Endometritis (inflammation of the uterus), symptoms, treatment, folk remedies. Endometrium of the uterus: normal thickness at different periods of a woman’s life

For monthly cycle changes occur in the uterus that affect the endometrium. Its thickness varies different days cycle. Depending on the size of the endometrium, doctors learn about the health of the uterus.

What is the size of the endometrium on different days? menstrual cycle? What could be the reasons for deviations from the norm?

Endometrium and its structure

The endometrium is the internal slime layer uterus. Its purpose is to create optimal conditions for the attachment of the embryo to the uterine cavity and provide normal development fetus

During the monthly cycle, the size of the endometrium changes under the influence of female sex hormones - progesterone and estradiol.

Estradiol promotes the maturation and thickening of the uterine layer, progesterone maintains the required thickness until the end of the cycle and in the event of fertilization.

The endometrium consists of 2 layers:

• Functional. It is this part of the surface of the uterus that is rejected during menstruation and undergoes changes during the menstrual cycle.
• Basal. This layer is adjacent to the middle uterine covering - the myometrium. It consists of various connective tissues and glands, permeated blood capillaries. In a healthy woman, its size is constant and amounts to 10-15 mm.

Why and how is endometrial thickness measured?

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The thickness of the uterine layer is measured if a woman has problems with reproductive function and irregular menstruation. Indications for clarifying the indicators of the endometrial layer:

• periodic delays in menstruation;
• absence of menstruation without pregnancy;
• intense or scanty menstrual discharge;
• problems with conception and pregnancy.

Endometrial thickness cannot be determined during a routine gynecological examination. An ultrasound is required for measurements.

The most optimal measurement method is transvaginal examination. The examination is carried out by inserting the apparatus tube directly into the vagina. This method allows you to obtain the most reliable data. Ultrasound is recommended to be performed in the period close to ovulation. If it is necessary to measure the size of the mucous layer during a complicated pregnancy, a routine ultrasound is performed.

Table of endometrial norms

The parameters of the endometrial layer change daily throughout the menstrual cycle. When deciphering the results, doctors are guided by the standards that the inner uterine layer must meet on a certain day. The table describes how many cm the layer should be normally.

Endometrial norms by phase

The endometrial layer goes through several phases of development: initial (bleeding), middle (proliferation), final (secretory). The minimum thickness of the endometrial layer is observed in the bleeding phase, the greatest - in the secretion phase.

Bleeding phase

The bleeding phase begins on the first day of the monthly cycle and lasts 5 days. During this period, the old layer is rejected and gradually restored due to the basal layer. The initial phase has two stages:

• Rejection. Lasts the first 2 days of the menstrual cycle. During this stage, the thickness of the endometrium reaches 4-9 mm. On ultrasound it is noticeable that the epithelial layer becomes loose, the vessels have increased fragility, bloody issues.
• Regeneration. Tissue restoration occurs on days 3-5 of the cycle. During this period, the old layer completely peels off, and the new one has not yet grown, so the mucous layer acquires the smallest thickness - 2-5 mm.

Proliferation phase

The proliferation stage occurs on days 6-7 of the menstrual cycle. Throughout the entire phase, the process of preparing the uterus for possible conception. Under the influence of hormones, the uterine layer grows intensively. Proliferative phase goes through several stages:

• Early. From days 6 to 7, the uterine layer has low density. On the first day of this stage it reaches 6 mm. Every day the endometrium increases by about 1 mm. By the end of the stage it reaches 7-8 mm.
• Average. From 8 to 10 days, the uterine layer grows from 8 to 11 mm. At this time, the endometrium begins to become overgrown with capillaries and acquires a pink tint.

• Late. At the final stage, from days 11 to 14 of the cycle, the layer reaches a thickness of 14 mm. The density becomes optimal for fertilization. Simultaneously with the preparation of the uterine layer, the egg matures in the ovaries. Ovulation occurs, which means pregnancy is possible.

Secretory phase

The final phase of endometrial development occurs from days 15 to 30 of the menstrual cycle. During this period, progesterone actively influences tissue growth. Under its influence, the uterine layer grows and thickens. It becomes overgrown with vessels and acquires functionality that provides nutrition to the embryo if it is attached to the uterus.

