometritis, a series of studies are conducted:

  • Careful examination of the gynecologist with a comparison of all the symptoms, discharge and condition of the uterus. An examination may show a slight compaction and an increase in the uterus in size,
  • Microscopic and bacteriological examination of smears,
  • Blood test.

    For a more detailed study of the causes of chronic endometritis of the uterus, ultrasound is performed as well as hysteroscopy. An ultrasound scan will show remnants of the placenta in the uterus, blood clots, tissue changes. The examination will also show what other organs are involved in the inflammatory process.

    When the diagnosis is fully confirmed, it is necessary to establish which bacteria or viruses infected the patient. For this, an additional examination is appointed:

  • Sowing material from the uterus. It is also carried out to determine which of the antibiotics will be most effective in the treatment,
  • A blood test for antibodies - allows you to determine whether the pathology is caused by viruses and which, if yes,
  • A smear on the flora that helps determine if there is inflammation in the uterus and vagina.

    To identify viruses, the doctor may prescribe serodiagnosis. As a result, antibodies to various pathogens can be detected in the blood.

    Exacerbation of chronic form

    Endometritis begins with an acute form, which can develop into a chronic one as a result of improper treatment. Chronic sluggish endometritis can last for a very long time, without particularly disturbing a woman or causing severe discomfort. Meanwhile, the disease develops, affecting the urogenital sphere more and more.

    Exacerbation of chronic endometritishappens suddenly. It can provoke pregnancy or abortion. On the background of these phenomena can open heavy bleeding. After this, an examination will show the presence of endometritis.

    Can chronic endometritis be cured? Of course, yes, when taking complex measures. The individuality of the treatment regimen depends on the results of the examination, the severity of the disease, the presence of concomitant diseases and complications. However, in principle, the treatment of chronic endometritis is not different. Almost all patients are prescribed:

  • Broad-spectrum antibiotics,
  • Antiviral drugs,
  • Proteolithics,
  • Vitamins,
  • Hormonal drugs,
  • Physiotherapy procedures.

    The treatment of chronic endometritis is aimed at restoring and improving the function of the endometrium of the uterus, as well as at fulfilling the woman’s desire to become pregnant.

    How to treat chronic endometritis? The treatment is carried out in three stages:

  • First of all, after establishing the source of infection, all funds are directed to eliminate it. This alone will reduce the discharge and relieve pain.
  • Then you need to work to restore the cells of the immune system.
  • At the final stage, in order to cure the disease completely, it is necessary to restore the structure of the endometrium and its functions.
  • First stage

    Initially, the attending physician will prescribe antibacterial drugs, namely one of the groups: cephalosporins, nitroimidazoles, macrolides, penicillin is also used. Drugs begin to be used simultaneously with fluconazole, ketoconazole or levorin on the 10th day of the monthly cycle.

    If, during the examination, pathogens of an anaerobic group are found, metronidazole is added to the treatment. The course of treatment with these drugs –10 days.

    Treatment of endometritis with antibiotics is mainly carried out in the hospital, since the medication is administered intravenously, the droppers are placed 2 times a day. Perhaps treatment with injections.

    If the detected infection is viral in nature, antiviral medications are prescribed.

    Second phase

    Further, the treatment of chronic endometritis involves taking metabolic, enzyme, immunomodulatory drugs, as well as those that improve microcirculation.

    It is possible to cure chronic endometritis faster and more efficiently if the prescribed drugs are injected into the uterine mucosa, concentrating their greatest concentration here.

    Third stage

    The final stage on the road to recovery involves the use of physiotherapeutic procedures. The most popular and effective are the following:

  • Mud therapy,
  • Plasmopheresis,
  • Laser irradiation
  • Magnetic therapy
  • Iontophoresis.

    These procedures are aimed at reducing the inflammatory swelling of the mucous membranes, activating blood circulation, stimulating the immune system. Also, women with a diagnosis of chronic endometritis may be prescribed hydrotherapy and mud therapy.

    In addition, during the period of the disease of chronic endometritis, treatment is also carried out with hormonal drugs such as Duphaston, estrogens, phytoecdysteroids. Reception lasts 3-6 months. Hormonal drugs restore the disturbed monthly cycle.

    Treatment with hormonal drugs must necessarily take into account the age of the patient, the severity of the disease, as well as how disturbed the hormones are.

    Along with the traditional methods of treatment and folk remedies. The disease is treated with infusions and decoctions that can be made from such herbs as: Althea root, nettle leaves, sweet clover, pine buds, leaves of wormwood and blueberries.

    Endometritis is chronic, as opposed to acute, requires prolonged treatment. As a rule, it may take more than one week to complete recovery, and sometimes even months. After the course of therapy, a re-examination is carried out, which will show whether endometrial inflammation has completely passed away or not.

    Complications

    Infectious disease chronic endometritis is very insidious in the sense that in the absence of pronounced symptoms can lead to infertility. Even if in the presence of the disease a woman manages to become pregnant, there is a big threat that she simply cannot bear the baby. Complications may also develop during childbirth. But the fact is that the inflamed endometrium is simply not ready to receive a fertilized egg.

    Complications of endometritis in women can also be:

  • The development of adhesions in the uterus,
  • The development of endometrial polyps and cysts,
  • The spread of pathology in the ovaries and tubes, neck, appendages, intestines and pelvic organs.

