Endometritis vs. Endometriosis

Medically reviewed by Cordelia Nwankwo, MD

Endometritis and endometriosis are two distinct conditions. Their names sound similar because they're both types of endometrial disease. The endometrium, or endometrial lining, refers to the lining of the uterus.

Endometritis is caused by a bacterial infection in the uterus. Endometriosis does not result from infection. The cause of endometriosis is unknown.

Since they both affect the endometrium, endometritis and endometriosis may have similar symptoms, such as pelvic pain and bloating. For this reason, you may not know which condition you have unless you get a medical diagnosis. Like endometriosis, endometritis can cause infertility.

This article will explain the differences and similarities between endometritis and endometriosis. It will also go into detail about the diagnostic processes and treatments for both conditions.

What Is Endometritis?

Endometritis is inflammation or irritation of the endometrium that results from a uterine infection. This condition can be chronic (long-term or recurrent) or acute (short-lived).

If you have chronic endometritis, its long-term impact on the endometrium may make it challenging to get pregnant. Healthy embryos can't implant and grow when the uterine lining is irritated and inflamed. This cause of infertility is referred to as repeated, or recurrent, implantation failure (RIF).

Chronic endometritis has also been linked to recurrent miscarriage.

What Is Endometriosis?

Endometriosis (endo) is the growth of endometrial-like tissue outside of the uterus, where it doesn't belong. Endo is a chronic condition that ranges from mild to severe.

Endometriosis is a common cause of infertility. It can cause inflammation, adhesions, and scar tissue to form throughout the reproductive tract, including on the ovaries and fallopian tubes. Endometrial tissue growth can also affect the bladder, bowel, rectum, and other organs.

Signs and Symptoms

Both endometritis and endometriosis may be asymptomatic (cause no symptoms). If symptoms do occur, they can range from mild to severe for both conditions.

There is a significant symptom overlap between endometritis and endometriosis. Abdominal swelling and constipation can be highly indicative of endometritis, particularly if gastrointestinal conditions have been ruled out. Pelvic pain is another common symptom.

Severe pelvic pain and intense menstrual cramps are the symptoms most commonly associated with endometriosis.

Endometritis Symptoms

Endometritis symptoms can include:

• Swollen abdomen (stomach)

• Pelvic pain

• Pain in the lower abdomen

• Abnormal uterine bleeding that is not part of menstruation

• Unusual or heavy vaginal discharge

• Constipation

• Painful or uncomfortable bowel movements

• Fever

• An overall feeling of not being healthy or well

• Trouble conceiving or carrying a pregnancy to term

Symptoms of Endometriosis

Endometriosis symptoms can include:

• Pain in the pelvis, lower abdomen, or lower back

• Pain deep in the vagina during or after sex

• Severe menstrual cramps

• Painful bowel movements, especially during your period

• Pain during urination, especially during your period

• Spotting or bleeding between periods

• Abdominal bloating

• Diarrhea

• Nausea

• Constipation

• Trouble conceiving or carrying a pregnancy to term
  

Causes

Endometritis is the result of a bacterial infection within the uterus. In contrast, endometriosis is never caused by an infection.

Endometritis Causes

The underlying infection that causes endometritis may originate from several initial sources, including:

• In some instances, this infection may occur after contracting a sexually transmitted infection (STI), such as gonorrhea or chlamydia.

• A secondary tuberculosis infection in the female genital tract that results from a tuberculosis lung infection can sometimes be a cause.

• Changes in the number and type of normal bacteria in the vaginal microbiome may also be at fault.

An endometritis-causing infection is most likely to occur after an event such as:

• Having a miscarriage

• Giving birth, particularly if you underwent a long labor or had a cesarean section (C-section)

• Having a pelvic procedure that requires entry through the cervix, like an endometrial biopsy (removing sample tissue for analysis in a lab) or D&C (dilation and curettage), which involves dilating the cervix and scraping the uterine lining to remove tissue

• Getting an intrauterine device (IUD), a type of contraceptive

Causes of Endometriosis

The cause of endometriosis is not known. It is thought that retrograde menstruation is the most likely cause.

Retrograde menstruation refers to the backward flow of menstrual blood and bits of endometrial tissue into the fallopian tube, pelvis, and other areas of the body. This enables the implantation and growth of endometrial-like tissue cells outside of the uterus.