Stages of the secretory phase:

• Early secretion. The uterine layer does not grow as quickly as in the previous period. From 15 to 18 days it thickens to only 16 mm. However, at this time its structure changes; the tissues reflect ultrasound most intensely at the edges. The shade of the layer is yellow.
• Average secretion. The stage occurs from 19 to 23 days of the cycle. During this period, the uterine layer reaches its maximum value - 18 mm. From this point on, the endometrium should not continue to thicken.
• Late secretion. From 24 to 28 days of the menstrual cycle, gradual preparation for future rejection of the uterine layer occurs. The endometrium becomes denser, but at the same time thins slightly (up to 12 mm). Atrophy of the enlarged endometrium occurs due to the fact that the level of progesterone begins to gradually decrease. Ultrasound shows changes in the capillaries, and the gradual formation of blood clots is noticeable.

Normal for delayed menstruation

Delayed menstruation occurs for various reasons: pregnancy, nervous tension, gain physical activity, hormonal disorders, genitourinary diseases. A few days before menstruation, the production of hormones that stimulate endometrial growth stops. The uterine layer is about 12 mm. If there is no menstruation due to pregnancy, the normal thickness of the endometrium is 11-13 mm.

If the delay occurs due to pregnancy, progesterone continues to be produced, which stimulates the growth of the inner uterine layer. Approximately 3 weeks after fertilization, the thickness of the endometrium reaches 2 cm. Many ultrasound machines determine the onset of pregnancy at early stages precisely by the increased thickness of the uterine layer.

Normal before menstruation

Before menstruation, the endometrium is in the secretion stage. A week before menstruation, the thickness of the endometrium reaches its maximum value - 18-20 mm. However, in last days During the menstrual cycle, the uterine layer becomes thinner. The uterus is preparing for the release of an unnecessary layer of epithelium, its growth stops. Gradually thickening, the uterine layer becomes thinner. 2-3 days before menstruation it reaches 12 mm.

Pathological conditions

Deviations in the development of the endometrium arise due to various reasons: operations in the uterine cavity, abortions, miscarriages followed by curettage, cesarean sections, inflammatory diseases genital organs, hormonal disorders.

The following pathologies affecting the inner uterine layer are distinguished:

• Thinning of the endometrium (hypoplasia). Diagnosed when there is a deviation from the norm by 0.5-0.8 cm. Most often it occurs due to a lack of endrogens and progesterone. With a thin endometrium, the uterus becomes vulnerable to infections, making it difficult to conceive and bear a child.
• Excessive thickness of the uterine layer (hyperplasia). Thickening of the endometrium occurs due to hormonal imbalance. The proliferation of the internal membranes of the uterus leads to the formation of benign and malignant tumors, infertility.
• Endometritis. Inflammation of the endometrium is often observed after surgical operations in the uterine cavity. Infection also penetrates into the uterus during prolonged inflammation of the genital organs and the installation of a spiral. The thickness of the uterine layer during inflammation has abnormal indicators.
• Endometriosis. The growth of uterine tissue in uncharacteristic places is observed as a consequence of complications of operations on the uterus.
• Uneven growth of the uterine layer. In this case, in one part of the uterus the endometrium becomes thicker than normal, and in the other - thinner.
• Degeneration of the uterine layer into a malignant tumor.
• Endometrial compaction, formation of cysts and polyps.

Elimination of pathologies depends on the causes that led to the disease. If the change is caused hormonal imbalance, the woman is prescribed hormone therapy. The lack of estradiol is compensated with the help of Divigel. The ripening of the layer is promoted by Utrozhestan and Duphaston. Excess uterine tissue is also corrected with hormone-containing drugs.

In the treatment of pathologies, physiotherapy is used: ozokerite therapy, vaginal irrigation, massage, acupuncture. In some cases, if the endometrium grows abnormally, the excess layer is removed by curettage.

Collapse

The endometrium is a hormone-dependent mucous layer lining inner surface uterus, which is renewed during the monthly menstrual cycle and to which the embryo is attached at conception. Since the layer is hormone dependent, it often undergoes changes when hormonal imbalance. Excessively thick endometrium– the most common type of pathology of the uterine mucosa. The material explains why it appears and how to get rid of this phenomenon.

Definition

The phenomenon of thick endometrium is called hyperplasia. What does it mean? This is a disease in which, under the influence of hormonal imbalance, there is an active proliferation of tissues of the mucous layer of the uterus. This happens when there is an excess of estrogen, since it is this hormone that regulates the growth and renewal of the layer in the menstrual cycle. And also, with a lack of progesterone, since it is able to suppress excessive estrogen activity.

In what cases can we say that an overly large endometrium has developed? This layer changes its thickness throughout the menstrual cycle. However, normally its thickness can vary from 5 mm to 15 mm.

The most serious deviation is a thick endometrium at the beginning of the cycle, since during this period it should reach a minimum thickness. And its thickening can lead to unpleasant and even severe symptoms.

