Chronic endometritis: symptoms and treatment

For many women, difficulties conceiving or repeated implantation failure can be heartbreaking, especially when every test seems to come back normal. Yet sometimes, the cause lies in something subtle and often overlooked: chronic endometritis, a silent inflammation of the uterine lining that can quietly interfere with embryo implantation and fertility.

In this post, we explain more about chronic endometritis, its symptoms, diagnosis and how it can be treated successfully.

What is Chronic endometritis?

Chronic endometritis is a persistent inflammation of the endometrium, the inner lining of the uterus. It is usually caused by a low-grade bacterial infection, though determining how common it truly is can be difficult. This is because other uterine conditions, such as fibroids, endometrial polyps or hyperplasia, can coexist and increase the likelihood of developing chronic endometritis.

The main cause of this condition is the presence of microorganisms inside the uterine cavity, most often bacteria.

There are also risk factors that may contribute to its appearance, including:

Use of an intrauterine device (IUD)
Miscarriage, with or without curettage
Abnormal uterine bleeding
Fallopian tube blockage
Having had multiple full-term pregnancies

How Chronic Endometritis Relates to Infertility

Chronic endometritis is often a silent condition, present in some women who find it difficult to conceive naturally.

Studies have shown that chronic endometritis is more frequent among women with fertility problems, particularly those with implantation failure, meaning women who have undergone several IVF cycles (usually more than two embryo transfers) without becoming pregnant.

This condition can affect what is known as the “window of implantation”, the short period when the endometrium is most receptive to the embryo.

If this window is disturbed, embryo implantation becomes more difficult, and this disruption has also been linked to recurrent miscarriage and pregnancy complications.

Symptoms and Diagnosis of Chronic Endometritis

In many cases, chronic endometritis causes few or no symptoms. Some women may notice mild pelvic pain, irregular bleeding, or abnormal vaginal discharge.

However, the most accurate way to diagnose chronic endometritis is by performing an endometrial biopsy, which allows specialists to study the tissue under the microscope (histopathology) and/or carry out an endometrial culture.

In the histology study, the key diagnostic finding is the presence of plasma cells in the endometrial tissue.

Through immunohistochemistry, the CD138 marker is identified, one of the most sensitive markers for this condition.

It is also possible to suspect chronic endometritis by observing the uterine cavity during a diagnostic hysteroscopy. Typical images include micropolyps and mucosa with a “strawberry-like” appearance.

These findings are seen in over 40% of women with implantation failure or recurrent miscarriage, and in around one in four women with unexplained infertility.

Treatment for Chronic Endometritis

Although chronic endometritis is relatively common, it is fortunately easy to treat, and treatment is successful in most cases.

More than 80% of patients recover fully after taking a proper course of antibiotics.

The most common treatment is doxycycline for 14 days.

If the infection is resistant, ciprofloxacin combined with metronidazole may be prescribed for the same duration.

For women trying to conceive, treating chronic endometritis can significantly improve implantation and pregnancy rates.

Conversely, leaving it untreated can reduce the chances of success in assisted reproduction.

When to Consult a Specialist

If you’ve been diagnosed with chronic endometritis — or suspect you may have it — it’s essential to talk to a fertility specialist.

At URE Centro Gutenberg, our team will assess your situation in detail, perform the necessary tests and recommend the most effective treatment plan for your case.

By addressing this condition, many women improve their fertility and increase their chances of achieving a healthy pregnancy.