    For these reasons, every self-respecting woman should go to the gynecologist every six months to make sure everything is in order. Or maybe vice versa, in time to diagnose pathology and in time to start treatment. If women have seen signs of chronic endometritis, this is also a reason to contact a gynecologist. After the correct treatment, the reproductive function of the woman is fully restored.

    Acute endometritis

    The onset of acute endometritis is often preceded by childbirth, abortion or mini-abortion. diagnostic curettage of the uterus, hysteroscopy and other intrauterine manipulations. Incomplete removal of residues of the ovum, placenta, accumulation of liquid blood and clots favor the development of infection and the acute inflammatory process of the inner surface of the uterus. The most common manifestation of postpartum infection is postpartum endometritis. It occurs in 4% -20% of cases after natural delivery and in 40% after a cesarean section. This is due to hormonal and immune restructuring in the body of a pregnant woman, reduced overall immunity and resistance to infections.

    Endometritis can be caused by various pathogens: bacteria, viruses, fungi, parasites, mixed flora. Depending on the nature of origin, specific endometritis and non-specific endometritis are distinguished. Specific include infectious (viral, chlamydial, bacterial, protozoal, fungal) and parasitic endometritis. They can be caused by pathogens such as herpes simplex viruses. cytomegalovirus. chlamydia. Mycobacterium tuberculosis. Toxoplasma, mycoplasma. Candida radiant fungi, gonococci, etc.

    In the development of endometritis, the state of the immune, endocrine, nervous systems, which often aggravate the course of the disease, matters. With the nonspecific nature of endometritis, the pathogenic flora in the uterus is not detected. Nonspecific endometritis can be caused by bacterial vaginosis. HIV infection. the presence of an intrauterine device, taking hormonal contraceptives.

    The chronic form of endometritis is often a consequence of undertreated acute endometritis that has arisen after childbirth, abortion, intrauterine manipulation, due to the presence of foreign bodies in the uterus. In 80-90% of cases, chronic endometritis occurs among women of the reproductive period and tends to increase, which is explained by the widespread prevalence of intrauterine contraception, an increase in the number of abortions, and intrauterine diagnostic and therapeutic procedures. Chronic endometritis is among the most common causes of infertility. miscarriages, failed in vitro fertilization attempts. complicated pregnancies, childbirth and the postpartum period.

    For the detection of an infectious agent in chronic endometritis, high-precision immunocytochemical diagnosis is used. The chronic form of endometritis often has an erased clinical course without marked signs of microbial infection. There is a thickening of the uterine mucosa, serous plaque, hemorrhages, fibrous adhesions, leading to disruption of the normal functioning of the endometrium.

    Acute endometritis usually develops 3-4 days after infection and is manifested by fever, lower abdominal pain, discharge from the genital tract with an unpleasant smell, painful urination, increased heart rate, chills. Acute endometritis in patients with intrauterine devices has an especially severe and rapid course. Therefore, the first signs of acute endometritis are the reason for the immediate passage of the gynecologist consultation.

    During a gynecological examination, a moderately enlarged and painful uterus, serous or serous-purulent discharge is determined. The acute stage lasts from a week to ten days and, with effective therapy, ends with a cure, otherwise - a transition to chronic endometritis.

    Symptoms of chronic endometritis

    The severity of chronic endometritis due to the depth and duration of the existence of structural changes in the endometrium. The main manifestations of chronic endometritis are violations of the menstrual cycle (scanty or heavy monthly), uterine bleeding. pathological sero-purulent or bloody discharge, aching pain in the lower abdomen, painful sexual intercourse. With a two-handed gynecological examination revealed a slight compaction and increase in the uterus in size.

    Structural changes in the endometrium in chronic endometritis can cause the formation and growth of polyps and cysts. Chronic endometritis in 10% of cases is the cause of infertility, in 60% of miscarriage. The muscular layer of the uterus is often involved in the inflammatory process - myoendometritis occurs.

    Risk of endometritis

    In the occurrence of endometritis, a special role is played by the reduction of barrier protection mechanisms that prevent the penetration of infection into the internal genital organs. This may be due to the following reasons:

    Ruptures of the perineum, vagina, cervix at birth contribute to the penetration of the infection into the genital tract and its ascent into the uterine cavity.

    mechanical, chemical, thermal factors affecting the vaginal mucosa

    Violation of hygiene of the genital organs, frequent douching, the use of vaginal spermicidal agents, etc., lead to a change in the normal microflora of the vagina and its protective properties.

    menstruation, childbirth, abortion

    Isolation of blood leads to leaching of secretion of the cervical canal, alkalization of the acidic environment of the vagina and reduction of its bactericidal properties. Under these conditions, pathogenic microorganisms freely penetrate from the external environment and actively multiply on the wound surface of the uterus.

    For a long time, intrauterine devices located in the uterine cavity become a potential source of inflammation, contributing to the penetration of infection in the ascending path through the IUD threads. If endometritis has occurred, then removal of the IUD is necessary.

    using vaginal tampons

    By absorbing bleeding, tampons are the optimal medium for developing an infection. Tampons should be changed every 4-6 hours, do not use them at night, before or after menstruation, in a hot climate. Violation of the rules of using tampons can lead to the development of toxic shock syndrome.

    chronic stress, overwork and lack of hygiene.

    These factors weaken the body and make it vulnerable to infection.