Why does thickening occur?

As mentioned above, the causes of thickening lie in hormonal imbalance, which develops as a result of stress, unhealthy lifestyle, non-compliance with work and rest schedules, lack of sleep, sudden weight gain or loss. Often this phenomenon can develop when endocrine diseases or ovarian hyperfunction.

A characteristic feature is that this disease develops exclusively in women reproductive age. Since in the post-reproductive phase the ovaries stop working altogether, and the endometrium decreases significantly. Thus, it cannot increase, since estrogen is completely or almost completely absent in the body.

Consequences

Hyperplasia can negatively affect the likelihood of conception, since the fertilized egg cannot attach to such endometrium. But even if this happens, there is high risk miscarriage as a result of embryo rejection during renewal of the pathological endometrium. Although sometimes it is still possible to carry a pregnancy to term. In this case, the place is complicated birth process accompanied by significant bleeding.

Symptoms

Thickening of the endometrium in the uterus can lead to quite severe symptoms. The following clinical picture is formed:

1. Increased volume of menstrual bleeding;
2. Lengthening menstruation;
3. Reducing the period between them;
4. Acyclic bleeding of varying intensity;
5. Pain in the lower abdomen, worsening on the eve of menstruation;
6. Sometimes pain and discomfort may occur during sexual intercourse.

The condition is not specific and may indicate many other diseases. For this reason differential diagnosis may cause difficulties for the doctor initial stage its implementation.

Diagnostics

The condition is diagnosed based on history and symptoms, but biggest role in diagnostics it is given instrumental studies. The following types of manipulations are performed:

1. Ultrasound examination of the uterus;
2. Diagnostic endometrial scraping;
3. Diagnostic hysteroscopy;
4. Blood test for hormones;
5. Colposcopy.

In some cases, other research methods may be prescribed.

Treatment

Hyperplasia is treated mainly with hormonal drugs. However, if the lesion is focal in nature, that is, localized in several small, clearly defined areas, then coagulation can be used.

Coagulation

This is a method of cauterizing foci of growth in one way or another, as a result of which they stop growing. What cauterization methods are used?

• Electrocoagulation – cauterization electric shock– the oldest and most traumatic method;
• Cryodestruction - cauterization liquid nitrogen– the most preferred method among those that are widely used;
• Laser treatment and radiosurgical methods are rarely used and expensive, but effective and safe methods low morbidity.

Cauterization is performed during hysteroscopy. With this intervention, a hysteroscope apparatus equipped with an optical system is inserted into the uterine cavity through the cervical canal. With its help, miniature surgical instruments are inserted into the cavity and cauterization is performed.

The use of this method should be combined with the use of hormonal drugs. Since in their absence, the uterine mucosa may become thicker than it should be, again, new lesions may appear.

Scraping

For both focal and common hyperplasia, the method of curettage of pathological endometrium can be widely used. During it, using a special loop or curette, mechanical removal foci of mucosal proliferation. This is also done by hysteroscopy. This method is quite traumatic, especially in large areas, therefore it is prescribed only when hormonal treatment did not help. It should also be carried out exclusively in conjunction with hormonal therapy, otherwise the problem may occur again.

Drug treatment

If thickening of the endometrium of the uterus is observed over the entire area of ​​the mucous membrane, then we can talk about total hyperplasia. Doctors prefer to treat this condition with hormonal drugs, as the method is the safest. Depending on the nature of hormonal imbalances in a woman’s body, certain medications can be used:

• Combined oral contraceptives that help normalize hormonal balance, align menstrual cycle, therefore, make the renewal of the endometrium more cyclical. These are products such as Yarina, Janine, Regulon, Marvelon. They are taken for 3-4 months, with each new packaging start from the first day of the menstrual cycle. These drugs contain estrogen and progesterone;
• Progesterone medications help because this hormone is able to suppress excessive estrogen activity without directly reducing its levels. These are products such as Duphaston, Utrozhestan. They are used for 3-4 months and help normalize the condition of the mucous membrane and the frequency of its renewal during this time;
• Gonadotropin-releasing hormone agonists are drugs such as Buserelin, Zoladex. Their regular use for 4-6 months helps to create a state of artificial menopause, during which the thick layer of the endometrium degrades. After stopping the drugs, the menstrual cycle returns to normal. This method is rarely used and only in cases where the rest medications ineffective.

An enlarged basal layer of the endometrium can cause serious consequences and unpleasant symptoms, so it must be treated in a timely manner. If you notice symptoms of this phenomenon, a woman should immediately consult a doctor.