Several risk factors may make you more likely to get endometriosis. They include:

• Having a close family member, such as a parent or sibling, who has endometriosis

• Never giving birth

• Having longer-than-average periods that typically last more than one week

• Having a short menstrual cycle of 27 days or less

• Having an immune system disorder, such as lupus or inflammatory bowel disease

Diagnosis and Complications

The procedures used to diagnose endometritis and endometriosis may differ from one another. Getting as timely a diagnosis as possible is important for reducing the risk of disease progression.

An endometritis diagnosis can lead to a cure, reducing or eliminating the possibility of infertility. Endometriosis cannot be cured, but treatments can greatly reduce symptoms and complications and enhance quality of life.

Diagnosing Endometritis

To diagnose endometritis, a healthcare provider will give you a physical examination that includes a pelvic exam. They’ll check whether your cervix and uterus are tender. They’ll also listen for bowel sounds, which they may not be able to hear. Bowel (abdominal) sounds are produced by movements of the intestines during digestion.

Diagnostic testing will also be done to confirm a diagnosis of endometritis or to rule out other conditions, including endometriosis. A healthcare provider may recommend some or all of these tests:

• Cervical culture: A swab is taken to check for the presence of infection.

• Endometrial biopsy: A tissue sample is taken and analyzed in the lab, looking for evidence of infection or other conditions, such as fibroids or endometrial cancer.

• Erythrocyte sedimentation rate (ESR): This blood test can indicate inflammation and possible active infection.

• White blood cell count: This blood test measures the number and types of white blood cells circulating. High levels of white blood cells can indicate the presence of a bacterial or viral infection.

• Wet prep: This test analyzes a swab of vaginal discharge under a microscope for signs of infection by bacteria, parasites, or yeast.

• Laparoscopy: This is a minimally invasive surgical procedure that provides information about the internal organs.
  

Diagnosing Endometriosis

A definitive diagnosis of endometriosis can only be obtained through a surgical procedure, such as a laparoscopy. Other tests may be done first, to provide clues as to a potential diagnosis, and to rule out other conditions, including endometritis.

Tests your healthcare provider may do or recommend include:

• Physical exam

• Oral medical history of symptoms

• Pelvic exam

• Magnetic resonance imaging (MRI)

• Transvaginal ultrasound
  

Treatment and Outlook

Getting a diagnosis is the first step toward treatment. Endometritis can be cured. There is no cure for endometriosis. However, treatments can significantly reduce the impact of this disease. Treatments also exist that can improve your chances of parenthood.

Endometritis Treatment

Since it is caused by a bacterial infection, endometritis can be successfully treated with antibiotics. If your condition is severe or you have just given birth, you may be given antibiotics intravenously (through an IV catheter placed in a vein). Bed rest may also be required.

Treatment for Endometriosis

Endometriosis treatment is geared toward symptom relief and improving pregnancy potential (if desired). The treatments for endometriosis vary based on whether you wish to become pregnant.

A healthcare provider may recommend hormonal birth control if you're not actively trying to conceive. Hormonal treatments that temporarily stop ovulation may also be used in people who wish to attempt pregnancy after treatment. These include the use of gonadotropin-releasing hormone (GnRH) agonists.

If your symptoms are severe and don't improve with noninvasive treatment, surgical removal of scar tissue, lesions, and adhesions may be done. Surgery may provide a window of several years during which you can conceive. However, even after surgery, endometrial tissue typically returns.

What Is the Difference Between Endometriosis and Endometritis?

In a nutshell, endometritis is a curable condition that is caused by a bacterial infection. Endometriosis is an incurable condition that is treatable. Its root cause is unknown.

Summary

Endometritis and endometriosis are separate conditions that may present similar symptoms.

You may get endometritis due to an STI, tuberculosis, or changes to vaginal flora (the bacteria living inside the vagina). Usually, endometritis is preceded by an event such as a cervical puncture procedure, a C-section, or an overly long labor. Untreated endometritis can cause symptoms such as pelvic pain, constipation, and infertility.

Endometriosis is a chronic condition with no known cause. Retrograde menstruation is thought to be the most likely cause. Genetics may also play a role. This condition is not curable. However, treatments can significantly reduce symptoms like pelvic pain, menstrual cramps, and bloating. Treatments can also restore fertility, at least temporarily.