    Treatment of acute endometritis

    In the acute phase of endometritis, patients are treated in a hospital with bed rest, mental and physical rest, an easily digestible full-fledged diet, and a drinking regimen. The basis of drug treatment for acute endometritis is antibacterial therapy, taking into account the sensitivity of the pathogen (amoxicillin, ampicillin, clindamycin, gentamicin, kanamycin, lincomycin, etc.). When mixed microbial flora shows a combination of several antibiotics. Due to the frequent addition of anaerobic pathogens, metronidazole is included in the treatment of acute endometritis.

    In order to remove intoxication, intravenous administration of salt and protein solutions up to 2-2.5 liters per day is indicated. It is advisable to include multivitamins, antihistamines, immunomodulators, probiotics, and antifungal agents in the treatment of acute endometritis. With analgesic, anti-inflammatory and hemostatic purpose, cold is applied to the abdominal area (2 hours - cold, 30 minutes - break). When relieving acute symptoms are prescribed physiotherapy. hirudotherapy (medical leeches).

    Endometritis - what is it

    Endometritis is an inflammation of the mucous membrane of the uterus (endometrium), morphologically consisting of two layers - functional and basal. The first is facing the uterine cavity and consists of a single layer of cylindrical epithelial cells. Between them are glandular cells producing protective mucus, and a large number of small branches of the spiral arteries. During each menstruation, the functional cell layer is destroyed and removed with blood and mucus, after which it is restored again from the cells of the basal layer in the first phase of the menstrual cycle.

    Such natural defense mechanisms as anatomical features of the structure, protective mucus of the uterus and cervical canal, containing immunoglobulins and antibodies, the acidic environment of the vagina, microbiocinosis of these departments, local immune protection in most cases can prevent the development of infection in the genitals. In case of their disorder, in this particular case, acute or chronic endometritis develops, the manifestation of which depends on the severity of the inflammatory response.

    Most often it is caused by urogenital infection with herpes simplex viruses and Epstein-Barr, mycoplasma and chlamydial infections. ureaplasma and cytomegalovirus, E. coli, streptococci, meningococci, enteroviruses and trichomonads, mycobacteria tuberculosis. Less commonly, conditionally pathogenic microorganisms cause the disease. Usually in the crops found mixed microflora.

    The risk factors that create favorable conditions in the uterus for the development and reproduction of the infectious pathogen include:

    The most likely risk factors are listed in the first four paragraphs.

    Clinical manifestations

    Symptoms of acute endometritis occur 3-4 days after infection. The disease begins acutely, arise:

  • Aching pains and a feeling of heaviness in the lower abdomen.
  • General malaise, fever.
  • Copious serous or serous, sometimes with a smell, discharge from the genital tract.
  • Bleeding if endometritis develops after childbirth or abortion.

    In case of a staphylococcal infection, acute purulent endometritis (pyometra) develops, in which the condition is much more difficult due to general intoxication. It is accompanied by chills, high fever, severe cramping pain in the lower abdomen, the appearance of abundant serous-purulent and purulent discharges, the development of a septic state is possible.

    Diagnosis of endometritis with an acute process is carried out on the basis of anamnesis (history of the disease), which allows to establish a risk factor and partially determine the treatment plan, clinical course and symptoms of the disease, gynecological examination data. In addition, a clinical study of blood and urine, ultrasound. clinical and bacteriological examination of smears from the vagina and cervix, culture of the contents of the genital tract on the sensitivity of pathogenic microflora to antibiotics, if necessary - hysteroscopy.

    Chronic endometritis

    Its prevalence is, according to different authors, 10-85%. Such a wide statistical range is due to the complexity of diagnosis, as well as clinical and morphological (tissue structure) confirmation.

    Currently, the chronic form of endometritis is considered as a clinico-morphological syndrome, in which, as a result of endometrial cell damage by an infectious agent, functional and structural changes in the endometrium occur. The latter violate its cyclic transformations (detachment and restoration), the receptor response of cells of the mucous membrane of the uterus and its ability to implant a fertilized egg.

    Some authors believe that chronic endometritis is generally not a clinical, but a morphological concept, and it is difficult to navigate by clinical symptoms. Very often, women do not make any complaints of an inflammatory nature, but only about infertility. And only when diagnosing the cause of infertility, does the asymptomatic endometritis occur.

    Autoimmune processes in chronic endometritis

    PID in recent years are considered as diseases caused by infectious pathogens and further developing as pathological, self-supporting, autoimmune reaction. An important factor in its development is the failure of the immune system as a result of its disadaptation. The resulting secondary immunodeficiency causes a decrease in the body's resistance to the effects of infectious agents.

    Active viruses or bacteria, which are antigens and cause long-term chronic endometritis, damage epithelial cells with the additional formation of antigens in the form of the destroyed proteins of the endometrial's own tissues (autoantigens).

    In addition, the infectious agent disrupts the formation of antibodies, resulting in the accumulation of additional antigens. The local immunocompetent system is activated to neutralize the antigens. It is overloaded and gradual depletion, the inclusion in the process of a weakened overall immune system of the body, which already destroys self-antigens and healthy tissues due to the lack of protein difference between them.

    That is, the immune system ceases to distinguish between its destroyed and healthy cells, as a result of which the autoimmune mechanism that has been formed affects the healthy endometrium. Chronic endometritis becomes a self-sustaining inflammatory chronic process - an autoimmune endometritis, for which it is no longer necessary to maintain an infectious pathogen. Therefore, it is often not detected during research.