When a woman crosses the border of perimenopause, a restructuring of her body begins, hormones jump, the mucous surface of the uterus gradually atrophies, leading to the logical conclusion of reproductive abilities.

But, if there is a norm for the endometrium of the uterus during menopause, then deviations from it naturally occur. And they occur quite often...

The endometrium is the mucous layer of the inner walls of the uterus. It is formed from two layers, different in structure and function. During hormonal activity, it undergoes a number of modifications, in particular its thickness also changes.

The clinical norm for the superficial mucous membrane of the uterus during menopause is 4-5 mm, but the thickness may vary depending on the phase:

This process is necessary for a woman to be able to conceive a child. The thickness of the inner layer of the uterus must be at least 12 mm to ensure implantation of the fertilized egg.

Every millimeter matters. On average, in the early secretion phase, the thickness that the endometrium reaches is 13 mm. If the endometrium is hypoplastic and thin, the pregnancy may end in miscarriage.

Due to hormonal changes that occur during the cessation of menstruation, the thickness of the internal mucous membrane gradually becomes smaller, as a result of which the woman loses the ability to bear a child.

Physiological hypoplasia is the normal thickness of the endometrium during menopause, it is about 5 mm.

Phases of menopause in women

Menopause is one of the stages of menopause when menstruation stops.

The phases of menopause are:

1. – the stage of menopause, which covers the period from the first menstrual cycle to the last.
   The term is sometimes used incorrectly to describe a condition known as premature menopause.
2. – refers to those years when hormonal fluctuations begin.
   In essence, it combines premenopause and menopause itself. The endometrium undergoes during menopause characteristic changes. Very often, it is during this period that a condition occurs that doctors call “endometrial pathology in menopause.”
3. – this is the period of complete cessation of menstruation and hormonal changes, which ends at the age of 65-69 years.
   At this time, the ovaries can no longer continue to function and menstruation stops completely. Menopause is considered complete when there have been no periods for a year.

In each phase of menopause, the structure of the endometrium changes.

As the cycle progresses, the thickness of the endometrium changes.

Let's look at what it becomes during premenopause:

• single-phase and two-phase cycles alternate, which are called anovular;
• prolonged exposure to low concentrations of estrogen leads to poor functioning of the mucous membranes, along with elements of moderate glandular hyperplasia, which is called transitional endometrium;
• improper distribution of gland functions leads to cystic formations;
• the nuclei of the epithelium of the glands have different locations;
• stromas have different densities;
• increased stimulation of progesterone causes ultramenstrual or secretory endometrial hyperplasia.

Changes in the endometrium in postmenopause are also quite characteristic:

• transitional endometrium is the state of the endometrium in the first few years, after the last menstruation;
• as a result of the fact that secretory function the ovaries are reduced, endometrial atrophy occurs, which is considered physiologically normal for this period;
• endometrial functions decrease in postmenopause, which indicates the inability to become pregnant.

What is hyperplasia of the inner layer of the mucosa?

Main endometrial condition female organ and the norm of its thickness during menopause indicates that the woman is healthy, although she has lost her reproductive function.

The thickness of the endometrium of the uterus in menopause should be 5 mm. When inner layer the uterus is 6 mm or more, we can already talk about hyperplasia.

Hyperplasia of the inner layer of the uterus during menopause is a change in the structure of its tissues and glands, that is, the growth of the endometrium is characterized by a change in its structure, which is characterized by a heterogeneous endometrium.

A pathological increase in the thickness of the functional layer of the mucous membrane of the uterine cavity can cause. Pathology of the endometrium during menopause indicates hormonal changes, indicating that reproductive function is lost.

Endometrial hyperplasia is a pathology.

Unfortunately, endometrial hyperplasia in postmenopause is highly likely to degenerate into a malignant process. Since during this period the woman’s uterine mucosa is not renewed, the structure of the endometrium also changes. This period is characterized by the fact that the inner layer is loose and the endometrium is heterogeneous.

There are a number of reasons that increase the likelihood of endometrial hyperplasia during menopause:

• history of mastopathy or uterine fibroids;
• excess adipose tissue;
• hypertension;
• history of treatment with hormones (estrogens);
• carbohydrate metabolism disorders (diabetes mellitus type I and II);
• liver pathology.

Expert opinion

Alexandra Yurievna

Doctor general practice, associate professor, teacher of obstetrics, work experience 11 years.

Heredity plays an important role in this, i.e. if close relatives female line have had a similar disease, there is every chance that the same thing will happen to you.

