The most common symptoms of a uterus infection are lower abdominal pain, fever, and unusual vaginal discharge with a bad smell. Some infections produce all three at once, while others cause only mild discomfort or no noticeable symptoms at all. Uterine infections fall into two main categories: endometritis, an infection of the uterine lining, and pelvic inflammatory disease (PID), which starts in the uterus and can spread to the fallopian tubes and ovaries.
Core Symptoms to Watch For
Whether the infection is limited to the uterine lining or has spread further into the reproductive tract, several symptoms overlap. The CDC lists these as the primary signs of a uterine or pelvic infection:
- Pain in the lower abdomen or pelvis. This is the most consistent symptom. It can range from a dull ache to sharp, persistent pain.
- Fever. A temperature above 101°F (38.3°C) is one of the markers doctors use to confirm a diagnosis.
- Abnormal vaginal discharge. The discharge often has a foul or unusual odor and may appear yellowish or greenish.
- Pain or bleeding during sex.
- Bleeding between periods.
- Burning sensation when urinating.
Endometritis specifically can also cause abdominal swelling, constipation or pain during bowel movements, and a general feeling of being unwell. That vague, flu-like sense that something is off can be an early clue, especially after childbirth or a gynecological procedure.
Why Symptoms Are Easy to Miss
One of the trickiest things about uterine infections is that they can be subtle. The CDC notes that many people with PID don’t realize they have it because symptoms are mild or absent entirely. Lower abdominal pain might feel like menstrual cramps, and light spotting between periods is easy to dismiss. This matters because untreated infections can cause lasting damage to the reproductive organs, including scarring of the fallopian tubes that leads to infertility or increases the risk of ectopic pregnancy.
If you’re sexually active and experiencing even mild, unexplained pelvic pain, especially alongside discharge or irregular bleeding, it’s worth getting evaluated. Doctors can often identify a uterine infection through a pelvic exam by checking for tenderness in the uterus, cervix, or the area around the ovaries.
Symptoms After Childbirth
Uterine infections are more common in the weeks following delivery, particularly after cesarean sections. The challenge is distinguishing normal postpartum bleeding (lochia) from signs of infection. Normal lochia smells like menstrual blood, sometimes metallic or slightly sour. It should not smell fishy or foul.
Warning signs of a postpartum uterine infection include:
- Greenish vaginal discharge
- A foul smell that’s distinctly different from normal period-like bleeding
- Soaking through a pad every hour
- Large blood clots (golf-ball-sized or bigger)
- Fever, chills, or flu-like symptoms
- Worsening pelvic pain or cramping
- Dizziness or feeling faint
Inserting anything into the vagina in the first six weeks after delivery, including tampons, can introduce bacteria into the uterus and raise infection risk.
How It Differs From a UTI or Endometriosis
Several conditions share symptoms with uterine infections, and they’re frequently confused. Painful urination and pelvic discomfort show up in urinary tract infections, endometriosis, and uterine infections alike. A few distinctions help sort them out.
A UTI primarily causes burning during urination, frequent urges to pee, and sometimes cloudy or strong-smelling urine. Pelvic pain from a UTI is usually centered around the bladder, not deep in the lower abdomen. A simple urine test can confirm or rule out a UTI quickly. If your symptoms persist after treating a UTI, the issue is likely something else.
Endometriosis causes pelvic pain that tends to follow your menstrual cycle, getting worse around your period. It can also cause pain during sex and painful urination, which is why it’s sometimes mistaken for PID. The key difference is that a uterine infection involves an active bacterial infection, so it typically comes with fever, abnormal discharge, and a relatively sudden onset. Endometriosis is a chronic condition that develops gradually over months or years. Doctors distinguish the two through physical examination and testing for infection markers.
How Diagnosis Works
There’s no single test that definitively confirms a uterine infection. Doctors piece together the diagnosis from your symptoms, a pelvic exam, and sometimes lab work or imaging. During the exam, they check for tenderness in the uterus and surrounding areas. Pain when the cervix is gently moved is one of the classic physical signs.
Lab tests can support the diagnosis. Vaginal fluid examined under a microscope may show elevated white blood cells, a sign the body is fighting infection. Blood tests measuring inflammation markers can also point toward infection, though they’re not always elevated. Fewer than half of people with acute PID show an elevated white blood cell count on a standard blood test, which is one reason doctors don’t rely on blood work alone.
In some cases, an ultrasound is used to look for complications like fluid-filled fallopian tubes or abscesses near the ovaries. These findings are more common when the infection has spread beyond the uterus itself.
What Treatment Looks Like
Uterine infections are treated with antibiotics, usually a combination that covers the range of bacteria most likely involved. For mild to moderate cases, you’ll take oral antibiotics at home for about two weeks. More severe infections, particularly those involving high fevers or abscesses, may require a hospital stay with antibiotics given through an IV.
Most people start feeling better within a few days of starting treatment, but finishing the full course is important even after symptoms improve. Stopping early increases the risk of the infection coming back or becoming harder to treat. If you have a sexual partner, they may also need treatment to prevent reinfection, especially if a sexually transmitted infection was the underlying cause.
When Symptoms Become an Emergency
A uterine infection that enters the bloodstream can trigger sepsis, a life-threatening immune response. This is rare but requires immediate emergency care. Signs that a uterine infection may be turning dangerous include a rapid heart rate, fast or difficult breathing, confusion or disorientation, very high or very low body temperature, extreme weakness, and skin that feels clammy or looks discolored. Some people develop small, dark-red spots on the skin. If you have a known or suspected uterine infection and develop any combination of these symptoms, treat it as an emergency.