At present, the problem of infertility concerns many women around the world, including Russia. Women try to solve this problem with the help of IVF. With this procedure, the cause of failure often lies in chronic endometritis. This is a rather serious inflammatory process, which is accompanied by painful sensations and irregular menstruation. Therefore, it is extremely important to detect the threat in time. Currently, there are several treatment regimens for chronic endometritis, which eliminates the inflammatory process itself and prevents complications from developing.
General information
Endometritis can be equated to diseases of the female reproductive system of an inflammatory nature, such as salpingitis and oophoritis. This serious illness among women of reproductive age is not so rare. According to statistics, approximately 95% of all cases of the disease fall into this category.
Moreover, of the total number of gynecological diseases, the proportion of endometritis in acute form is 2.1%, while in chronic pathology the percentage is higher - 14%. It is chronic endometritis that poses the greatest threat to the health of the female body. The likelihood of infertility cannot also be ruled out.
In most cases, the diagnosis of postpartum endometritis is made, and from 5 to 20% are women who have given birth to a baby on their own, and 40% after a cesarean section. But can chronic endometritis be cured or is this the final verdict? Let's try to figure it out, but first you need to understand what this disease is.
What is the point?
To understand what exactly is this disease, it is worth recalling the school lessons of anatomy. Female reproductive organ consists of three layers:
- External - is covered with a visceral sheet of the peritoneum and is called perimetry.
- Medium - muscle, or myometrium.
- Internal - mucous membrane, or endometrium.
As can be understood from the name of the disease, we are interested in just the inner layer. In turn, it is also represented by two components:
- The superficial layer (functional) - in every period of menstruation, it is rejected.
- The basal layer (sprout) - from it during the menstrual cycle, the functional previous layer is born.
After successful conception, the functional layer transforms into the decidual membrane, which supports the development of a fertilized egg. Since the functional layer is updated monthly, the mucous membrane of the genital organ, in particular the basal layer, undergoes inflammation.
Mentioning endometritis, it is worth noting that there is a more severe form of the disease in which the inflammatory process affects the muscle layer, since the mucous membrane of the uterus and the myometrium are closely related. As a result, metroendometritis develops.
Causes of Chronic Endometritis
For the development of such a disease, a trigger factor is necessary - the penetration of pathogenic microorganisms into the uterine cavity. In this case, the infection has two ways: ascending (from the vagina and neck of the genital organ) and descending (uterine appendages). Also, two conditions are enough to start the inflammatory process: an open state of the cervix and damage to its mucous membrane. If the intermediate layer is intact, then the other link is weak immunity due to pregnancy.
Therefore, the development of endometritis is facilitated by certain factors:
- Abortion, curettage. In this case, the risk increases significantly in violation of the rules of asepsis, the use of non-sterile tools, poor-quality treatment of antiseptics of the genital tract. The same can be said about the complete removal of the functional layer - an extensive wound is formed, and nothing prevents pathogenic microorganisms from starting their destructive activity.
- Miscarriage. Complications can arise due to the presence of residues of the ovum, as this is an excellent breeding ground for most microorganisms. Even if they were for a short time, this may be enough for the development of pathology.
- Hysteroscopy (hysterosalpingography). During this procedure, the cervical canal expands. In addition, weakened immunity should be taken into account. It is important how well these procedures are carried out. Otherwise, it will be necessary to select a treatment regimen for chronic endometritis, which is not in favor of the specialists responsible for such manipulations.
- Intrauterine device. Infection can enter the uterine cavity through the threads of an intrauterine device. In addition, the observance of precautions when introducing a spiral is important.
- Douching. Carrying out such a procedure too often leads to a violation of the microflora of the vagina, due to which, in turn, the protective properties are reduced. As a result, microorganisms do not restrain from penetration into the uterine cavity.
- Lingering labor. Childbirth lasting more than 12 hours usually proceeds against the background of the opening of the fetal bladder. In this case, the uterine cavity also becomes vulnerable to an army of pathogenic “aliens”. And this not only threatens the development of postpartum endometritis, but also has a negative effect on the child.
- Sexual intercourse with menstruation. During menstruation, the cervical canal expands slightly, the functional layer begins to be rejected, revealing the germ layer. Unprotected intercourse these days contributes to infection on the resulting "wound". As a result, the development of the inflammatory process.
Often a pathological condition is provoked by such intrauterine interventions, when the placenta is separated manually. In addition, some examinations also contribute to infection. We are talking about probing the uterus, with manual control of the cavity of the genital organ.
Is pregnancy possible?
Many women are interested in such an important question: is it possible to get pregnant with chronic endometritis and what to do in this case. In fact, for those women who want to feel all the charms of motherhood, this becomes a serious obstacle. But maybe it's still possible to bear a full-fledged child ?! In this case, doctors put a disappointing verdict - it is worth to refrain from conception. And there are certain reasons for this.
