Patient information from BMJ

Pelvic inflammatory disease

Last published:Feb 05, 2021

If you think you might have an infection in your lower abdomen it's important to see your doctor straight away. Delaying treatment can lead to long-term pain and damage your reproductive organs, making it hard for you to have a baby in the future.

What is pelvic inflammatory disease?

Pelvic inflammatory disease (PID for short) means you have an infection in your reproductive organs that has caused inflammation (swelling). These organs include your womb (uterus), your ovaries, and your fallopian tubes.

PID is almost always caused by an infection that is spread by having sex (a sexually transmitted infection or STI for short). The infection starts in your vagina or your cervix and spreads to the rest of your reproductive organs.

The fallopian tubes carry eggs from your ovaries to your womb. If these tubes get inflamed, scar tissue may form and block them. This makes it hard to get pregnant.

And if you do get pregnant the baby might start growing part of the way along your fallopian tube instead of in your womb. This is called an ectopic pregnancy and it can be dangerous.

PID is often caused by the same bacteria that cause gonorrhoea or chlamydia, but it can be caused by many types of bacteria.

Any sexually active woman can get PID. It's most common in women younger than 25. Other things that make you more likely to get PID are having had a sexually transmitted infection before, and having an intrauterine contraceptive device (an IUD or 'coil') put in.

Your chances of getting PID (or any other sexually transmitted infection) also increase the more sexual partners you have.

What are the symptoms?

It's not always easy to tell if you have PID. The symptoms are sometimes very mild. But if you do notice symptoms it's important to see a doctor.

Symptoms can include:

• Pain in the lower part of your abdomen (tummy)

• Pain during sex

• Bleeding between your periods or after sex

• Discharge from your vagina, which may smell bad

• A fever

• Pain in your lower back

• Feeling sick

• Needing to pass urine often and find passing urine painful

• Having more pain than usual during your period or in the middle of your menstrual cycle

• Your periods stopping completely.

Your doctor will check you for a high temperature (fever is a common sign of infection) and examine your abdomen and the inside of your vagina. Your doctor may also take a blood sample and a swab from your cervix, to check for infection.

But if your doctor suspects that you have PID, he or she will probably start treatment straight away, before getting the results of these tests. This is because delaying treatment could damage your fertility.

What treatments work?

PID is treated with antibiotics. You probably won't need any other treatment. But you may still have long-term problems if your fallopian tubes were damaged before you started the treatment.

Treatment for mild to moderate PID

You will probably start with an injection of antibiotics followed by a course of tablets. It's important that you take the tablets exactly as your doctor advises. For example, don't just stop taking them if you start to feel better. Finish the whole course unless your doctor tells you otherwise.

Most women don't need to be treated in hospital and can carry on with their lives as normal while the antibiotics work. But your doctor might suggest that you try to get as much rest as you can for a week or two.

Common side effects of antibiotics are feeling sick and diarrhoea. But these are usually mild.

As well as prescribing antibiotics your doctor might suggest that you take medicines for any pain you might be having. This might just be painkillers that you can buy over the counter, like paracetamol or ibuprofen.

Your doctor should see you again one or two days after you start taking your antibiotics. You should have started to improve by then. If you haven't begun to feel better your doctor might want to do more tests, or he or she might advise you that you need treatment in hospital.

Treatment for more severe PID

Some women with PID need to be treated in hospital, usually with intravenous (IV) antibiotics. Your doctor might suggest that you need hospital treatment if:

• Your symptoms are severe: for example, you have a high fever and are vomiting

• You have not improved after taking antibiotics for a few days

• Your doctor thinks that your symptoms might be caused by something other than PID, such as appendicitis, for which you might need surgery

• For some reason you can't take your antibiotic tablets

• You are pregnant.

Some women need to have a procedure called a laparoscopy to help find out what is causing their symptoms. This involves a surgeon making a small cut in your abdomen that a tiny camera can pass through. The surgeon can then see inside the abdomen and hopefully discover the cause of the problem.

Things you can do for yourself

The best way to protect yourself against PID is to avoid the sexually transmitted infections (STIs) that cause it. You should:

• Avoid having multiple current sexual partners

• Use condoms correctly every time you have sex

• Not have sex under the influence of alcohol, money, or drugs.

If you have done any of these things, or if you have a new partner, or if you are younger than 25 years old (even if you haven't taken any of these risks), then you should be regularly tested for STIs.

If you have PID it's important that your sexual partner gets checked for infection. Even if your partner has no symptoms they might still have gonorrhoea or chlamydia.

This means that your partner will need to be treated to avoid passing the infection back to you. You will need to avoid having sex until you and your partner have both finished taking the antibiotics.

Some couples choose to be tested for chlamydia when starting a relationship. Women who have PID should also be offered HIV testing.

What will happen to me?

About 9 out of 10 women are cured of PID by taking antibiotics, either at home or in hospital.

If you use a contraceptive coil (IUD), you might need to have it removed.

Unfortunately, treatment for PID won't undo any damage that the infection has already done to your reproductive organs.

PID can happen again if you get a new infection. So it's best to do everything that you reasonably can to avoid sexually transmitted infections.