Pelvic inflammatory disease is a bacterial infection of one or more female reproductive organs. Although it is common, especially in women under 25, untreated cases can lead to scar tissue accumulation or blockages in the fallopian tubes, a frequent cause of female infertility. Here’s what to know.

What causes pelvic inflammatory disease?

Pelvic inflammatory disease develops when bacteria spread from the vagina to a female reproductive organ such as the uterus, fallopian tubes, or ovaries. It most often occurs as a complication of a sexually transmitted infection (STI), with gonorrhea and chlamydia accounting for 90% of all cases, but it may also be caused by bacteria naturally found in the vagina.

Non-sexually transmitted bacteria can enter a reproductive organ after childbirth, miscarriage, pelvic surgery, or insertion of an intrauterine device (IUD). (The rare risk of pelvic inflammatory disease after IUD insertion is highest in the weeks immediately after the procedure.)

There are several risk factors linked to pelvic inflammatory disease:

• Being under the age of 25

• Having multiple sexual partners, or a partner who has multiple sexual partners

• Having unprotected sex

• Having a history of pelvic inflammatory disease or an STI

Signs and symptoms

Pelvic inflammatory disease isn’t always accompanied by visible symptoms. Many people first receive a diagnosis after experiencing difficulty becoming pregnant and seeking a fertility evaluation.

When they appear, common symptoms include:

• Pain in the lower abdomen and pelvis - can range from mild to severe

• Heavy vaginal discharge, or discharge that is abnormal in color or odor

• Abnormal vaginal bleeding during or after penetrative sex or between periods

• Fever, with or without chills

• Painful or frequent urination

Symptoms typically develop days to weeks after infection if caused by gonorrhea or chlamydia. If the cause is non-sexually transmitted bacteria, symptoms may develop up to months after infection.

If you think you might have pelvic inflammatory disease, it’s important to speak with your provider as soon as possible. Seek care immediately if you have severe abdominal pain or a fever over 101 degrees Fahrenheit, or if you are experiencing nausea and vomiting.

Complications and impact on fertility

Without prompt, effective treatment, pelvic inflammatory disease can lead to the accumulation of scar tissue and/or infected fluid in the reproductive tract, sometimes resulting in permanent damage to a reproductive organ.

Tubal factor infertility

A common form of structural damage to a reproductive organ after pelvic inflammatory disease is fallopian tube obstruction, which occurs when one or both fallopian tubes are narrowed or completely blocked. Also referred to as tubal disease or tubal factor infertility, it can interfere with natural conception and accounts for 25-30% of all female infertility cases.

Risk of ectopic pregnancy

Relatedly, scar tissue in the fallopian tubes as a result of pelvic inflammatory disease can prevent an embryo from moving through the fallopian tubes, interfering with embryo implantation and pregnancy development. The implantation of an embryo anywhere outside of the uterus is an ectopic pregnancy, a serious health concern that can lead to complications such as ruptured fallopian tubes without prompt treatment to end the pregnancy.

Read Understanding Tubal Factor Infertility.

Treatment and prevention

In cases of pelvic inflammatory disease, there is a correlation between duration of infection and severity. Prompt treatment can help you avoid more serious complications, including fertility issues.

Oral antibiotics are the first-line treatment for pelvic inflammatory disease. Typically, a 14-day course is needed to get rid of the infection. It’s important to continue taking the medication for as many days as your doctor has prescribed even if you feel better before then.

If you still experience symptoms after taking antibiotics, treatment in a hospital setting may be necessary.

Tell any sexual partners about your diagnosis so that they can also seek medical care. This is important for your health as well as theirs, since you can develop another infection from having sex with them if they do not receive necessary treatment.

There are steps you can take to reduce your risk of pelvic inflammatory disease and protect your health and others:

• Practicing safe sex

• Getting regularly tested for STIs and encouraging your partner(s) to do the same

• Regularly visiting your gynecologist for routine check-ups

Fertility treatment options

If you are experiencing infertility as a result of pelvic inflammatory disease and fallopian tube obstruction, surgery or in vitro fertilization (IVF) — a form of assisted reproductive technology (ART) that bypasses the fallopian tubes — are the two main treatment options to support your family building journey. The best option for you depends on the extent of the blockage and individual reproductive health factors. If you are conceiving as a couple, your doctor will also account for your partner’s sperm count and quality when making treatment recommendations.

Choose the right fertility pharmacy

Fertility treatment can be a challenging journey, but Alto is with you every step of the way. We offer reliable same-day delivery of your medications and fertility resources like personalized injection guide videos and access to fertility-trained pharmacists.

Interested in learning more about how Alto can support your treatment? Request a price quote online or reach out through secure in-app messaging.

All third party trademarks (including logos and icons) referenced by Alto Pharmacy remain the property of their respective owners. Unless specifically identified as such, Alto’s use of third party trademarks does not indicate any relationship, sponsorship or endorsement between Alto and the owners of these trademarks.