The fact is that due to the inflammatory process affecting the endometrium, the production of lymphocytes in the basal layer increases. For this reason, a fertilized egg will not be able to fix on the damaged wall of the uterus, and as a result, the embryo is rejected. Nothing prevents the fertilization of the egg, and the process will go smoothly. However, it is interrupted at the stage of zygote attachment to the uterine mucosa. In this regard, endometritis is the cause of not only infertility, but also spontaneous abortion.
As for IVF, purely theoretically, with endometritis, such a procedure can be performed, since there are also no obstacles for this. But for obvious reasons, it is pointless to do such a procedure - the embryo can only survive with a normal thickness of the endometrium. In the case of endometritis, the inner membrane becomes thinner.
For this reason, in the absence of treatment of chronic endometritis before IVF, this scheme does not work. In addition, no specialist will agree to carry out such a procedure.
Symptomatology
The chronic form of endometritis is devoid of pronounced symptoms, and a woman may not even be aware of such a disease. And those ladies who have already suffered an acute form of this disease, in the future also may not feel the characteristic signs of sluggish inflammation.
For a long time, endometritis can make itself felt only with insignificant signals, which many women perceive as malaise. Therefore, do not rush to visit a doctor. Only in the period of exacerbation does the disease make itself felt with the following symptoms:
- With physical exertion, dull pain in the lower abdomen is felt.
- The menstrual cycle is broken.
- During menstruation, heavy spotting.
- Discharge can be a mucous consistency with the presence of pus on the background of an unpleasant odor.
- Chills.
- Fatigue, and it comes quickly.
- Elevated body temperature.
During remission, any clear signs cannot be noticed. For this reason, diagnosing endometritis in a chronic form is rather difficult. In this connection, in most cases, the disease is detected during a regular scheduled examination when visiting a antenatal clinic.
Diagnostics
Before choosing a treatment regimen for chronic endometritis before IVF, a proper diagnosis should be made. But as mentioned above, such a disease is devoid of obvious symptoms, and therefore women should carefully monitor their health. At the slightest sign that is not characteristic of a normal state, it is worth contacting a specialist.
Performing diagnostics, the doctor first of all “arms” with mirrors for external examination of the vagina and cervix. Often, in this case, swelling and redness of the tissues can be detected, which indicates the occurrence of inflammation.
In addition, the patient is assigned a general blood test and biochemical study. Hysteroscopy is mandatory, during which biomaterial is taken. A smear on the flora is also being made to identify the type of pathogenic microflora.
If necessary, a woman may be prescribed serological tests, including ELISA and PCR. All this allows you to determine the type of pathogen that triggered the launch of the inflammatory process. Without this, it is impossible to select the necessary medications for the course of treatment.
Diagnosis also includes instrumental methods of examination, ultrasound of the uterus and appendages is often performed. In this case, the echo signs of chronic endometritis are clearly visible: you can notice a thickening of the mucous layer, as well as an expansion of the cavity of the genital organ. In addition, the structure of blood vessels is changed. In addition, ultrasound can show the presence of cords, adhesions and other formations of connective tissue.
Need for treatment
As we now know, due to the inflammatory process that affects the intermediate layer of the female reproductive organ, pregnancy is impossible. The probability of a miscarriage is almost 100%. But even if, despite the presence of such a disease, a miracle still happened and the embryo entrenched (which is hard to imagine), serious complications cannot be avoided.
Due to the injured endometrium, severe bleeding during contractions can begin, which is very difficult to stop. Sometimes this can lead to rupture of the uterine wall.
In other words, there are no technical obstacles to conception naturally or through IVF. However, fertilization attempts in this case will not succeed, and everything can result in serious complications. For this reason, before attempting to become pregnant, it is necessary to select the appropriate treatment regimen for chronic endometritis in women.
Of course, this applies to those women who have been diagnosed with endometritis. But everyone else should undergo a preliminary examination in order to be sure that there are no barriers to conceiving and bearing a child.
Antibiotic therapy
The doctor selects the course of treatment for each patient strictly individually, depending on a number of factors:
- woman's condition;
- the type of pathogen that caused inflammation;
- the severity of the disease.
Any form of endometritis is treated with antibiotics. Only in the acute stage of the disease, the course of therapy is carried out exclusively in a hospital, while chronic endometritis can be treated at home. Tablets are prescribed in rare cases, mainly doctors prefer drugs that are administered intramuscularly or intravenously. In this case, a more pronounced effect is exerted.
In this case, medications of a wide spectrum of action are preferable, since in most cases the disease is caused by pathogens of several varieties. Accordingly, a specific treatment regimen for chronic endometritis is selected.
- "Amoxicillin" - has a wide spectrum of action. The dosage is selected individually, but usually is 500-100 mg per day at a time. The course of therapy is 7-10 days. The drug is effective against most pathogenic microorganisms. For this reason, it is prescribed when a specific type of pathogen has not yet been established.
