Chronic Endometritis Definition and Etiology:  Definition: Chronic endometritis is a persistent inflammation of the endometrium, the inner lining of the uterus. Unlike acute endometritis, which is characterized by a sudden onset and typically associated with infections, chronic endometritis develops slowly and can be caused by a variety of factors.  Etiology: o Infections: Chronic endometritis is often associated with persistent bacterial infections, including those caused by Chlamydia trachomatis, Mycoplasma, and Ureaplasma species. These infections may persist after initial treatment or arise from untreated acute infections. o Postpartum or Post-Abortal Infection: Chronic endometritis can follow childbirth, miscarriage, or abortion, especially if there is retained placental tissue or an infection was not adequately treated. o Autoimmune Conditions: Conditions such as systemic lupus erythematosus or rheumatoid arthritis may predispose individuals to chronic endometrial inflammation. o Foreign Bodies: Presence of foreign objects like intrauterine devices (IUDs) can sometimes contribute to chronic inflammation. Clinical Presentation:  Symptoms: Chronic endometritis may present with a range of symptoms, which can be subtle and nonspecific. Common symptoms include abnormal vaginal bleeding (such as spotting or menorrhagia), pelvic pain, abnormal discharge, and infertility. In some cases, the condition may be asymptomatic and discovered incidentally during investigations for other issues.  Infertility: Chronic endometritis is a known cause of infertility, as the persistent inflammation can impair endometrial receptivity and disrupt the implantation process of an embryo. Diagnosis:  Clinical Evaluation: Diagnosis often involves a detailed patient history and physical examination. Symptoms and risk factors for chronic endometritis guide further investigation.  Endometrial Biopsy: Histopathological examination of an endometrial biopsy is crucial for diagnosis. The biopsy reveals characteristic features such as plasma cell infiltration, which is indicative of chronic inflammation.  Imaging: Ultrasound imaging can be used to evaluate the endometrial lining and identify any abnormalities or retained products of conception. However, ultrasound is not diagnostic for chronic endometritis but can help rule out other conditions.  Microbiological Testing: Cultures of endometrial tissue or vaginal secretions may help identify specific infectious agents, though not all cases of chronic endometritis are due to identifiable infections. Treatment:  Antibiotic Therapy: Treatment typically involves a course of antibiotics to address any underlying bacterial infection. The choice of antibiotics may be guided by culture results or empirical treatment based on suspected pathogens.  Management of Underlying Conditions: If autoimmune disorders or foreign bodies are contributing to the condition, appropriate management or removal of these factors is necessary.  Follow-Up: Regular follow-up is essential to ensure the resolution of symptoms and to prevent recurrence. In cases of infertility, further reproductive evaluation and treatment may be required. Conclusion: Chronic endometritis is a persistent inflammatory condition of the endometrium with various possible causes, including infections and autoimmune disorders. It can present with a range of symptoms, including abnormal bleeding and infertility. Diagnosis typically involves endometrial biopsy and microbiological testing, while treatment focuses on addressing infections and managing contributing factors. Effective management requires a comprehensive approach and ongoing follow-up to ensure resolution and prevent complications.