Chronic endometritis

　　Chronic endometritis has the following pathogenic factors:
　　1. Although the endometrium has a cyclic shedding, its basal layer does not shed with it. Once there is chronic inflammation in the basal layer, it can infect the functional layer of the endometrium for a long time, leading to chronic endometritis. The mechanism of tuberculosis endometritis is the same.
　　1. Long-standing salpingo-oophoritis or severe cervicitis can lead to chronic endometritis.
　　2. Intrauterine contraceptives can cause chronic endometritis.
　　3. Small placental residues or incomplete involution of the placental attachment site after delivery or abortion are often the causes of chronic endometritis.
　　4. Postmenopausal women, due to the significant decline in estrogen levels in the body, the endometrium and vaginal mucosa become thin, which is easy to be invaded by pathogens, leading to the occurrence of inflammation. In clinical practice, senile endometritis and vaginitis often coexist.
　　6. Submucosal fibroids of the uterus and mucosal polyps may also lead to chronic endometritis.
　　7. Chronic endometritis with no obvious cause may exist, and the pathogens are mostly from the vaginal flora.

　　Chronic endometritis may lead to serious consequences such as diffuse peritonitis, sepsis, and infectious shock. Specifically, as follows:

　　1. Diffuse peritonitis is when the area of the peritoneum is almost equal to the area of the skin of the entire body. After the onset of acute diffuse peritonitis, there is a lot of exudate, a large amount of toxic substances are absorbed, and the systemic toxic condition is also severe.

　　2. Sepsis, which refers to the entry of bacteria into the blood circulation, their growth and reproduction, and the production of toxins, causing systemic severe infection. Clinical manifestations include fever, severe toxic symptoms, rash, petechiae, enlargement of the liver and spleen, and an increase in the number of white blood cells.

　　3. Infection shock, also known as septic shock, refers to a sepsis syndrome accompanied by shock caused by microorganisms and their toxins and other products. Microorganisms and their toxins, cell wall products, and other substances in the focus of infection enter the blood circulation, act on various organs and systems of the body, affect their perfusion, leading to ischemia and hypoxia of tissue cells, metabolic disorders, dysfunction, and even multiple organ failure.

　　The clinical manifestations of chronic endometritis are not specific, but when combined with a history of infection, increased leukorrhea and menstrual blood volume, hidden pain in the pelvic area, and dysmenorrhea, these four major symptoms are of great value for diagnosis. Curettage can determine the cause of the disease and exclude malignant lesions. Specifically, as follows:

　　1. Pelvic pain:About 40% of patients complain of lower abdominal distension, pain, and lumbar sacral pain during the interval between menstrual periods.

　　2. Increased leukorrhea:It is caused by the increased secretion of endometrial glands, and it is usually thin, watery, light yellow, and sometimes bloody leukorrhea.

　　3. Menorrhagia:The menstrual period remains regular, but the amount of menstrual blood is doubled, and the bleeding period is also significantly prolonged. Only a few patients may develop anemia due to excessive bleeding, which may be caused by thickened endometrium and inflammatory congestion. Irregular uterine bleeding is not common, and it may occasionally occur for several hours or last for 1 to 2 days before stopping.

　　4. Dysmenorrhea:Painful menstruation is more common in nulliparous women, but it is rare in severe dysmenorrhea cases. This may be due to the over-thickened endometrium, which hinders the normal degeneration and necrosis of tissues, and stimulates excessive uterine spasmodic contraction.