- "Doxycycline" - effective against chlamydia, but also has a wide range of effects. The duration of therapy is up to two weeks at 200 mg twice a day. In some cases, taking the drug can be combined with other medicines.
- 3rd or 4th generation cephalosporins - placed intramuscularly in combination with Metrogil (intravenously). Dosage is selected individually.
- "Metronidazole" - is prescribed most often because it destroys anaerobic organisms. The course is from 7 to 10 days at 500 mg per day.
- Fluoroquinolones - indicated against gram-positive microorganisms. Often prescribed "Ciprofloxacin" at 500 mg twice a day for a week.
- "Sparfloxacin" - has the same effect that the drug is higher, but patients are prescribed strictly individually.
- "Vilprafen" - this drug is prescribed in the form of tablets of 1 pc. three times a day for 10-14 days. Like Doxycycline, it effectively fights against chlamydia.
- "Terzhinan" - a treatment regimen for chronic endometritis also includes the use of suppositories for prophylactic purposes (before the pathogen is established), one each. at night for 6 days. The dosage can be up to 10 suppositories per day, but is selected by a doctor.
At the end of the course of therapy, bacteriological culture is carried out again, which allows to evaluate the effectiveness of the treatment, and if necessary, adjust it. In cases where treatment should be started immediately, antibiotics begin to be taken until the pathogen is established.
The use of hormonal drugs
As a rule, women are prescribed oral contraceptives - Novinet, Rigevidon, Regulon. They contribute to the restoration of the menstrual cycle, as well as normalize the cyclic change of the endometrium. You should start taking the drugs from the first day of the cycle, at the end take a short break (5-7 days), and then move on to the new package.
In addition, medications reduce pain in the abdomen. The amount of discharge is also normalized. In this regard, such drugs are very popular in the fight against many gynecological diseases. And in most cases, it is monophasic drugs that are prescribed.
Immune medications
How to treat chronic uterine endometritis, in addition to antibiotics? An integrated approach is important here, and the main role is given to the immune system of the whole organism and specifically to the local immunity of the tissues of the uterine lining. And if there is enough strength, then he can independently resist the attack of microorganisms. But not always the body itself can cope with the problem, and therefore it should be further strengthened.
For this purpose, such drugs as Likopid, Immunal, Viferon, Timalin are prescribed. Women after 40 years of age especially need this because their immune system is weakened by the approaching menopause.
Restorative course of treatment
In the fight against endometritis, a systematic approach to treatment is also important. For this purpose, non-steroidal anti-inflammatory drugs are prescribed - "Nurofen", "Ibuprofen" and the like. They have an analgesic effect and can relieve inflammation.
If the pain is severe, it is acceptable to take analgesics. Only their use is one-time when symptoms appear. Anti-inflammatory drugs are taken for 5 to 7 days.
If the reason lies in the fungus, appropriate medications are prescribed - "Flucostat" (once 150 mg).
The benefits of vitamins
Vitamins also play an important role in the diagnosis of chronic endometritis, since with enough of them, human immunity remains strong. The most important trace elements are B vitamins (B6 in particular), vitamin C, as well as A and E. The latter have important properties:
- anti-inflammatory;
- antitumor;
- antioxidant;
- regenerative;
- healing.
It is possible to supply them with the body by taking multivitamin complexes, and in some situations they are administered by injection in compliance with the individual dosage. Also, drugs can be administered intramuscularly. The course is 1-2 weeks.
In addition, it is worth sticking to a balanced diet, because most of these elements come with food.
Physiotherapy
This therapy is longer in terms of treatment and recovery period. The exact time depends on the type of procedure. Moreover, they can be prescribed as an addition to the main course using drugs. Physiotherapy allows you to relieve inflammation, remove swelling, promotes resorption of adhesions of the pelvic organs, the appearance of which provoked an inflammatory process.
Sometimes such procedures are more effective than medical treatment, and in this regard, they are prescribed in almost all cases. And if after undergoing therapy and re-passing the necessary tests, chronic inactive endometritis is detected, the woman may make an attempt to become pregnant.
Ozone therapy and similar procedures allow you to activate the forces of local immunity, improve blood circulation, and also lead to faster healing and tissue regeneration. Also, with endometritis, other procedures also show themselves effectively: electrophoresis with zinc, copper with iodine, lidase. In rare cases, ultrasound and magnetotherapy are used. The negative consequences of physiotherapy, if they appear, are not so pronounced.
The opinion of women
According to statistics, many women cannot become pregnant for various reasons. And then the IVF procedure comes to the rescue, but, as the ladies themselves note, the presence of endometritis seriously complicates the matter. And as we now know, this is simply not possible for the reasons described above.
Most patients underwent a rather long course of therapy. Just some physiotherapy helped some women, in particular the electrophoresis procedure with copper, while drug treatment did not bring results.