Symptoms.—The symptoms of chronic endometritis are often obscured by symptoms that are to be referred to other accompanying conditions. For instance, the endometritis very often accompanies subinvolution of the uterus, laceration of the cervix, uterine displacement, or ovarian and tubal disease. Cases of simple uncomplicated endometritis are the exception.
The menstrual function is usually affected. The period is of longer duration, the loss of blood is greater, and the periods may occur more frequently than normal; in other words, there is present menorrhagia. In this disease bleeding also occasionally occurs between the menstrual periods. Hemorrhage is a symptom that is most prominent in cases of interstitial and fungoid endometritis.
The secretion of the utricular glands is also increased in amount. This symptom is most pronounced in cases of glandular endometritis. The secretion is thin and purulent in character, and is often streaked with blood. It decomposes very readily, and consequently is often offensive and excites the suspicion of malignant disease.
The character of the typical discharge from the body of the uterus is usually obscured by admixture with discharge from the cervical mucous membrane. Cervical catarrh, or inflammation of the cervical mucous membrane, may, and usually does, occur alone, without involvement of the upper endometrium, but chronic corporeal endometritis is usually associated with inflammation of the cervix. If the discharge is observed at the vulva, it will be still further altered by admixture with the vaginal secretion. The discharge from the corporeal endometrium is thinner and more serous than the mucus of the cervical canal, and is more usually purulent and streaked with blood.
The discharge from the endometrium is very often increased very decidedly immediately before and after the menstrual period.
Pain is a general symptom of chronic endometritis. The pain is uterine in character, and is referred to the lower abdomen and the back. There is also very constantly present reflex headache localized on the top of the head or in the occiput.
The pain may be present at all times, but it is usually most marked when the woman is upon her feet and the pelvic congestion is increased. The pain is always greatest immediately before and during the menstrual period.
General physical weakness and debility are often very pronounced, and seem to be out of proportion to the extent of the local disease. This same phenomenon has been spoken of in the consideration of uterine displacements. The weak and aching back, the dragging sensations in the pelvis, the tired legs, may all appear after the woman has been upon her feet but a short time, and utterly incapacitate her for any kind of labor.
Nervousness, neurasthenia, hysteria, and mental depression and melancholia are apt to occur in this disease. Such nervous phenomena are common to all diseases of the uterus. The mental depression is often very marked, and is exaggerated before and during each menstrual period.
The woman with chronic endometritis is usually sterile; or if she becomes pregnant, abortion will probably occur. The discharges in the uterine cavity are inimical to the spermatozoa, and the diseased endometrium furnishes an inefficient place for the attachment of the ovum.