Endometritis and other uterine inflammation
How bacteria reach the endometrium after birth, miscarriage or procedures, why retained tissue feeds infection and sepsis, why plasma cells define chronic endometritis, how pus collects behind a narrowed cervix, and how scarring causes Asherman syndrome.
By the end, you can
- Describe the endometrium, its basal and functional layers, and the barriers that normally keep the uterine cavity free of infection.
- Explain how acute endometritis follows childbirth, miscarriage or procedures, why caesarean birth in labour and retained tissue raise the risk, and how infection spreads through the wall to cause puerperal sepsis.
- Explain the causes of chronic endometritis, including intrauterine devices and tuberculosis, and why plasma cells in the stroma define it.
- Relate cervical narrowing to pyometra, and explain why pyometra in an older person raises concern for cancer.
- Explain how loss of the basal layer leads to intrauterine adhesions (Asherman syndrome) and reduced fertility, recognise the tissue picture and tests of uterine inflammation, and explain how the main treatments act on its mechanism.
What it is
Endometritis is inflammation of the endometrium, the lining of the uterine cavity. Acute endometritis is a bacterial infection, usually after childbirth, miscarriage or a procedure that opens the cervix; chronic endometritis is low-grade, often silent inflammation defined by plasma cells in the endometrial stroma. Infection that spreads into the muscle is endomyometritis; pus trapped in the cavity behind a narrowed cervix is pyometra.
4 types to tell apart
- Acute postpartum and post-abortion endometritis
- A polymicrobial infection, ascending from the vagina, of the decidua and placental site after birth, miscarriage or abortion, with neutrophils, fever and a tender uterus. It can spread into the myometrium and parametrium and cause puerperal sepsis.
- Chronic endometritis
- Persistent inflammation with plasma cells in the stroma, after retained tissue, with an intrauterine device, with chronic pelvic infection or without a clear cause. Often silent; it can cause irregular bleeding and is linked with infertility and miscarriage.
- Tuberculous endometritis
- A granulomatous chronic endometritis, nearly always spread from tuberculous uterine tubes. Monthly shedding keeps the granulomas small and usually non-caseating.
- Pyometra
- Pus filling a cavity whose outflow is blocked, mostly in older people with cervical narrowing after the menopause, surgery, radiotherapy or a cancer of the cervix or endometrium.
US spelling: oestrogen → estrogen.
Normal function
The uterine cavity and its defences
The of the uterus surrounds a slit-like cavity lined by the endometrium: columnar epithelium dipping into tubular glands in a cellular stroma. Its deep basal layer rests on the muscle (myometrium) and survives each period; the functional layer above it thickens under oestrogen and progesterone, is shed at menstruation and is rebuilt from the basal layer. In pregnancy the functional layer becomes the decidua, to which the placenta attaches.
The vagina below teems with bacteria, but the cavity above holds few or none. The narrow canal, from the to the , is filled with a plug of thick mucus carrying antibodies and antimicrobial peptides; an acidic, lactobacillus-dominated vagina restrains other bacteria; and regular shedding clears the lining. The normal endometrium contains lymphocytes, macrophages and natural killer cells, and neutrophils at menstruation, but no plasma cells.
Childbirth, miscarriage and procedures breach these defences at once: the cervix opens, the membranes rupture and hands or instruments pass through it. The placental site is left as a large raw wound of decidua, clot and open vessels. Over the following weeks the uterus contracts down (involution), the remaining decidua is shed as lochia, red for a few days and then paler, and the endometrium regrows from the basal layer.
Underlying change · Step 1 of 6
How bacteria reach the endometrium
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 2 of 6
Acute endometritis and endomyometritis
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 3 of 6
Beyond the uterus: puerperal sepsis
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 4 of 6
Chronic endometritis: plasma cells in the stroma
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 5 of 6
Pyometra: pus behind a narrowed cervix
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Consequences · Step 6 of 6
Scarring of the cavity: Asherman syndrome and fertility
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Symptoms and signs
Symptoms, signs and findings
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Exam detail
Exam detail
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Treatment
How treatment works
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Recap
Recap
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Self-check
Check your understanding
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .