Chronic Endometritis 101

Chronic Endometritis (CE) contributed to my failed IVF transfer and early miscarriage this fall. It’s also preventing me from moving forward with FET prep this holiday season.

I was woefully unfamiliar with this condition before being diagnosed, so I’ve really spent time asking questions and digging into the research. As I expand my expertise and work to make educated decisions about my treatment plan, I wanted to share the answers to many of the questions I’ve gotten about CE!

Let’s start with some basics…

What is Chronic Endometritis?

Simply put, endometritis is inflammation of the endometrium, or the lining of your uterus, often due to active infection.

Acute form of Endometritis is usually of short duration, and can be caused by STI’s, pregnancy, retained placenta, miscarriage or abortive tissues, and/or in combination with Pelvic Inflammatory Disease (PID).

The chronic form of Endometritis is a persistent inflammation in your uterus, and can be associated with unexplained infertility, recurrent miscarriages, embryo implantation failure, and poor obstetric outcomes. Chronic Endometritis is often caused by a low grade or dormant infection.

What are the symptoms of Endometritis?

Symptoms can include any of the following:

• Abnormal vaginal bleeding or discharge

• Abdominal swelling

• Changes in bowel movement habits

• Fever/general sickness

• Pelvic pain

• No noticeable symptoms

Note: many patients with Chronic Endometritis have no symptoms what-so-ever, myself included. The only reason, in fact, that my doctor ordered a biopsy to test for CE was due to my failed FET.

What are the risk factors for Endometritis?

• Miscarriage

• Childbirth (especially long labor or cesarean delivery)

  • Note: I did not experience a long labor or cesarean delivery, and I still experienced Endometritis.

• Medical procedure entering your uterus (ie: Hysteroscopy, IUD placement, D&C, D&E)

How is Endometritis diagnosed?

Most doctors will combine a pelvic exam, and a culture for bacteria, an endometrial biopsy, or a laparoscopy procedure.

What are some potential complications of Endometritis?

• Infection symptoms/side effects

• Infertility

• Pelvic Infection

• Pus/Abscesses in the pelvis or uterus

How is Endometritis treated?

First line of treatment is a broad spectrum antibiotic (commonly a 14 day course of something like Doxycycline).

Second line of treatment usually involves another more aggressive course of antibiotics, unless you are sensitive to this type of medication. Sometimes, your partner may also be treated with antibiotics.

Third line of treatment can involve excising the inflamed tissue via hysteroscopy or laparotomy.

Note: Serious cases, often acute endometritis shortly after childbirth may require IV fluids and treatment in the hospital.

What was my treatment plan?

I started with a two week course of the antibiotic Augmentin. Due to my GI history, antibiotic use leaves my gut bacteria all out of whack, and often challenges me with another type of infection. Because of this, we carefully selected the “best chance” antibiotic for my body.

A second, repeat biopsy still showed presence of CE. My third cycle of FET prep was cancelled before it even started, and my doctor and I agreed on a surgical approach to CE.

Last week, I had a hysteroscopy under anesthesia.

The goal was to hopefully excise the inflamed tissue and to send off additional samples for a third round of biopsies. My doctor felt hopeful that the procedure was successful, but we still don’t know for sure. As I write this, I’m still waiting for the surgery biopsy results. It’s very likely that I’ll need a fourth biopsy at the beginning of my next cycle to insure the inflammation is truly gone and it’s safe (and advised) to proceed with FET prep.

I find myself really feeling my feels this week.

Waiting (again) is hard.

Recovering from the anesthesia was a bit challenging for me.

Not knowing the timeline for our next steps feels icky.

Recently, I shared some feelings on standing still. My second go-round with Infertility has been anything but what I expected, and this has felt more challenging than I anticipated, especially as we approach both the holidays and the end of the year.

I also didn’t imagine several rounds of treating a currently silent but very impactful infection before I could find success again in IVF, but here we are.

So I turned to the thing that has made me feel empowered before - education.

I’m hoping this might be helpful for you as well. If you’ve experienced CE, I’d love to hear what did and didn’t work for you below. If you have any other questions, feel free to drop them in the comments, or to email me directly.

Thinking of you,

Amanda