Yes, absolutely. Symptoms of chronic endometritis can be very subtle. Women are often very tough and have learned to endure pain, such as period pain, or put up with discomfort, which can make their symptoms not very reliable. They may experience some heaviness, mild spotting, midcycle bleeding, or discharge, or even prolonged bleeding, but often, they don’t pay much attention to these symptoms. Some women might think they are experiencing heavy bleeding when they are actually using three or four pads, while others may not notice anything unusual at all.
Symptoms alone may not be reliable indicators of endometritis. Mild to moderate endometritis may cause no symptoms at all. Some cases of endometritis may be transient, meaning they could resolve with a period, as the period helps shed the endometrium and regenerate the uterus and its lining. However, if the symptoms are severe, this could indicate pelvic inflammatory disease (PID), which we need to be very cautious about.
For example, recently, I performed a laparoscopy on a woman who came all the way from the US with Asherman syndrome. She had suffered a very difficult miscarriage and had undergone numerous hysteroscopies without anyone considering the possibility of a laparoscopy. Her condition had caused significant damage to her endometrial cavity, as well as pelvic adhesions, possibly damaging her tubes and creating hydrosalpinges, which can harm fertility.
Many cases of PID or issues like hydrosalpinges go unnoticed until they are seen on a scan, even though the women have no symptoms. Some may recall mild pain from years ago, which they managed with painkillers and didn’t think much of. This shows that symptoms can often be unreliable.
As fertility experts, we need to keep the possibility of endometritis in mind, and understand that vaginal and cervical swabs are not enough to diagnose it. It’s essential to consider all factors in cases of unexplained infertility, as many cases hide conditions like endometriosis or endometritis. It’s crucial to perform a thorough assessment, including tubal evaluation, endometrial biopsy, hysteroscopy, or laparoscopy, before concluding a diagnosis of unexplained infertility.