　　Although chronic endometritis has a relatively low incidence, once a person is affected, it can bring many impacts on life and work, and also cause a lot of pain to the patient. Therefore, we should actively prevent its occurrence.
　　Firstly, attention should be paid to menstrual hygiene and sexual intercourse during menstruation should be strictly prohibited to prevent pathogenic bacteria from taking advantage of the opportunity to invade.
　　Secondly, attention should be paid to contraception to avoid unnecessary abortions. Childbirth and hysteroscopic surgery should be done in strictly disinfected regular hospitals to prevent direct contamination during surgical procedures. Women with a possibility of infection should receive prophylactic anti-inflammatory treatment.
　　In addition, after childbirth, the endometrium has an incision, and the cervix is slightly open compared to usual, and it takes a certain amount of time to completely recover. Avoid early sexual intercourse. It is easy to carry bacteria into the wife's reproductive organs, causing endometritis or pelvic inflammatory disease. While mild cases or those treated promptly can still be completely recovered, many people may suffer from endometrial destruction or fallopian tube obstruction, leading to lifelong infertility. In severe cases, bacteria may enter the wound and spread with the blood flow, causing sepsis and threatening life. Therefore, during this period, as a husband, one should control oneself and wait until two months after the lochia is completely clean and the endometrium and its function are completely restored before having sexual intercourse.
　　Finally, after women enter menopause, their bodies also enter the 'autumn of many things', and they should pay more attention to sexual matters. After women enter old age, due to the significant decline in ovarian function, the reproductive system organs gradually atrophy, and sexual desire significantly decreases. However, the sexual life ability of husbands with similar ages can be maintained for a longer time, and their sexual demand is relatively stronger than that of their wives. At this time, as a husband, one should especially show sympathy and care for one's wife and should not force sexual intercourse to avoid causing lacerations to the vagina that is beginning to atrophy and has reduced secretions. In addition to controlling the frequency of sexual intercourse to a low physiological level, the preparation time for each sexual encounter should be prolonged, and the movements should be gentle, avoiding roughness. If necessary, artificial lubricants should be used. Moreover, after the wife's menopause, the natural defense ability of the vagina is weakened, making it prone to infection. Therefore, during sexual intercourse, the husband should pay special attention to the cleanliness and hygiene of the organs.

　　Chronic endometritis is mainly diagnosed by hysteroscopy and biopsy. Under hysteroscopy, scraping the endometrium for pathological examination can show a large number of plasma cells and lymphocytes infiltrating in the endometrial stroma. The clinical manifestations of chronic endometritis are not special. If combined with a history of infection, increased leukorrhea and menstrual flow, hidden pain in the pelvic region, and dysmenorrhea, these four symptoms are of great value for diagnosis. Dilation and curettage can determine the cause of the disease and exclude malignant lesions.

　　Patients with chronic endometritis can assist in treatment with the following food therapy recipes:

　　Prescription 1

　　Radix Rehmanniae and Black Chicken: 250 grams of radix rehmanniae, 1 black chicken, 150 grams of syrup. Remove the feathers and clean the intestines and stomach of the chicken, finely chop them, mix the radix rehmanniae with sugar evenly, stuff it into the chicken's abdomen, steam it over water without adding salt, vinegar, or other seasonings. This recipe has the function of nourishing yin and clearing heat.

　　处方二

　　槐花苡米粥：槐花10克，冬瓜仁20克，大米适量。将槐花、冬瓜仁同煎成汤，去渣，放入苡米及大米同煮成粥服食。本方具有益气祛湿之功。

　　慢性子宫内膜炎一般有药物治疗、物理治疗和手术治疗方法，具体包括如下方面：
　　一、药物治疗
　　老年性子宫内膜炎，可应用已烯雌酚0.25mg～0.5mg，每日口服1次，连服1～2周，并选用适宜的抗生素治疗5～7天。同时针对老年性阴道炎进行治疗(见老年性阴道炎)。
　　二、物理治疗
　　中、重度患者在药物治疗无效的情况下，可以选择物理治疗，但物理治疗会对身体造成伤害，有很大的副作用，容易导致阴道壁神经不敏感，性生活无快感，而且容易导致不孕，因此未育女性不可采用此疗法。
　　三、手术治疗
　　重度患者在药物治疗和物理治疗均无效的情况下，可选择是否采用子宫颈锥切术或全子宫切除术，不到万不得已，不推荐使用手术治疗。
　　1、并发宫腔积脓者应立即扩张颈管，引流脓液。术后置橡皮引流管于颈管至无脓液流出为止，同时应用上述药物治疗。为了排除癌肿，排脓后可轻轻搔刮颈管及宫腔，所取组织送病理检查。
　　2、如确诊为癌肿则按癌肿处理。脓液应送细菌培养及药敏，为选用抗生素的参考。
　　3、非癌肿性宫腔积脓可行宫腔灌洗，消毒药液如1∶5000过锰酸钾溶液或碘酒溶液(3％碘酒溶于生理盐水中，酒精含量应低于50％)，灌洗时压力要低，速度缓慢。如无双腔子宫灌洗管，可将导尿管插入宫腔，用100ml注射器将药液注入。一次灌洗液量根据积脓多少而定，一般30ml～50ml，须使灌洗液流尽后再第二次注入药液，如此反复多次，待流出液较清为止，然后放置橡皮管引流。如此每日进行一回。