How to diagnose endometritis (infection of the endometrium)?

From the Guidelines

To diagnose endometritis, a healthcare provider should perform an endometrial biopsy, which involves collecting a small tissue sample from the lining of the uterus, as it is the most direct method to confirm the infection 1. This procedure can be done in an office setting using a thin tube inserted through the cervix to extract tissue. Some key points to consider when diagnosing endometritis include:

• Symptoms that might prompt testing, such as abnormal vaginal discharge, pelvic pain, abnormal bleeding, or fever
• The use of alternative diagnostic methods, including endometrial cultures, where samples are collected and tested specifically for bacterial growth, or hysteroscopy, which allows direct visualization of the endometrial cavity using a thin, lighted scope
• Blood tests may be ordered to check for elevated white blood cell counts or inflammatory markers that suggest infection
• Transvaginal ultrasound can help identify endometrial thickening or fluid collections that might indicate infection
• Postpartum endometritis should be suspected when the patient presents with high fever, abdominal pain, uterine tenderness, and foul lochia, usually a multi-organism syndrome 1 It is essential to diagnose endometritis promptly, as it can lead to more serious conditions like pelvic inflammatory disease if left untreated, and may require antibiotic treatment, depending on the causative organism 1.

From the Research

Diagnosing Endometritis

To diagnose endometritis, which is an infection of the endometrium, several methods can be considered, although the provided studies do not directly focus on the diagnosis of endometritis in a comprehensive manner.

• The study 2 discusses the reliability of vaginal and endocervical cultures for evaluating the microbiology of the endometrial cavity in women with chronic endometritis. It found that common bacteria, Ureaplasma urealyticum, and Chlamydia trachomatis are prevalent infectious agents, but both vaginal and endocervical cultures have low concordance with endometrial cultures, suggesting that these methods may not be reliable for diagnosing endometritis.
• The other studies provided do not directly address the diagnosis of endometritis but discuss related topics such as endometriosis 3, 4, infertility evaluation and management 5, and the association between endometrial polyps and chronic endometritis 6.
• For diagnosing endometritis specifically, the most relevant information comes from 2, which implies that direct endometrial sampling may be necessary for accurate diagnosis due to the poor reliability of indirect methods like vaginal and endocervical cultures.
• There is no direct guidance from the provided studies on a step-by-step approach to diagnosing endometritis, suggesting that current research may not fully address this question or that diagnosis may involve clinical judgment and additional tests not covered in the provided evidence.

Related Conditions and Diagnostic Challenges

• Endometriosis, a condition where endometrial tissue grows outside the uterus, can cause similar symptoms to endometritis and is discussed in 3 and 4. However, its diagnosis and treatment are distinct and involve assessing symptoms, signs, and sometimes surgical confirmation.
• Infertility, which can be related to endometritis or endometriosis, is evaluated through a comprehensive medical history, physical examination, and specific tests like semen analysis, ultrasonography, or hysterosalpingography, as mentioned in 5.
• The association between endometrial polyps and chronic endometritis, explored in 6, suggests a potential link between these conditions, but this does not directly inform the diagnosis of endometritis.