🔍 What Are CEH & Pyometra?

Cystic Endometrial Hyperplasia (CEH) is a progesterone-driven thickening and cyst formation in the uterine lining after several heat cycles. It sets the stage for infection. When bacteria invade this cystic lining, usually Escherichia coli and other vaginal flora, pyometra develops—pus-filled uterus that can become life-threatening :contentReference[oaicite:3]{index=3}.

1. Risk Factors & Epidemiology

• Occurs several weeks after estrus, especially with repeated non-pregnant cycles :contentReference[oaicite:4]{index=4}.
• Older intact queens at highest risk, but even young cats may develop it after hormonal drugs :contentReference[oaicite:5]{index=5}.
• Progesterone promotes glandular secretions, suppresses immune defense, relaxes cervix, and impairs uterine contractility :contentReference[oaicite:6]{index=6}.

2. Open vs Closed Pyometra

Two forms:

• Open: cervix allows pus to drain—vaginal discharge is common but often cleaned by the fastidious cat :contentReference[oaicite:7]{index=7}.
• Closed: cervix sealed—uterus distends, toxins accumulate, risk of systemic illness and rupture is high :contentReference[oaicite:8]{index=8}.

3. Clinical Signs & Systemic Effects

• Vaginal discharge (open cases), abdominal distention, anorexia, vomiting, diarrhea, polyuria/polydipsia, lethargy, and fever in ~30% :contentReference[oaicite:9]{index=9}.
• Closed cases are often more severe—rapid deterioration, signs of sepsis, and toxin-induced kidney dysfunction :contentReference[oaicite:10]{index=10}.

4. Diagnostic Approach

1. History & intact status, clinical exam and palpation of enlarged uterus.
2. Bloodwork: leucocytosis or leucopenia, elevated globulins, azotemia, low urine specific gravity :contentReference[oaicite:11]{index=11}.
3. Imaging: radiographs show distended tubular uterus; ultrasound confirms fluid, thickened walls and cysts :contentReference[oaicite:12]{index=12}.
4. Vaginal cytology or culture in open pyometra.

5. Treatment Options

a. Emergency Ovariohysterectomy

• Primary treatment for all but breeding candidates :contentReference[oaicite:13]{index=13}.
• Requires stabilization: IV fluids, broad-spectrum antibiotics before and post-op :contentReference[oaicite:14]{index=14}.
• Complex surgery due to inflamed, fragile tissues—longer anesthesia and post-op hospitalization.

b. Medical Management

• Considered in breeding queens only; uses prostaglandins (dinoprost, cloprostenol), aglepristone, and antibiotics :contentReference[oaicite:15]{index=15}.
• Open pyometra: success ~75‑90%; closed: much lower (~25‑40%) :contentReference[oaicite:16]{index=16}.
• Risks include uterine rupture and recurrence (~50‑75%) :contentReference[oaicite:17]{index=17}.

6. Recovery & Prognosis

• Spayed cats generally recover fully; monitor for kidney health, appetite, activity, and incision healing.
• Medical management has lower success and high recurrence—future breeding unpredictable :contentReference[oaicite:18]{index=18}.
• Closed pyometra or untreated cases risk peritonitis and death.

7. Prevention & Breeding Advice

• Spaying eliminates risk permanently; ideal before first heat.
• Breed only once per season and avoid hormonal drugs.
• Monitor breeding queens with ultrasound and regular exams for early signs.

8. Ask A Vet Remote Support 🐾📲

• 📸 Upload photos of abdomen, discharge, and ultrasound scans for remote evaluation.
• 🔔 Medication reminders: antibiotics, fluids, post-op care.
• 🧭 Triage for worsening symptoms like abdominal bloating or fever.
• 📊 Track appetite, drinking, urination, and wound healing in-app logs.

9. FAQs

Can pyometra resolve without spay?

Highly unlikely—surgical spay is safest and most definitive. Medical therapy is risky and not recommended if the cat is systemically ill :contentReference[oaicite:19]{index=19}.

Should I spay immediately after an open pyometra?

Yes—delay increases recurrence risk and complications.

Can queens breed after medical treatment?

Some can, but recurrence risk is significant and fertility doesn't guarantee.Close ultrasound monitoring is critical.

Is closed pyometra more dangerous?

Yes—pus buildup causes toxic illness, septic shock, and possible uterine rupture.

Conclusion

Pyometra following CEH is a serious and potentially fatal condition. Prompt diagnosis via ultrasound and labs is essential. Emergency spaying is the gold-standard treatment. Medical management is risky, especially for closed cases, and recurrence is common. Preventive spaying or careful breeding protocols are strongly advised. Enhanced by the support of Ask A Vet, remote assessment, medication alerts, and recovery tracking help ensure timely decisions and better outcomes in 2025 and beyond 🐾📲.

If you notice lethargy, abdominal swelling, drinking/urination changes, or vaginal discharge in your intact female cat, seek immediate veterinary care—and use Ask A Vet for guided assessment and expert recovery planning.