    Thus, autoimmune endometritis is not an independent disease, but a later stage of the same chronic endometritis.

    Can I get pregnant with endometritis?

    The sensitivity of the endometrium and, accordingly, the reproductive functions at the initial stage of chronic endometritis still remain at a satisfactory level, thanks to the presence of certain compensatory mechanisms. Their effectiveness largely depends on the presence of a combined pathology of the reproductive organs, the activity of the infectious agent, the adequacy of the hormonal regulation, the activity of the immune system. Therefore, pregnancy in the initial stages of chronic endometritis is quite possible.

    Chronic endometritis can quietly develop independently, be the result of risk factors or acute endometritis listed in the section “Acute Endometritis”. In accordance with the modern classification, conditionally distinguish endometritis:

    1. Specific. The trigger for the development of inflammation is practically any microorganisms that are present in the vagina, except for bifidobacteria and lactobacilli, that is, those that can cause acute endometritis. However, the most common are ureaplasma and genital herpes virus (about 80%), cytomegalovirus, chlamydia, mycoplasma, gardnerella, and microbial associations.
    2. Nonspecific, in which specific infectious pathogens are not detected in the endometrial cells. In these cases, predisposing factors are mainly long-term use of intrauterine contraceptives, untreated, long-term current bacterial vaginosis, HIV infection and the use of radiation therapy for oncological diseases of the pelvic organs.

    The disease is characterized by nonspecificity of clinical manifestations, a long course, a small number of symptoms and their non-expression or absence of symptoms (in 35-40%), the presence of erased forms. The clinical course is a reflection of the depth of the functional and structural changes in the endometrial tissue. Main clinical symptoms:

  • Abundant bleeding during menstruation and an increase in their duration.
  • Scanty discharge of blood during menstruation, the volume of which does not even reach physiological (50 ml).
  • Bloody, serous or sero-purulent leucorrhea or bleeding between periods.
  • Violation of cyclical menstruation.
  • Periodic, rarely permanent unexpressed nagging pain in the lower abdomen and dyspareunia.
  • Infertility, recurrent miscarriage (miscarriages) and unsuccessful attempts at IVF or embryo transfer.

    Diagnostic methods

    Diagnosis of chronic endometritis is based on the analysis of the following data:

  • history (history) of the disease,
  • symptoms, if any,
  • microscopic examination of vaginal, cervical and urethral smears,
  • the results of seeding on the microflora, the polymerase chain reaction (PCR) of the contents of the vagina, the uterus and secretions from the cervix.
  • transvaginal ultrasound of the pelvis with Doppler at 5-7 and 22-25 days after the start of menstruation.
  • hysteroscopy and endometrial biopsy in the first half of the menstrual cycle (days 7-11).

    How to treat endometritis of the uterus in chronic

    Practitioners use mainly a phased scheme of treatment of endometritis with a chronic course. Its principle is:

  • Stage I - elimination (removal) of infectious agents from the endometrium.
  • II— restoration of the level of cells of the immune system.
  • III - restoration of the structure of the endometrium and expression of its receptors (sensitivity of the specific cellular receptor apparatus to the action of estrogens and progesterone).
  • Stage I includes a combination of broad-spectrum antibiotics that can easily enter the cell:

  • drugs from the group of nitroimidazoles with the latest generation macrolides,
  • 3rd generation cephalosporins with macrolides,
  • macrolides with protected penicillins, for example, "Amoxacillin + Clavulonic Acid",
  • fluoroquinolone nitroimidazoles.

    One of these combinations is used from the 1st day of menstruation for 5-10 days. Antifungals are prescribed simultaneously - Levorin, Fluconazole, Ketoconazole, etc.

    In the presence of anaerobic pathogens in the culture of smears, Metronidazole is added - an average of 10 days. Combined infection is an indication for the use of vaginal suppositories, etc., with combined antimicrobial agents (Polygynax) or antiseptics (Hexicon).

    When a viral-type infection is detected after antibiotic therapy is performed, a course of treatment with antiviral and immunomodulatory drugs is performed.

    Stage II is the use of hepatoprotective, metabolic (vitamins, antioxidants, macro- and microelements), enzyme, immunomodulatory (bioflavonoids) and microcirculation improving agents.

    At the third stage, the maximum importance is attached to physiotherapeutic methods. For this purpose, laser therapy is used, including intravenous blood irradiation with laser beams (VLOK), plasma exchange, mud therapy, magnetic therapy, iontophoresis with copper and zinc ions. In addition, stimulation of receptor expression is carried out through courses of cyclic hormone therapy with progesterone (Duphaston) and estrogens, as well as phytoecdysteroids.

    There are disagreements among researchers regarding the need for the use of antibiotics and antibacterial agents. Some of them believe that in the absence of obvious inflammatory processes, antibiotics have no effect and can lead to dysbiosis. However, the majority of clinicians suggest that endometritis therapy cannot be sufficiently effective in underestimating the microbial factor and without the use of antibiotics.

    Differences between endometritis and endometriosis

    Endometriosis is a benign proliferation of tissues that, by their morphological characteristics and functional properties, are similar to endometrium. These tissues include not only the upper layer of the latter, but even glandular cells and the connective tissue supporting structure (stroma). However, they are just like healthy endometrial tissue.