Classification of hyperplasias

Depending on which cells begin to enlarge and proliferate, they are distinguished:

According to the type of spread, diffuse and focal forms of the disease are classified. With the first type of hyperplasia, the surface layers of the mucosa grow evenly, and it is characterized by manifestations of diffuse changes.

With focal – different severity is observed structural changes on different areas mucous membrane. What is common is that all types are characterized by a heterogeneous endometrium, diagnosed by ultrasound.

How to diagnose hyperplasia

If a woman goes to the doctor complaining of bleeding and pain during menopause, what does this mean?

To begin with, the doctor must familiarize himself with the patient’s medical history, history of past diseases, focusing on pathologies of the reproductive sphere, it is also necessary to find out what kind of treatment she had previously, find out whether there were any surgical interventions on the organs reproductive system.

To complete the picture, the doctor must ask whether the patient’s mother had similar complaints during menopause.

Before diagnosis and treatment, a woman must undergo a series of diagnostic procedures, because endometrial pathology during menopause is very common.

In this case, the examination should be comprehensive and include examination in a gynecological chair, biochemical and general blood tests, cytology smears, ultrasound, as well as invasive diagnostic methods, which make it possible to establish an accurate diagnosis and type of hyperplasia.

Diagnosis must be timely, because with a delay in diagnosis, the risk of malignant degeneration is likely to increase.

To assess the thickness of the mucous membrane of the uterine cavity, a transvaginal ultrasound is performed. If the thickness of the endometrium during menopause is normal, then it is 6 mm, in which case the ultrasound is repeated several more times within 6 months to make sure that there is no growth.

The main signs of hyperplasia on ultrasound:

1. Uniform tissue thickening, uniform echogenicity and smooth outlines.
2. Polyps are characterized by increased acoustic density, smooth contours and an echo-negative rim. If the polyps contain oncological changes, their rim has a jagged, scalloped contour. Sonographic signs of polyps are local thickening tissues and the presence in the structure is due to the presence of formations with anechoic inclusions.
3. In the case when the endometrium in menopause is 8 mm -10 mm, treatment is prescribed and diagnostic curettage. This procedure, along with diagnostic purposes, also has a therapeutic purpose.
4. The presence of inclusions of increased echogenicity.
5. It is diagnostically difficult to identify a glandular polyp of the mucosa, which has a soft consistency, flattened shape and sound conductivity close to that of the inner lining of the uterus, i.e. it is practically isoechoic.
6. In case of cancer of the inner layer, the echographic picture is polymorphic, its heterogeneity is also

A biopsy is advisable when diffuse form hyperplasia. This method makes it possible to determine the exact thickness of the endometrium, the type of pathological changes in it, and cancer.

How to treat hyperplasia

There are both conservative and radical surgical methods treatment of this pathology:

1. In some cases, it brings positive results. Women are prescribed pharmacological preparations progesterone series. The duration of treatment with hormones can range from 3 months to 1 year.
2. Another type of treatment for hyperplasia, when the growth of the endometrium is significant, are methods surgical intervention, namely diagnostic curettage, on the basis of which a more accurate diagnosis is established. In addition, this method is used to stop uterine bleeding.
3. In case of local processes of hyperplastic growths, the thickened layers of the uterine mucosa are cauterized.
4. At atypical form development of hyperplasia, with high probability cell degeneration, surgical hysterectomy is prescribed, that is, removal of the uterus.
5. Currently, more and more people are resorting to combined methods treatment.

During menopause, treatment includes vitamin preparations, immune stimulants that increase the body's resistance. And Special attention pay attention to normalizing lifestyle and giving up bad habits.

Life in menopause is the norm

From all of the above, we can conclude that pathological changes V menopause– a frequent phenomenon, due to the characteristics of changes hormonal levels women. Diagnosis and treatment should be carried out in specialized medical institutions.

Every woman, entering a difficult period of life for her, must realize that her health and well-being are 90% dependent on herself. No one is immune from reproductive problems, but when timely diagnosis and adequate therapeutic measures, this pathology can be preserved high quality woman's life.

So, dear ladies, do not wait for the onset of the disease, but be regularly examined and visit your gynecologist.

This is the internal mucous membrane of the body of the uterus, lining its cavity and abundantly supplied blood vessels. It plays a major role in the menstrual cycle, but its main function is to create conditions favorable for implantation of the fertilized egg in the uterus.

