bubble_chart Overview

Clinically, apart from subcutaneous nodules and senile endometritis, other lesions are actually relatively rare. Even with extensive chronic adnexal inflammation, the endometrium may remain completely normal. This is mainly because the uterine cavity has good drainage conditions and periodic endometrial shedding, which rarely allows inflammation to persist in the endometrium for long periods. As a result, lesions often gradually diminish and disappear. However, if treatment during the acute phase is incomplete or if an infection source persists, the condition may recur repeatedly.

bubble_chart Clinical Manifestations

(1) Pelvic pain: About 40% of patients complain of lower abdominal distending pain and soreness in the lumbosacral region during the intermenstrual period.

(2) Increased leucorrhea: Caused by increased secretion of the endometrial glands. It is usually thin, watery, and pale yellow, sometimes bloody leucorrhea.

(3) Hypermenorrhea: The menstrual cycle remains regular, but the flow doubles, and the bleeding period is significantly prolonged. Only a very small number of patients develop anemia due to heavy bleeding, possibly caused by endometrial thickening and inflammatory congestion. Irregular bleeding is rare, occasionally lasting a few hours or persisting for 1–2 days before stopping.

(4) Dysmenorrhea: More common in nulliparous women, but severe pain is rare. It may be due to excessive endometrial thickening, hindering normal tissue degeneration and necrosis, leading to excessive spasmodic contractions of the uterus.

Senile endometritis is often accompanied by atrophic vaginitis, presenting with purulent leucorrhea, often containing small amounts of blood, which can easily be mistaken for malignant sexually transmitted disease of the uterus. When pyometra occurs, the discharge is purulent and foul-smelling. Patients may experience dull abdominal pain and systemic inflammatory symptoms, though some remain asymptomatic.

Signs: In grade I inflammation, bimanual examination may reveal no abnormalities, so it is often clinically diagnosed as dysfunctional uterine bleeding. Among 1,000 cases of dysfunctional uterine bleeding subjected to pathological examination, 11% were found to have endometritis.

If pyometra is present, the uterus becomes globular, soft, and may even be palpable as a mass above the pubic symphysis midline, with tenderness. If the discharge intermittently passes through the cervical canal, bloody pus with a foul odor may be seen on speculum examination. Acute vaginitis is often concurrent.

bubble_chart Diagnosis

The clinical manifestations of chronic endometritis are not specific, but the combination of four major symptoms—history of infection, increased leucorrhea and menstrual flow, pelvic dull pain, and dysmenorrhea—holds significant diagnostic value. Diagnostic curettage can determine the cause of the disease and exclude malignant sexually transmitted diseases.

Senile endometritis is often misdiagnosed as endometrial carcinoma or cervical carcinoma, and diagnostic curettage is necessary to rule these out. Generally, senile endometritis rarely presents with isolated bleeding.

Pyometra sometimes lacks systemic symptoms. However, because it is often associated with senile vaginitis, the foul-smelling leucorrhea may sometimes be attributed to this condition. Special attention should be paid to the possibility of uterine carcinoma (diagnostic curettage should be performed), and care should also be taken not to misdiagnose an enlarged, soft uterus as an ovarian cyst.

bubble_chart Treatment Measures

(1) If obvious predisposing factors are identified, they should be removed.

(2) For senile endometritis, administer diethylstilbestrol 0.25–0.5 mg orally once daily for 1–2 weeks, along with appropriate antibiotic therapy for 5–7 days. Concurrently, treat senile vaginitis (see Senile Vaginitis).

(3) For cases complicated by pyometra, immediately dilate the cervical canal to drain the pus. Postoperatively, place a rubber drainage tube in the cervical canal until no more pus is discharged, while continuing the aforementioned drug therapy. To rule out malignancy, gently curette the cervical canal and uterine cavity after pus expulsion and send the obtained tissue for pathological examination. If malignancy is confirmed, manage it accordingly. Send the pus for bacterial culture and sensitivity testing to guide antibiotic selection. For non-malignant pyometra, perform uterine cavity lavage using disinfectant solutions such as 1:5000 potassium permanganate solution or iodine solution (3% iodine dissolved in normal saline with alcohol content below 50%). Use low pressure and slow flow during lavage. If a double-lumen uterine lavage tube is unavailable, insert a catheter into the uterine cavity and inject the solution using a 100 ml syringe. The volume of lavage fluid per cycle depends on the amount of accumulated pus, typically 30–50 ml. Allow the lavage fluid to drain completely before the next infusion, repeating the process until the effluent becomes relatively clear, then place a rubber tube for drainage. Perform this procedure once daily.