What are the symptoms of chronic endometritis?

Symptoms of Chronic Endometritis

Chronic endometritis is often asymptomatic but may present with abnormal uterine bleeding, pelvic pain, dyspareunia, and infertility when symptomatic. 1, 2

Common Clinical Presentations

Primary Symptoms

• Abnormal uterine bleeding - Most common symptom when present
  • Irregular menstrual bleeding
  • Intermenstrual spotting
  • Menorrhagia (heavy menstrual bleeding)
• Pelvic pain - Often mild and nonspecific
  • Dull, chronic lower abdominal discomfort
  • May be confused with other pelvic pain conditions
• Dyspareunia (painful intercourse)
• Infertility - Found in up to 40% of infertile patients 1
• Recurrent pregnancy loss
• Repeated implantation failure in assisted reproduction

Associated Reproductive Issues

• Implantation failure in IVF treatment
• Recurrent miscarriage
• Subfertility without other symptoms

Diagnostic Challenges

Chronic endometritis is considered a "ghost" pathology 1 because:

• Many cases produce no noticeable signs or only mild symptoms 3
• Prevalence rate is approximately 10% in the general population 3
• It is found in up to 40% of infertile women 1
• Symptoms often overlap with other gynecologic conditions

Diagnostic Methods

The diagnosis of chronic endometritis requires specialized testing:

1. Histopathological examination

   • Presence of plasma cells in endometrial stroma is the diagnostic hallmark 4
   • Immunohistochemistry is recommended to increase diagnostic accuracy 2

2. Hysteroscopy

   • Considered by some as the gold standard diagnostic tool 2
   • Findings include micropolyps, stromal edema, and hyperemia

3. Microbial cultures and molecular testing

   • Identifies causative pathogens (Enterococcus, Streptococcus, Staphylococcus, Mycoplasma, etc.) 1
   • Molecular methods (PCR) can detect both culturable and non-culturable pathogens

Clinical Significance

Chronic endometritis is particularly important to consider in:

• Women with unexplained infertility
• Patients with recurrent pregnancy loss
• Cases of repeated implantation failure during IVF
• Women with persistent abnormal uterine bleeding without other identifiable causes

Treatment Implications

Proper identification of chronic endometritis is important because:

• Effective antibiotic treatment can improve pregnancy rates and live birth rates in patients with recurrent pregnancy loss 2
• Treatment can increase ongoing pregnancy rates in patients with recurrent implantation failure 2

Pitfalls to Avoid

• Underdiagnosis - Due to subtle or absent symptoms, chronic endometritis is often overlooked
• Misdiagnosis - Symptoms may be attributed to other conditions like endometriosis or pelvic inflammatory disease
• Inadequate testing - Relying on only one diagnostic method reduces detection rates; combining histology, hysteroscopy, and microbial testing improves accuracy 1

Remember that chronic endometritis represents a persistent inflammation of the endometrial lining that may significantly impact reproductive outcomes even when symptoms are minimal or absent.