The endometrium has two layers - basal and functional. During menstruation, the functional layer is rejected, but thanks to the unique regenerative ability of the basal layer, it is restored already in next cycle. The endometrium is sensitive to hormones, so in the second phase of the menstrual cycle, it thickens significantly and is more abundantly supplied with blood. In this way, preparations for embryo implantation occur. But if pregnancy does not occur, then the functional layer is rejected and menstruation begins.

Important for pregnancy endometrial thickness, defined using ultrasound examination. Depending on the phases of the cycle, it changes.

• During the early proliferation phase ( 5-7 days of the cycle) thickness ranges from 3-6 mm, averaging 5 mm.
• On 8-10 days of the cycle(average proliferation) the endometrium thickens somewhat - on average up to 8 mm (fluctuations 5-10 mm).
• During the late proliferation phase ( 11-14 days) the endometrium thickens to 11 mm (fluctuations 7-14 mm).
• For the early secretion phase ( 15-18 days) typical fluctuations range from 10-16 mm, averaging 11 mm.
• During the mid-secretion phase ( 19-23 days) the endometrium reaches its maximum thickness - an average of 14 mm (fluctuations 10-18 mm).
• On 24-27 days of the cycle(late secretion) the thickness of the endometrium decreases slightly - on average 12 mm (fluctuations 10-17 mm).

Among the disorders of the endometrial structure, it is customary to distinguish between hyperplasia (thickening) and hypoplasia ("thin" endometrium).

Hyperplasia (HE) is characterized by changes in the glands and stroma of the uterine mucosa. This is an excessive growth of the endometrium, in which it becomes much thicker than normal.

Hyperplastic processes occur against the background of hormonal disorders, which are characterized by an excess amount of estrogen and a deficiency of progesterone. Women who suffer from diabetes mellitus and other metabolic disorders leading to obesity. And also patients with arterial hypertension. Hyperplastic processes in the endometrium are often combined with diseases such as uterine fibroids, genital endometriosis, chronic inflammatory processes female genital organs.

More often, HE is asymptomatic, but dysfunctional symptoms may occur. uterine bleeding during an anovulatory cycle. As a rule, after or in normal cycle. Often the diagnosis of GE is made when a woman begins to be examined for infertility.

The absence of pregnancy during GE is due to two factors:

• lack of ovulation associated with hormonal disorders;
• the impossibility of embryo implantation into the pathologically altered uterine mucosa.

Treatment of GE can be medicinal, which is based on taking hormonal drugs, or surgical, which involves removing the endometrial layer. Severe cases of hyperplasia may require removal of the uterus. Often necessary complex treatment– removal of the endometrial layer and subsequent low-dose maintenance hormonal therapy.

"Thin" endometrium (or hypoplasia)

In some women, the thickness of the endometrium remains consistently thin throughout the menstrual cycle, which is due to the presence of chronic endometritis, insufficient blood supply to the endometrium, or a disorder in the estrogen receptors in the endometrium.

The problem of “thin” endometrium is identified using ultrasound monitoring, which allows one to evaluate changes in the thickness and structure of the endometrium. Unfortunately, this form Endometrial disorders are difficult to treat and are rather temporary. So, obstetricians-gynecologists prescribe high doses estrogens and small doses of aspirin. A good endometrial response is caused by physical therapy and some forms of alternative medicine(, acupuncture) by improving blood circulation in the pelvis. Installed positive influence sage on endometrial growth.

Treatment of any endometrial disorder should begin with identifying and eliminating the causes that led to them. Therefore, we advise you not to waste time on self-medication and contact a gynecologist in a timely manner.

Endometritis refers to inflammatory diseases of the female reproductive system, which occur in at least half of women childbearing age(according to some data – 90%).

Among possible consequences inflammatory processes in the pelvic organs - miscarriage, infertility, chronic pelvic pain syndrome, ectopic pregnancy.

The acute form of the pathology accounts for about 2% of cases of inflammatory diseases, the chronic form – about 14%. Most often, endometritis develops after childbirth.

Is it possible to get pregnant with uterine endometritis? We’ll talk about the main symptoms and signs of the disease, including after childbirth, as well as methods of treating the disease in our review!

What kind of disease is this and why is it dangerous?

Endometritis of the uterus in women - what is it? accessible language? The uterine wall consists of three layers: endometrium, myometrium and perimeter.

The perimetry is one of the layers of the peritoneum and covers the outside of the uterus, the myometrium is formed by smooth muscles, the endometrium or mucous membrane is formed by epithelial tissue.

Endometritis is an inflammatory process in the lining of the uterus.. The endometrium consists of basal and functional layers.

The functional layer is subject to cyclic changes, as hormonal levels change, it grows and is rejected during menstruation.