    Molecular defects and genetic changes of endometrial cells ensure their ability to germinate in adjacent tissues and metastasize with blood and lymph to more distant organs, where they, growing, destroy healthy tissue.

    Endometriotic foci can be localized on the uterine appendages and in the space behind it (Douglas space), on the septum between the rectum and the vagina, on the peritoneum, on the surface of the intestinal wall and bladder, in skin scars left after laparoscopy. Endometriosis foci are found even, which happens much less frequently, in the vagina and bladder, in the brain and spinal cord, in the lungs.

    This disease is a long and progressive process with exacerbations. It may contribute to inflammatory processes, but is not their cause. With its properties, endometriosis resembles malignant tumors, has no relation to the inflammatory and immune processes in endometritis and is completely different from them in the clinical course and the results of laboratory and diagnostic studies.

    What is the diagnosis of "Endometritis". The causes and forms of the disease

    Very often, after the birth of a baby, an unpleasant abortion procedure or any gynecological intervention, the woman is faced with endometritis. The fact that this disease can be successfully cured is good. Therefore, many people are concerned about the question: what is this disease and how to deal with it.

    Endometritis is an inflammation of the mucous membrane of the uterus, namely the endometrium, the structure of which changes over the course of the menstrual cycle. With each cycle, endometrium grows and re-ripens, creating all the necessary conditions for the attachment of a fertilized egg. If the pregnancy does not occur, he begins to reject. A healthy uterine cavity is protected by endometrium from various infections. But if they wilt inside, the inflammatory process begins in the inner layer, which provokes the disease.

    The disease can take an acute or chronic form. Also, the infection can spread to the ovaries and fallopian tubes, which leads to inflammation and further to adnexitis. The disease is more characteristic of women of childbearing age.

    What leads to the development of the disease

    Endometrium is divided into two layers: basal and functional. When the menstruation cycle comes to an end, the functional layer exfoliates. And it is formed from the basal, thereby causing the onset of new menstruation. When the structure of the uterine lining is damaged, all the conditions for the development of the disease begin to be created. You should know that damage is not so dangerous. Complications are caused by viruses or infections that penetrate through damage. Microorganisms, therefore, find favorable conditions for their functioning and development.

    The obvious causes of damage to the mucous membrane of the uterus:

  • sounding
  • childbirth
  • abortions,
  • hysteroscopy
  • scraping,
  • douching done carelessly.

    With such intrauterine manipulations, the risk of ingestion of pathogens is large enough. Among them are the following types: mycoplasma, E. coli, enterobacter, chlamydia, Proteus, and others. Often the disease occurs after childbirth. Moreover, if they passed naturally, then the risk is not so great and amounts to no more than 3%. It increases with a caesarean section - up to 15%, and with an unplanned and urgent procedure it generally increases to 20%.

    Other factors causing inflammation:

  • weak immunity,
  • chronic infections
  • use of intrauterine device,
  • injuries to the uterus,
  • avitaminosis,
  • poor hygiene of the intimate area,
  • sexual intercourse during menstruation.

    Causes of Endometritis

    The main causes of endometritis in women are intrauterine manipulations in the treatment of gynecological diseases and infection of the damaged mucous membranes lining the genital organ. Under normal uterine conditions, the endometrium is protected from exposure to pathogens. They cannot sneak into the uterine cavity until tissue is damaged.

    Damage to the endometrial sublayers and the entry of infectious pathogens into the formed wounds are the main cause of endometritis. But the disease with the introduction of pathogens in the mucous membranes affects not all women. This requires the presence of risk factors for endometritis:

  • genital infections
  • impaired microflora,
  • hormonal imbalance
  • diagnostic and therapeutic manipulations.

    The disease often develops in immunocompromised patients. The weakened defense mechanisms of the body do not cope with the destruction of infectious agents. In the uterine cavity creates pathogenic microflora.

    Pathogens

    Causes of endometritis of the uterus - various harmful microorganisms:

  • aerobic and anaerobic microbes present in the normal microflora of the penis,
  • pathogens that are sexually transmitted,
  • gonococci, trichomonads.

    The appearance of the inflammatory process rarely leads to one kind of pathogens. Usually it is caused by a whole coalition of pathogens: strains of staphylococci, streptococci, viruses, fungi, and other agents.

    Pathogens fall on the internal mucous membranes:

  • from the cervical canal or vagina,
  • from the fallopian tubes,
  • from the intestines
  • with lymph flow,
  • with the bloodstream.

    Causes of acute form

    Why endometritis occurs, it turns out when collecting the patient's history. The disease is provoked by:

  • scraping the uterus to obtain the biomaterial necessary for analysis,
  • performing time-consuming manipulations in the uterus,
  • abortion (especially repeated execution of the procedure leading to abortion),
  • accumulation of blood or blood clots in the uterine cavity,
  • extraction of the placenta or the remaining elements of the amniotic sac,
  • postpartum complications
  • cesarean section.

    Sometimes in diagnostic or therapeutic procedures, physicians violate the integrity of the endometrium. Inflammatory processes occur as a result of hysteroscopy, biopsy, sensing.

    Doctors leave on the mucous membranes of the wound with tools used for the manipulation. Pathogens trapped in the uterus easily pass through unprotected wound surfaces, affecting the endometrium.

