Welcome to the Woven Well Podcast. I'm your host, Caitlin Estes. I'm a certified fertility care practitioner with a master of divinity degree. Each episode will cover a topic that helps educate and empower you and your fertility while honoring the deep connection your fertility has with your faith. Let's get started.
Welcome back to the Woven Well podcast!
When you first saw today’s show title, you may have thought that it said “endometriosis.” That’s certainly a topic we talk about a lot—I’ll make sure to link some episodes in the show notes—because it’s important and a common struggle for women dealing with period pain or infertility. But today’s episode is actually about “endometritis.”
While endometriosis is the traveling of uterine cells outside of the uterus, endometritis is actually the inflammation of the lining of the uterus itself. They are two separate, unrelated conditions that come up in women’s health. And while they’re both worth learning about, today is dedicated to endometritis specifically.
First, let me remind you that I am not a medical professional, but a Certified Fertility Care Practitioner. My job is not to diagnose or treat anyone, but to be a guide that helps you advocate for your best healthcare and plan your family naturally.
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So, your experience of endometritis could be symptoms that come on fast and strong—this is known as an acute form of endometritis. Or it may be slow and steady, and maybe feel a little bit nonexistent—this is a chronic form on endometritis. I’ll try to give information about both, but I want to say at the outset that the acute form is much more noticeable and therefore more likely to be treated effectively and quickly because of that; whereas, the chronic endometritis that often goes under the radar and can cause some different problems.
With acute endometritis, you’re going to have really noticeable symptoms that sometimes feel like they come out of nowhere. You can experience pelvic pain, vaginal bleeding or discharge, bowel movement discomfort, abdominal swelling, and even develop a fever.
Women with chronic endometritis may not even realize they have it. It’s often asymptomatic, meaning there aren’t really any symptoms for it. And for those that do have symptoms, they may be as mild as unusual bleeding or general pelvic pain.
That’s because the starting point for these types of inflammation are a little bit different.
Acute endometritis is often brought on by very easily identifiable events. And each one of these events are situations where inflammatory vaginal bacteria is introduced into the uterine lining.
So, I want to pause here just to say that vaginal bacteria is a good thing! We want and need healthy vaginal bacteria! So this is not putting that down at all. But if that good healthy vaginal bacteria were to travel outside of the vaginal canal, where it’s supposed to be, and instead plant itself in, let’s say, the uterine lining, or if there is a more damaging type of bacteria present, these scenarios are ones in which it may cause some trouble.
This can happen certainly through STIs, or uterine procedures like an endometrial biopsy, a pregnancy loss and procedures related to that, abortion procedures, placement of an IUD, or even a C-section. In fact, acute endometritis is the most common postpartum infection!
All of the symptoms I mentioned are enough to signal to providers that there’s an infection that must be treated. It’s usually very obvious, and just the symptoms alone are enough for a provider to diagnose what’s going on and give you the treatment you need.
Chronic endometritis is a bit of a different story. Symptoms are harder to spot, and so is the cause. There are certainly things that can put you at a higher risk for developing it, like having an IUD or previous abortions or a history of multiple pregnancy losses. But sometimes the only known risk factor is simply having unusual bleeding. Unusual bleeding meaning any bleeding that is outside of the period itself. Because it can be so challenging to pinpoint, it’s not always initially tested for — yet some studies suggest that 10% of women currently have it.
For these cases, the only way to really diagnose it is to do an endometrial biopsy. This is where the medical provider will actually go in, take a sample of the uterine lining, and then test it for endometritis, that particular type of inflammation.
And — I know what you’re thinking — wasn’t that one of the things that could possibly cause endometritis?? Yep. I know. Double edged sword, for sure. But maybe that’s why some patients choose to be treated for it without a full diagnosis. And I’m not saying that’s what should happen. I’m saying there are pros and cons to this.
The treatment itself is a round of antibiotics — and usually more than one antibiotic at a time. There are lots of thoughts about antibiotic use, especially such a strong dose over longer periods of time. But, this is known to be a bacterial infection, so it really is the only course of treatment available — that I know of! :)
So, sometimes there are providers that’ll say, hey, you may have chronic endometritis, let’s go ahead and try a round of these antibiotics and see if you notice a difference. But there are benefits to waiting until you have a confirmed diagnosis too. For instance, if you do well with biopsies and they aren’t very painful for you, your provider may want you to repeat the procedure after treatment, to be able to confirm that it was effectively treated. It makes it a bit more measurable too, which is really nice. You want to know that, hey, I had this, and it was taken care of; it’s no longer an issue.
