Unrecognized and untreated endometritis in the postpartum period may progress

• Overview
• Symptoms and Causes
• Diagnosis and Tests
• Management and Treatment
• Prevention
• Living With
• Frequently Asked Questions

Overview

What is endometritis?

Endometritis is inflammation of the endometrium (the inner lining of your uterus) due to infection. It can be acute (starts suddenly and is short-term) or chronic (lasts a long time or occurs repeatedly). Acute endometritis can happen after childbirth or miscarriage, or after a surgical procedure involving your cervix or uterus. Chronic endometritis is more common after menopause or if you have an infection like chlamydia or gonorrhea.

Endometritis isn’t a life-threatening condition, but it can cause complications without prompt treatment (with antibiotics).

Who gets endometritis?

Anyone with a uterus can get endometritis. Endometritis is one of the most common infections after you give birth. It could start as chorioamnionitis in labor and progress to endometritis after you give birth, or begin after childbirth (postpartum). It’s slightly more common if you have a C-section. Endometritis is common in people with pelvic inflammatory disease (PID). Many different bacteria cause PID, but infection from unprotected sex is most common.

Symptoms and Causes

What are the signs of endometritis?

Symptoms of endometritis include:

• Fever.
• Pelvic pain.
• Vaginal bleeding or discharge.
• Constipation or pain with bowel movements.
• Swelling in your abdomen.
• General unwell feeling.

What causes endometritis?

Endometritis is caused by a bacterial infection in your uterus. It can be due to sexually transmitted infections (STIs), tuberculosis or from bacteria that occur naturally in your vagina. Having bacteria in your vagina is normal, but this can sometimes change after you give birth or have a procedure involving your vagina. This “mixing” of bacteria can cause infection, which leads to inflammation.

Diagnosis and Tests

How is it diagnosed?

Your healthcare provider performs a pelvic exam to diagnose endometritis. They may also recommend the following tests to help confirm the diagnosis:

• Testing fluid from your vagina for bacterial or sexually transmitted infections (STIs) like chlamydia and gonorrhea.
• Removing tissue from your uterus and testing it for bacteria (biopsy).
• Performing laparoscopy to get a closer look at your uterus.
• Blood tests to look at white blood counts (WBC) or erythrocyte sedimentation rate (ESR). High levels can indicate infection or inflammation.
• Looking at vaginal fluid under a microscope.

Can endometritis be seen on ultrasound?

The lining of your uterus may appear thicker or irregular on ultrasound, but this alone doesn’t mean you have endometritis. Many conditions can cause an abnormal appearance of your uterine lining.

Management and Treatment

What is the treatment for endometritis?

Your provider will treat you with antibiotics if you have endometritis. If you’ve just given birth or have a serious infection, treatment may involve intravenous (IV) fluids and bed rest.

What happens if endometritis is left untreated?

Untreated endometritis can lead to more serious infections and complications. Some complications include:

• Infertility.
• Pelvic infection.
• Pelvic or uterine abscesses (a collection of pus).
• Septicemia (inflection in your blood).

How soon after treatment will I feel better?

In most cases, you’ll feel better after you finish your antibiotics. The infection and inflammation usually goes away after treatment.

Prevention

What are risk factors for endometritis?

You may be at higher risk for endometritis if you recently gave birth or had a procedure involving your cervix. Some examples of procedures are:

• Dilation and curettage (D&C).
• Dilation and evacuation (D&E).
• Endometrial biopsy (taking tissue from your uterine lining for testing).
• Hysteroscopy.
• Childbirth (especially if you have an infection during labor, prolonged rupture of membranes or are positive for Group B strep).
• Placement of an IUD (intrauterine device).

Some people get endometritis from douching or inserting other objects into their vagina.

Preventing endometritis

Since untreated STIs often cause endometritis, the best prevention is to:

• Follow safe sex practices (use condoms).
• Treat STIs promptly.
• Get regular screenings for STIs.
• Encourage your sexual partners to get regular screenings for STIs.

People having a C-section should have antibiotics before the procedure to prevent infection.

Living With

When should I see my healthcare provider?

Call your healthcare provider if you have symptoms of endometritis, especially if you’ve recently had any of the following procedures or life events:

• You’ve given birth.
• You’ve had a miscarriage.
• You’ve had an abortion.
• An IUD was inserted into your uterus.
• You’ve had surgery on your uterus or cervix.

Frequently Asked Questions

What is the difference between endometritis and endometriosis?

Endometritis and endometriosis are two different conditions. Both conditions affect the inner lining of your uterus (endometrium). Endometriosis is when pieces of your uterine lining develop in places other than the uterus, like your ovaries or fallopian tubes. Endometritis is inflammation of the lining of the uterus.

A note from Cleveland Clinic

Endometritis is a condition that causes inflammation to the lining of your uterus. It’s caused by bacterial infections after surgical procedures, childbirth or from sexually transmitted infections. Getting endometritis after a surgical procedure is typically beyond your control. However, you can reduce your risk for getting endometritis by using condoms during sex. Let your healthcare provider know if you have irregular bleeding or discharge, fever or pelvic pain. They can diagnose endometritis and prescribe antibiotics.

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Last reviewed by a Cleveland Clinic medical professional on 10/25/2022.

References

• Mackeen AD, Packard RE, Ota E, Speer L. Antibiotic regimens for postpartum endometritis. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7050613/) Cochrane Database Syst Rev. 2015;2015(2):CD001067. Accessed 10/25/2022.
• Merck Manuals. Postpartum Endometritis. (https://www.merckmanuals.com/professional/gynecology-and-obstetrics/postpartum-care-and-associated-disorders/postpartum-endometritis) Accessed 10/25/2022.
• Taylor M, Pillarisetty LS. Endometritis. (https://www.ncbi.nlm.nih.gov/books/NBK553124/) 2021 Apr 4. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022 Jan-. Accessed 10/25/2022.

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