Chronic Endometritis – Diagnosis, Symptoms and Treatment

Endometritis is a silent but serious disorder that affects women. It is caused by inflammation or infection of the endometrium, the uterine lining. It is divided into two types: acute and chronic endometritis. 

While both types can harm reproductive health, studies show that chronic endometritis is more closely associated with infertility and recurrent pregnancy loss. In fact, research shows that up to 45% of infertile women, particularly those with recurrent implantation failure, have evidence of chronic endometritis. In this article, let's dig deeper into what chronic endometritis is, its symptoms, how it is identified, and why timely treatment is critical for your reproductive journey.¹

What Is Chronic Endometritis?

Chronic endometritis (CE) is a condition characterised by mild but persistent inflammation of the endometrium, the inner lining of the uterus. It is often referred to as a "silent condition" because, unlike acute endometritis, it usually does not present with any symptoms.

A key feature of CE is the presence of plasma cells, a type of immune cell in the endometrial tissue. Under normal conditions, plasma cells are not found in the endometrium. Their presence is a strong indicator of ongoing inflammation or infection within the uterus.

Unlike acute infections, CE does not usually present with any symptoms, which makes it simple to overlook or misdiagnose.

What Causes Chronic Endometritis?

The actual cause of chronic endometritis is often difficult to determine. Often, the inflammation may not be related to a specific infection, which makes diagnosis and treatment more challenging. However, some potential non-infectious triggers have been noted, including:

• Intrauterine contraceptive devices (T-shaped devices inserted into the uterus to prevent pregnancy)
• Endometrial polyps (non cancerous growth that form in the inner lining of uterus)
• Submucosal fibroids (non-cancerous tumours that grow in the uterus)

These conditions may irritate the uterine lining and lead to long-term inflammation, even in the absence of a clear infection.²

Common Microorganisms Involved in Chronic Endometritis 

Though chronic endometritis may be associated with non-infectious factors, it is typically considered an infectious condition involving multiple microorganisms commonly found in the vaginal tract. The following bacteria and fungi have been frequently identified:²

• Streptococcus species
• Enterococcus faecalis
• Escherichia coli (E. coli)
• Klebsiella pneumoniae
• Staphylococcus species
• Mycoplasma
• Ureaplasma
• Gardnerella vaginalis
• Pseudomonas aeruginosa
• Saccharomyces cerevisiae and Candida species (fungal organisms)

Who is at Risk?

Women with certain conditions and lifestyle factors can increase their risk of developing chronic endometritis, including:

• Use of IUDs for contraception
• Multiple pregnancies (multiparity)
• Previous abortions
• Abnormal uterine bleeding

These risk factors can either introduce bacteria into the uterus or cause changes in the uterine lining that make it more susceptible to inflammation.

Common Symptoms of Chronic Endometritis

Chronic endometritis does not always show clear symptoms, which makes it easy to miss. The signs are often mild, vague, or mistaken for other conditions, especially in women struggling with fertility issues. Here are the few signs to watch for ³

• Pelvic discomfort
• Spotting or intermenstrual bleeding
• Leucorrhoea (abnormal vaginal discharge)
• Hypomenorrhoea (scanty periods)
• Secondary amenorrhoea (absence of menstrual periods)
• Infertility
• Fever
• Pelvic pain
• Abnormal vaginal bleeding or unusual discharge
• Constipation or pain with bowel movements
• Abdominal swelling
• General unwell feeling

Common Diagnostic Tests Include:

Vaginal Fluid Testing

A sample of vaginal discharge is tested for common bacterial or sexually transmitted infections (STIs) such as chlamydia or gonorrhoea, which can be underlying causes of endometritis.

Endometrial Biopsy

A small tissue sample is taken from the lining of the uterus and examined under a microscope. This test helps detect inflammation, the presence of plasma cells, or bacteria, which are key signs of chronic endometritis.

Laparoscopy

In some cases, a minimally invasive surgical procedure called laparoscopy may be done. It uses a small camera to allow direct visualisation of the uterus and surrounding structures, helping rule out other causes of pelvic inflammation.

Blood Tests

Blood samples are checked for markers like white blood cell count (WBC) and erythrocyte sedimentation rate (ESR). Elevated levels can suggest the presence of infection or inflammation in the body.

Microscopic Evaluation of Vaginal Fluid

A sample of vaginal fluid is examined under a microscope to look for clues of infection, such as increased white blood cells or bacterial overgrowth.

Treatment Options for Chronic Endometritis

Antibiotic therapy is the main line of treatment for chronic endometritis. The goal is to eliminate the underlying infection causing persistent inflammation of the uterine lining. Treatment typically begins with a single antibiotic that targets common bacteria. If the condition does not improve, a broader combination of antibiotics may be used to address different types of bacteria, including those that are more resistant.

All treatment plans should be guided by a healthcare provider based on test results, response to initial therapy, and the presence of any underlying causes

Why Timely Treatment Of Endometritis Matter?

If endometritis is not treated on time, it can lead to serious health risks. The infection may spread to the fallopian tubes and ovaries, increasing the chances of:

• Infertility
• Pelvic infections
• Pelvic or uterine abscesses (pus-filled pockets)
• Septicemia (a severe blood infection)

Early diagnosis and treatment of endometritis are key to preventing serious complications.

Why Choose LifeCell Diagnostics for Chronic Endometritis Testing?

If you're dealing with ongoing symptoms like pelvic discomfort, unusual discharge, or fertility issues, getting the right test matters. LifeCell Diagnostics offers a simple, accurate, and reliable way to detect Chronic Endometritis with our DICE-TB PCR Plus Panel (Qualitative).

Conclusion

Chronic endometritis is a subtle but impactful condition that can quietly interfere with a woman’s reproductive health, especially when left undiagnosed. Its vague symptoms often go unnoticed, yet research clearly links it to infertility, implantation failure, and recurrent pregnancy loss.

The good news? With the right diagnostic tools and timely treatment, chronic endometritis is both detectable and treatable. Understanding your condition, recognising its signs, and opting for accurate testing can make a significant difference in your fertility journey.

If you're experiencing unexplained pelvic symptoms or facing difficulty in conceiving, don’t wait. Choose expert support and precise testing with LifeCell Diagnostics to take control of your reproductive health early—because occasionally, the quietest conditions need the loudest attention.

Frequently Asked Questions

What is chronic endometritis?

Chronic endometritis is a mild but long-lasting inflammation of the endometrium, the inner lining of the uterus. It often has no obvious symptoms but can affect fertility and cause other reproductive health issues.

How is chronic endometritis diagnosed?

It is diagnosed through a combination of tests such as endometrial biopsy (taking a small tissue sample from the uterus), vaginal fluid tests, blood tests for infection markers, and sometimes laparoscopy. These help identify inflammation or infection in the uterine lining.

What is the difference between acute and chronic endometritis?

Acute endometritis is a sudden and severe inflammation usually caused by an infection, often with clear symptoms like fever, pelvic pain, and vaginal discharge. Chronic endometritis is a milder, ongoing inflammation that often has no obvious symptoms and can be harder to detect.

What are the symptoms of chronic endometritis?

Symptoms are often mild or absent but may include pelvic discomfort, spotting or irregular bleeding, abnormal vaginal discharge, reduced menstrual flow, missed periods, and infertility.