Without the biopsy, the signs that may point to chronic endometritis can be a little bit more difficult, maybe just unusual bleeding or possibility infertility, or delayed conception.
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Now, for women charting their cycles through the Creighton Model System, which is what we teach at Woven Natural Fertility Care, they’re likely to notice this unusual bleeding fairly quickly. Yes, there are other things that can cause it — but being able to quickly see when and where it’s occurring — including how long, under what scenarios, and after what treatment — it really gives incredibly helpful information to you and your provider about its cause. For instance, if you’re noticing that you have a few days of brown bleeding after your period, but they’ve tested all the other things that could possibly cause this, like your progesterone hormone was in a healthy range the previous cycle, you have no fibroids or polyps, and your thyroid looks good — it may point them to chronic endometritis. Without that charting, maybe it would be a little bit more difficult. But I would also say, without the provider who knows how to interpret that charting, it would be a little bit more difficult.
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Maybe the bigger question here is, is it worth treating at all?
Especially for women who don’t have any symptoms, what difference does it really make?
Well, that’s one key difference in and of itself. Those with acute endometritis, they are going to have very noticeable symptoms and will have a lot of motivation to get that taken care of. If they chose not to, they could develop abscesses, further pelvic infection like Pelvic Inflammatory Disease, and — in serious cases — possibly become septic. You want to get it treated.
But for chronic endometritis? The only symptom may be infertility, or a little bit of brown bleeding at the end of the period, like I mentioned earlier. There may not always be a huge level of motivation to get that treated, especially for women who aren’t currently trying to get pregnant. Maybe you’re not interested in getting pregnant today, but you are in the future.
This type of chronic inflammation of the uterine lining may make pregnancy difficult, because the fertilized egg must implant in that same lining. A million things have to go right to allow a successful pregnancy, and implantation is one of those critical ones. If the lining is inflamed, the embryo may not be able to implant or implant in a stable, lasting way.
In fact, some studies suggest that 30% of women experiencing recurrent pregnancy loss have chronic endometritis. So, that’s important.
But also, even if you’re not currently trying to get pregnant, unchecked endometritis can worsen and spread, possibly contributing to pelvic inflammatory disease, which is that inflammation that can travel outside of the uterus and put the fallopian tubes and other reproductive organs at risk. That also increases your likelihood of having increased or severe pelvic pain, which no one wants.
This matters for all women, not just those trying to conceive a pregnancy or even those who one day want to.
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For me, this goes back to the importance of knowing your body and your own signs of health or concern.
If you begin charting your cycles with the Creighton system, and you see any type of unusual bleeding — that’s a symptom worth investigating. There is going to be a cause.
Many of these symptoms may not cause you problems on a daily basis. You know, day in and day out, it doesn’t make that much of a difference to your everyday life. But it doesn’t mean they aren’t worth investigating and treating. They could have an impact on your health or fertility in the future, even if they aren’t bothering you today.
Partnering with a medical provider who feels the same way makes all the difference in the world. I always want to mention this, because not all providers are the same, not all of them have the same approach. You want to work with someone who also believes that women deserve the highest quality of life right now — not just when they’re trying to get pregnant, but right now. Now, for those who are trying to get pregnant, working with a provider who wants to help you be as healthy as possible and address ALL the underlying roadblocks to pregnancy, that’s also equally as important!
I’m very glad that restorative reproductive providers like those trained in NaProTechnology share this same mindset. I’m constantly talking about these different types of providers, because yes, they are OBGYNs, they’ve had the full training and residency and everything that you want in a provider, but they’ve also received additional education and training in this more restorative approach, and it makes all the difference in the world. They know about chronic endometritis. They want to treat it to improve your health and your fertility.
If you need help getting connected with a provider like this in your area, please don’t hesitate to reach out to us at Woven Natural Fertility Care! I’d be more than happy to help you find someone you can work well with as you move forward.
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I hope you’ve enjoyed this episode on Endometritis 101. We’ll release a downloadable resource in the days ahead so that you can have this in a digital format, if that helps, as well. I *always* want to make sure our listeners have the resources they need to advocate for their health and naturally plan their families. Check out our other free resources at wovenfertility.com/resources, which will also be a link in the show notes.
If you enjoyed today’s episode or our other episodes at Woven Well, I would LOVE it if you took a minute to write a 5-star review on your podcasting platform of choice, wherever you listen to us. These reviews make a HUGE difference to other listeners who are looking for resources. Your 5-star review would mean a lot.
As always, thanks for listening as we continue to explore together what it means to be woven well.