When pregnancy occurs, rejection of the functional layer does not occur, it provides further development embryo. The basal or germinal layer ensures the restoration of the functional layer of the endometrium.

With endometritis, it is the germinal layer of the mucous membrane that is involved in the inflammatory process.

Inflammation can progress and spread to muscle layer uterine wall, in such cases, endometritis turns into endomyometritis or metroendometritis.

The disease is infectious in nature, that is, inflammation develops only due to the penetration of the pathogen into the uterine cavity. The development of the disease is facilitated by damage to the mucous membrane. If the immune system is severely weakened or a particularly aggressive infection penetrates, damage to the entire tissue may occur.

Pathogens penetrate into the uterine cavity or from the appendages ( descending path), or from the vagina and cervical canal (ascending route).

Normal development infectious processes prevent acidic vaginal environment, mechanisms of local immune defense(antibodies, immunoglobulins contained in mucus and natural microflora vagina) and partially, anatomical features structure of the reproductive system.

Inflammatory reactions develop against the background of disorders of natural defense mechanisms.

Causes of occurrence in women and risk factors

Inflammatory processes are caused by bacteria, viruses, fungi and protozoa. In most cases, we are talking about a combined pathology, when several infectious agents take part in the development of the disease.

The viral form is caused by some types of papillomaviruses, cytomegalovirus, virus herpes simplex. Infection with fungi of the genus Candida leads to the development of fungal endometritis.

Bacterial endometritis is caused by:

• Enterobacter;
• Klebsiella;
• Streptococcus;
• Gonococcus;
• Proteus;
• Mycoplasma;
• Chlamydia;
• Escherichia coli.

Sometimes cases of infection with pathogens of diphtheria and tuberculosis are detected, as well as microorganisms classified as opportunistic.

Endometritis can also be protozoal in nature; in some cases, the causative agent of the disease is Trichomonas.

Most often, infection occurs through an ascending route. Infection occurs when two conditions coincide: an open cervical canal and damage to the endometrium.

Among the most probable causes, provoking inflammation of the endometrium:

Sometimes the inflammatory process develops as a concomitant pathology against the background of fibroids, polyps, infectious diseases excretory system, immunodeficiency states, endocrine disorders.

Cases of spread of infection from foci of chronic inflammation through the bloodstream or lymphatic system. Most often, gynecologists encounter postpartum endometritis. After spontaneous childbirth, inflammatory processes develop in approximately 20% of cases, after caesarean section– in 45%.

Classification, ICD-10 code, symptoms and treatment

The code for acute endometritis according to ICD-10 is N 71.0, chronic – N 71.1.

In gynecology, according to the course of the disease, three forms of endometritis are distinguished:

• Spicy;
• Subacute;
• Chronic.

Based on their origin, they distinguish between specific and nonspecific endometritis. By specific we mean an inflammatory process caused by pathogenic microorganisms; nonspecific inflammatory reactions are caused by representatives of opportunistic microflora against the background of weakened immunity.

Based on the severity of clinical manifestations, the following degrees of severity of the disease are distinguished:

• Light;
• Moderate;
• Heavy.

How does the acute form manifest?

Symptoms of an acute inflammatory process appear 3-4 days after infection. Manifestations of the disease depend on several factors:

• The nature and aggressiveness of the pathogen;
• Area of ​​endometrial damage;
• Presence of concomitant pathologies;
• Immunity states;
• Predisposing conditions;
• Patient's age.

Most severe course The disease is observed after complicated childbirth, spontaneous abortions, and during the use of an IUD.

The acute form begins with a feeling of heaviness and pain, most often above the pubis, in the middle part lower section abdomen, less often - in the lumbar or sacral area. Sometimes the pain radiates to the legs or under the shoulder blades. The intensity of the sensations ranges from mild to unbearable, the nature of the pain is aching or cramping.

With severe inflammation, there is a risk of developing peritonitis. At the same time with pain syndrome body temperature rises to 39-40 degrees, sweating and chills are possible.

As the disease progresses, other signs of general intoxication appear: lethargy, general weakness, loss of appetite, nausea, and sometimes vomiting.

One of the most characteristic symptoms – copious discharge, mucopurulent, sanguineous or purulent, sometimes with admixtures of blood. During development purulent process The discharge has a distinct unpleasant odor.

Postpartum endometritis may cause bleeding. Accession staphylococcal infection leads to the development of a purulent process, and there is a threat of sepsis.

Anamnesis data for the diagnosis of endometritis are supplemented with data gynecological examination And laboratory research.