    When performing abortion or curettage, the endometrium is completely removed. The cavity of the uterus from the inside turns into an extensive wound with exposed bloodstream. Infectious agents trapped on it instantly cause acute inflammation.

    Factors leading to postpartum endometritis

    The acute form of the disease mainly occurs in women after childbirth. It is noted in 5% of women who gave birth naturally. With a cesarean section, this figure is significantly higher. It appears in 30% of laboring women.

    If a doctor is asked: what are the main risk factors for postpartum endometritis? First of all, he refers to hormonal changes occurring in the body.

    Then lists the other causes of endometritis after childbirth. These include:

  • weakened immunity
  • infection with a bacterial, viral, fungal or parasitic infection.

    In addition, the causes of postpartum endometritis lie in how well it functions:

  • nervous
  • endocrine,
  • the immune system.

    If these systems fail, the course of the disease is greatly complicated.

    Causes of chronic form

    Chronic endometritis - a consequence of the untreated inflammatory process that has arisen on the mucous membranes. The provocateurs of the disease in this case are:

  • intimacy during menstruation,
  • trauma to the uterus or cervical canal,
  • vitamin deficiency
  • stressful conditions
  • chronic pathologies that undermine immunity,
  • ignoring intimate hygiene,
  • chronic genital infections.

    The disease is caused by the use of an intrauterine device. Pathogens rise in the uterus through the threads of the device. Sometimes doctors bring them in, inserting a spiral with poorly disinfected instruments.Chronic endometritis, the causes and symptoms of which the doctor establishes, occurs with prolonged use of the helix.

    Practicing doctors claim that the chronic form of the disease mainly develops in women of childbearing age who have had abortions or use intrauterine devices. The disease develops in 80% of these patients.

    Other reasons

    Endometritis leads to:

  • Injuries to the perineum that occur during childbirth: ruptures of the neck and vagina. Infectious agents easily penetrate the uterine cavity through wounds in the perineum.
  • Endometrial damage caused by chemicals.
  • Often held douching.
  • The use of chemical vaginal contraceptives. Spermicides destroy the natural vaginal microflora.
  • The use of tampons. If a woman does not change tampons for a long time, a flora is formed in the vagina that is favorable for the development of pathogens. Microbes multiply, causing inflammation in the genitals.

    The disease is able to develop in isolation. However, he does not go beyond the periphery of the affected tissues. If the inflammation begins to spread, all uterine layers are drawn into the pathological process.

    Inflammation in the endometrium can not be in isolation for a long time. The layers that form the wall of the uterus are closely interrelated. The infection quickly penetrates deep into, seizing the muscular layer of the penis. That is why endometritis is the cause of infertility. With the defeat of the uterine layers, the chance to become pregnant decreases sharply.

    With a diagnosis of acute endometritis, the causes and treatment must be determined immediately. While the disease has not turned into a chronic condition, it has not affected the myometrium and perimetry, it has not led to complications, it is necessary to visit a gynecologist, who will draw up a scheme for the treatment of pathology.

    In advanced cases, women experience sexual dysfunction and the threat of infertility is created. Treatment of endometritis, started at the first symptoms, retains the ability to conceive a child.

    Signs and symptoms of endometritis in women

    Endometritis manifests itself quickly. Signs of exacerbation occur on day 3 after infection. With extensive lesions of the mucous membranes, the symptoms are pronounced, if the focus of inflammation is small, they are blurred.

    In any form of development of the disease - endometritis, the doctor must determine the course of treatment!

    Self-medication leads to the fact that the disease takes a chronic form. Tissues grow pathologically, sexual dysfunction develops, the ability to become pregnant is lost.

    Common symptoms

    Infection, penetrating into the uterine cavity, causes an acute inflammatory process on the superficial mucous membranes. If limited segments of the endometrium are affected, the symptoms of endometritis in women are mild. Attempts to cure themselves lead to the disappearance of signs of the disease. Pathology enters the subacute stage, which, without treatment, is transformed into chronic endometritis.

    With extensive inflammatory processes on the mucous layer, the disease is acute. His symptoms begin to disturb the woman for 3-4 days after infection.

    Infection with damaged protective mechanisms of the cervix rises into the uterine cavity, causing various changes:

  • blood vessels dilate
  • endometrium thickens,
  • mucous membranes are covered with pyogenic plaque, they die off and are rejected,
  • glands, compressed by edematous tissues, intensively produce inflammatory exudate, which leads to abundant vaginal secretions.

    Infection in women develops in different ways. Therefore, with endometritis, the symptoms and treatment of the uterus vary. In some patients, signs are erased, in others, acute inflammation occurs with vivid symptomatology. But in any case, women appear characteristic signs confirming inflammation that flows in the uterine cavity. Their intensity indicates the severity of the disease.

    If you read the forum, the symptoms and signs of endometritis in women are described as follows:

  • mucus is secreted, sometimes with pus,
  • exudate publishes a bad putrid smell (the phenomenon occurs when the disease is caused by E. coli),
  • discharge with blood (this is possible with the destruction and rejection of the mucous membrane),
  • pain in the pelvis from the lungs pulling to acute unbearable (in some cases, they give the lower back, sacrum, groin, the direct section of the intestine).

    On palpation of the uterus, pain occurs (its intensity depends on the degree of organ damage, if the muscle layer is damaged, the pain is sharp, intolerable).

    Symptoms of acute form

    In the acute course of the disease on the 4th day the following symptoms appear:

  • the temperature rises to 37.5-400 C,
  • there is a sharp deterioration
  • intense pains in the lower abdomen appear, radiating to the rectal intestine, sacrum, groin.

    If myometrium is enveloped in inflammation, women complain of spilled soreness that does not have obvious localization.

    Pronounced fever accompanied by:

  • headaches,
  • nausea-vomiting syndrome
  • weakness,
  • tachycardia.

    Vaginal discharge abundant, serous-purulent. Defects on the affected membranes do not have time to recover. For this reason, from the uterine cavity for a long time, leave the blood exudate.

    A damaged endometrium is not properly rejected from the uterine cavity during menstruation. Menstruation is upset, it is replaced by a long abatement of profuse bleeding.

    Aggravated specific inflammation caused by gonococci adapts to prolonged menstrual or intermenstrual bleeding.

    After an unsuccessful abortion, when elements of the amniotic egg remain in the uterine cavity, the organ is unable to properly contract. As a result, profuse bleeding opens, at which dark clots come out.

    The maximum duration of exacerbation is 10 days. With proper therapy, the development of the disease is interrupted. Judging by the reviews, the symptoms of endometritis, which was not treated, gradually disappear, but the pathological processes do not stop progressing. The disease takes on a chronic form, endometritis is in remission.

    Symptoms of chronic inflammation

    Prolonged inflammatory process flows sluggishly. Its signs, like the symptoms of endometritis in a cat (chronic), are mild. At present, any chronic inflammatory process in the endometrium is regarded as an autoimmune endometritis.

    With prolonged development of the disease, the mucous layer is constantly damaged during periods of exacerbation. During remission, the wound heals. Connective tissue grows on lesions. It does not allow mucous membranes to function normally. Endometrium loses the ability to grow and reject in a timely manner.

    If you analyze reviews of endometritis, the symptoms of the chronic form of the woman and the doctors describe as follows:

  • failure of the menstrual cycle, although the ovaries function correctly,
  • persistent pelvic pain,
  • the changed structure of the endometrium (the mucous membranes heal improperly, the infection passes into the underlying layers, develops in them cyclically, resulting in lesions in the depth of the uterine wall).

    In the chronic catarrhal form of the disease, turbid, watery exudate is constantly released from the vagina. This type of disease develops very rarely.

    Chronic endometritis is difficult to treat. Accompanied by severe complications.

    Signs of endometritis on ultrasound

    Indirect signs of endometritis in women are detected by ultrasound of the uterus. The doctor recognizes defects that have arisen in the early stages of the disease and during the chronic course of the disease.

    Demonstrates the following symptoms of endometritis ultrasound photo:

  • how much the uterus is enlarged
  • endometrial thickness
  • adhesive formation in the uterus.

    The obtained clinical signs of endometritis on ultrasound do not allow to determine the level of progression of the pathology, the severity of its course. Biopsy provides more information about the signs of the disease. But they do it only in severe forms of the disease.

    Untreated disease takes severe forms, leads to infertility and damage to other organs. In order to maintain health, it is necessary to undergo regular routine check-ups, which reveal blurred symptoms, to visit a doctor at the first signs of endometritis.

    Symptoms of acute and chronic endometritis. Examination and diagnosis

    The most important symptoms of the disease may appear within a couple of days after childbirth, gynecological surgery or other examinations in this area.

    For births characterized by the following symptoms:

  • high temperature up to 38 ° C and higher
  • prolonged and pulling soreness in the lower abdomen,
  • pain in the process of sexual contact,
  • vaginal discharge unpleasant odor, with pus and blood that are not associated with menstruation.

    For the postpartum form of the disease are characterized by such signs:

  • copious and foul-smelling discharge from the genital tract, starting immediately after childbirth,
  • high temperature up to 39 ° C during the week after birth, not counting the first day,
  • severe pain in the lower abdomen,
  • deterioration of health, weakness, loss of appetite, chills.

    If you find these symptoms, you can not hesitate. And self-education turn around is sad. You should know that any inflammatory disease has the ability to capture more and more territory. Therefore, the longer the treatment is delayed, the more difficult it will be.

    Symptoms of the chronic form

    The most often chronic form of the disease is not associated with various gynecological procedures, childbirth or abortions, but with sexually transmitted diseases. Therefore, symptoms that are characteristic of any infection that provoked the disease appear.

    Very often, the chronic form generally goes away without symptoms, and it can be detected only during a routine examination, which is carried out to solve the problem of infertility or when preparing for the birth of a child.

    Possible symptoms include:

  • prolonged and mild pain in the lower abdomen,
  • the appearance of the temperature periodically to 38.5 ° C,
  • problems with conception and the development of infertility,
  • a long and abundant menstrual cycle of more than seven days,
  • vaginal discharge, which in its structure may be different. It all depends on the infection that caused the disease.
  • Typical symptoms

    If acute endometritis occurs. Its symptoms are expressed as follows:

  • the temperature rises to 37.5-400 C,
  • there is chills, weakness, heart palpitations, difficulty urinating,
  • intense pain that radiates to the groin and the sacrum appears in the suprapubic area.
  • abundant vaginal secretions are sero-pussy in nature (since the recovery of the endometrium is slow, they are often serous),
  • if the ovum partially remains in the uterine cavity, there is a strong blood loss,
  • with gonorrhea infection, bleeding always opens (it looks like prolonged menses or appears several days after menstruation),
  • if the disease is caused by Escherichia coli, the pyogenic secretions emit a foul odor,
  • due to exfoliation of epithelial tissue, blood inclusions are present in the secretions,
  • in case of disturbed rejection of the endometrium, hyperpolymenorrhea develops (menstruation is extended, blood loss increases).