The patient needs to pass clinical tests urine and blood, vaginal and cervical smears. Additionally, ultrasound is prescribed, and if indicated, hysteroscopy.

Treatment tactics for acute endometritis are selected individually, depending on predisposing circumstances. If the disease develops due to the use of an IUD, it is removed. After this, the uterine cavity is scraped.

After curettage, the patient is prescribed:

• Antibiotics;
• Antibacterial drugs;
• Anti-inflammatory drugs.

Additionally, desensitizing and restorative therapy is carried out. For antibiotic therapy, drugs are mainly used wide range actions. If anaerobic microflora is detected, Metronidazole or Ornidazole is additionally prescribed; according to indications, vaginal sanitation is carried out.

Purulent processes are indications for use infusion therapy drugs that improve blood flow and eliminate intoxication of the body. IN severe cases Radical surgery may be required.

As the patient’s condition improves and the inflammatory process subsides, physiotherapeutic treatment is prescribed. The complex of physiotherapeutic procedures includes magnetic therapy, laser therapy, and low-intensity ultrasound.

You can learn about diagnostic measures for urethritis in women, as well as what medications are usually prescribed for its treatment: in this article:

Chronic inflammation

If there is insufficient or untimely treatment spicy pathological process can go to chronic form. Clinical manifestations weakly expressed, in approximately 40% of cases the disease is asymptomatic.

On chronic endometritis indirectly indicate:

• Abundant or very scanty discharge during menstruation;
• Irregularities in the duration of menstruation;
• Changes in the cyclicity of menstruation;
• Intermenstrual bleeding, mucous, mucopurulent and bloody discharge;
• Periodic or permanent nagging pain lower abdomen;
• Habitual miscarriage, infertility, unsuccessful attempts IVF (with endometritis, attempts to conceive are almost unattainable).

Since the symptoms of the disease are nonspecific, the main diagnostic value have the results of bacteriological and microscopic studies contents of the vagina, uterine cavity, cervical canal.

Additionally, ultrasound and Doppler ultrasound are performed at the beginning and second half of the menstrual cycle. On days 7-11 of the cycle, hysteroscopy and endometrial biopsy may be recommended.

At chronic inflammation applies step-by-step treatment. At the first stage, broad-spectrum antibiotics are prescribed in combination with antifungal drugs and Metronidazole.

When a combined infection is detected combinations are prescribed antimicrobials and antiseptics. Chronic inflammatory processes of viral origin require the use of antiviral and immunomodulatory drugs.

At the second stage, the patient is prescribed antioxidant, hepatoprotective, metabolic, enzyme preparations, as well as products that improve blood microcirculation.

At the third stage, physiotherapeutic treatment is carried out. The course of treatment may include magnetic therapy, mud therapy, plasmapheresis, and iontophoresis. Additionally, cyclic hormone therapy can be performed.

Postpartum type

How does postpartum endometritis manifest? With postpartum endometritis, the patient is bothered by constant aching pain, prolonged bleeding.

There may be an increase in body temperature and other signs of intoxication. Postpartum endometritis also manifests itself as a slowdown in uterine contractions.

During treatment postpartum endometritis breastfeeding factor is taken into account. In severe cases, the need to refuse breastfeeding cannot be ruled out.

In addition to therapy aimed at eliminating the acute inflammatory process the patient is prescribed oxytocin and no-spa to improve the outflow of secretions from the uterine cavity and improvements contractility myometrium.

Curettage may be performed to remove the contents of the uterus., vacuum aspiration or comparatively new method– enzymatic curettage.

After caesarean section

In most cases, when inflammatory complications After a caesarean section the following is carried out:

infertility in this article.

Read about the treatment plan chronic cystitis in women, and how to remove unpleasant symptoms in its acute form.

Is pregnancy possible if diagnosed?

Is it possible to get pregnant with endometritis? Pregnancy with endometritis is not excluded, but often inflammatory processes lead to infertility. If uterine endometritis is detected in a timely manner after treatment, reproductive function is restored and there is a chance of pregnancy.

Endometritis of the uterus in women - what is it and is it treated? in simple language the specialist will tell you in the following video:

Prevention

The maximum risk of inflammatory reactions is eliminated when using an IUD, after abortion and cesarean section. For the prevention of endometritis after complex gynecological procedures prescribe a course of antibiotics, which should not be neglected.

It is very important to visit a gynecologist in a timely manner, especially when using intrauterine devices. The practice of preventive examinations increases the chances of early detection and treatment of gynecological diseases.

It is important to carefully follow intimate hygiene and the use of barrier contraceptives, especially during sexual intercourse during menstruation.