    Symptoms at gynecological examination

    The doctor during the examination reveals the symptoms of acute endometritis in women will see:

  • uterus puffy, inelastic, enlarged,
  • palpation of the organ causes acute pain (pain is most intense along the lymph nodes and from the sides),
  • when inflammation engulfs the peritoneum, pain occurs when the cervix is ​​moved.

    The results of the tests revealed pathological signs:

  • ESR increased
  • leukocyte formula moved to the left.

    Acute endometritis lasts 10 days. With adequate therapeutic treatment, the pathology is completely cured. If the treatment is carried out incorrectly or ignored, the illness enters the subacute or chronic phase, leading to serious problems.

    General information

    After cesarean section, a severe form of endometritis develops. Primary infection is entered when the incision is made. A strong inflammatory process interferes with the healing of a wound that appears on the wall of the uterus.

    The situation is complicated by the fact that the contractile function of the uterus falls sharply. Due to the weak contraction of muscle tissue, the discharge of secretions accumulating in the uterine cavity is difficult. Symptoms usually occur 1-5 days after cesarean section.

    Well, that woman at this time is in the hospital. Doctors quickly determine the symptoms of endometritis after cesarean, and treatment is immediately prescribed.

    Signs during a gynecological examination

    The doctor, examining the woman, notes:

  • the patient experiences pain during palpation of the uterus,
  • the uterine cavity is unnaturally dilated,
  • muscle layer contracts sluggishly
  • in the uterine cavity are pathological inclusions,
  • in the area of ​​the surgical suture air accumulates, the scar is deformed.

    When studying analyzes revealed that in the blood increased concentration of leukocytes, ESR increased.

    Sometimes signs of endometritis after cesarean section after a month appear (in some women in labor even after 1.5-2 months). At this time, the woman with the baby is at home. She should be more careful about her health. If you experience any discomfort, visit a doctor. Timely treatment increases the chances of full recovery.

    On day 3 after the start of therapy, the temperature returns to normal, the pain disappears. On day 7, good blood test results are obtained. By day 10, vaginal discharge is restored. Sometimes a woman who has undergone treatment has endometritis symptoms after cesarean section again. Relapse lasts 2-3 days.

    Endometritis is dangerous in the development of serious complications. When it occurs, it is unacceptable to self-medicate. If you find suspicious signs after cesarean section, you need to visit a doctor. In the absence of an effective treatment, the risk of infertility is high.

    Signs of mild form

    Symptoms of the disease, flowing in mild form, occur 5-12 days after delivery. In women, there is:

  • high temperature - 38-39 degrees,
  • chills,
  • frequent heart rate
  • increased concentration of white blood cells,
  • increased ESR,
  • pains in the uterus lasting 3-7 days
  • enlarged uterus
  • discharge of bloody lohii.

    Severe symptoms

    Signs of postpartum endometritis, severe current, 2-4 days after birth. In 25% of patients, inflammation flares up against the background of difficult labor, surgeries, and chorionamnionitis.

    Women complain about:

  • pain in the suprapubic region,
  • insomnia
  • loss of appetite
  • rapid pulse,
  • heat (temperature stays at 39-40 degrees),
  • fever.

    The number of leukocytes in the blood of patients is increased, the ESR is greatly increased. They suffer from anemia and low blood pressure.

    Examining a woman, the doctor finds:

  • delayed uterine contraction,
  • organ pain when palpating,
  • lochia brown shade, with prolonged process in them appear pyogenic inclusions,
  • As soon as the woman begins treatment of endometritis after childbirth, the symptoms of the disease quickly subside. The temperature returns to normal for 2-4 days. Pain syndrome disappears for 5-7 days, by the same time lochias normalize. Improvement of blood occurs on day 7-10.

    Symptomatology erased forms

    Most women find it difficult to determine the severity of the disease. Usually, signs of endometritis are blurred after birth. To identify mild symptoms is not easy.

    Blurred form occurs after an independent delivery and cesarean section. Pathology manifests itself on day 3-4. In some women, it is found in the first 24 hours after delivery, or only for 5-7 days.

    At the initial stages of development, the temperature does not rise above 38 degrees. Chills occur occasionally. The blood test is bad: there are many leukocytes in it, ESR is above the norm. In half of the patients, the absence of a neutrophilic shift is noted, in the remaining parturient women it is insignificant.

    Lochia is modified, become succinic, sometimes pyogenic with an unpleasant odor. Pain in the uterus lasts 3-8 days. Although it may take up to 2 weeks.

    In women taking the treatment, the temperature drops by 5-10 days. But there are cases when they do not retreat to 14-45 days. Contraction of the uterus is slowed down.

    Endometritis is difficult to treat. Fading symptoms suddenly flare up again. The exacerbation lasts 2-8 days. The worn form is dangerous because the infection begins to spread with the bloodstream throughout the body, leading to sepsis. This phenomenon occurs when the severity of endometritis is underestimated or inadequate treatment is given.