Pyometra in Dogs: Conventional Treatment and Natural Approaches

When I was growing up, my mom always said the “shoemaker’s children go without shoes.” And it’s often very true.

When my own dog Della became ill with pyometra, I had the tools to prevent surgery, but I didn’t react quickly enough. We had many, many successful cases treating pyometra in dogs in our clinic, and if I had to do it over again, I would have acted much sooner. I would have had my ducks in a row with the clinic I was working with (by this time I had sold my own practice and moved out East).

Fortunately Della survived, but only after a lengthy and scary battle. But I want to share my personal and professional experience, along with the signs and symptoms to watch for, so you can take fast action when pyometra strikes.

It’s vitally important with pyometra that your veterinarian sees your dog. You need a diagnosis before approaching or choosing any form of treatment. I’ll discuss signs and symptoms, as well as some of the different treatment options coming up.

But first, what is pyometra?

What Is Pyometra in Dogs?

The term pyometra comes from the Greek words pyo, which means pus, and metritis, which means uterine inflammation. And this is a good description of pyometra in dogs.

There are many causes of pyometra, the main one being a combination of hormonal changes that happen during a dog’s heat cycle. Every heat cycle, there’s a natural reduction of white blood cells from the uterus to allow for safe sperm passage. However, these white blood cells are important for fighting infection, and this reduction leads to a lapse in protection.

In nature, most dogs would breed and either produce puppies, abort, or not conceive because of another underlying condition. That could be a lack of nutrition, stress in the environment, etc. 

In domestic settings, however, unless dogs are breeding, intact females continue to have heat cycles without reproduction in any shape or form. When dogs continue to go through estrus (heat) without being bred, their progesterone levels remain elevated for eight to ten weeks – this thickens the lining of the uterus in preparation for pregnancy. The entrance to the uterus (the cervix) remains tightly closed, except during estrus when it can allow bacteria that are normally found in the vagina into the uterus.

In a normal, healthy uterus, the environment isn’t susceptible to bacteria. However, when the lining continues to thicken with every estrus, some dogs develop cysts that can start to expel large amounts of fluid. When progesterone levels are high, this reduces the ability of the muscles in the uterine wall to contract, thereby inhibiting the natural discharge of the fluid and bacteria inside.

This fluid then builds up. And the dog’s body temperature, along with the absence of circulating air inside the uterus, creates the perfect conditions for bacterial growth, which can lead to an infection of the uterus, or pyometra.

You often see pyometra in unspayed dogs over the age of five – but it can occur at a younger age as well.

Other Causes of Pyometra

These are things I observed in my own practice on numerous occasions. This is not to say its been researched, but I believe it’s noteworthy to try and stay ahead of something that could be potentially fatal!

A hormonal and sexually suppressive situation could lead to pyometra in dogs. For example, I’ve noticed that many females who have been in close contact with intact males but aren’t allowed to breed exhibit a higher incidence of pyometra. That’s exactly what happened to my Della! I rescued an intact male and they were obviously together in my house and on my farm but were not allowed to breed.

It’s possible that the increased desire and possibly stronger triggers of wanting to be a mother could contribute to the abnormal hormonal changes. 

This could also support my observation that dogs who go through many pseudo or false pregnancies may suffer a greater incidence of pyometra.

If you’ve never seen a false pregnancy, signs can vary in so many ways. Common symptoms are:

• Nesting (constantly taking blankets and pushing them into a ball or nest)
• Taking all their stuffed toys into their bed
• Whining more than normal, restlessness, or seeming frustrated
• Engorged mammary glands and even producing milk
• Increased or ravenous appetite or no appetite at all
• Wanting more attention or wanting to be alone

In most cases, symptoms will appear between the second and third month after a heat, but I’ve seen them as early as one month post heat and as long as four months post heat.

Open Vs. Closed Pyometra in Dogs

There are two types of pyometra in dogs: open and closed. And one is much more dangerous than the other. 

1. Open pyometra occurs when the cervix is open. The open cervix gives the fluid a way to discharge.
   
2. Closed pyometra is when the cervix is closed. When the cervix is closed, there is no way for the infection and fluid to discharge – so the uterus continues to fill, leading to toxicity from the bacteria and if enough fluid builds up, the uterus can actually rupture. This can cause a rapid septic infection and even death.

Closed pyometra typically ends in surgery because the infection has no place to drain. But in the case of open pyometra, there are several treatment options at your disposal. Just remember, the first and most important thing is to have your veterinarian diagnose your dog. It is literally the difference between life and death!

A note to breeders: the use of progesterone or estrogen based drugs used for any reproduction condition can cause thesame changes in the uterus and predispose your dog to pyometra. There are a few opinions on the exact physiology and causation, but all end with the samedisease.

So, what are the signs and symptoms to watch for when it comes to pyometra in dogs?

Pyometra in Dogs: Signs And Symptoms

Symptoms of pyometra in dogs can appear anywhere from two to eight weeks after your dog’s heat cycle, but we have seen them as late as 12 weeks.

The signs of open pyometra include:

• Any excessive licking after their heat cycle
• Vaginal discharge (usually white, yellowish, or green but it can also start off clear)
• The dog can seem a little “off” in behavior (if they are usually cuddly, they may become distant, or the opposite – becoming needy rather than their usual independent nature)
• They may be depressed, grumpy with other dogs or people, etc.
• They may drink more often than usual, or become lethargic or picky with their food

Always err on the side of caution – if you are even questioning, take her in to your vet!

The signs of later stage or closed pyometra include:

• Lethargy/weakness
• Excessive panting
• Increased thirst and water craving
• Anorexia
• Distention of the abdomen
• Vomiting
• High fever – 104 to 106oF

If your dog exhibits even ONE of the following symptoms after her heat, seek veterinary help immediately. The most important thing is to catch pyometra early!

Once your dog has been thoroughly examined by your veterinarian, including her cervix and discharge, we recommend doing an ultrasound and blood work. The ultrasound will show the size of her uterus and rule out possible pregnancy. 

If she does have pyometra, there will usually be a marked elevation of the white blood cell count. There is a type of protein produced by the immune system called globulins that may also be elevated.

Treating Pyometra Conventionally to Avoid Surgery

If your dog has pyometra, consult with a homeopathic veterinarian. This is your best chance at avoiding surgery.

A conventional vet will suggest a different approach from homeopathy, so I want to discuss some of the options he’ll give you. That way you’ll know the pros and cons of these conventional treatments before making a decision.

1. Aglepristone. This is a synthetic steroid. Historically, aglepristone has been shown to disengage progesterone’s support of pregnancy by blocking its receptors. By taking over the progesterone receptors, the drug also removes the effect progesterone plays in containing pyometra, allowing the dog’s natural uterus purging mechanism to occur. This treatment is said to be quick and very gentle, and may help avoid surgery and that’s a good thing. However, your dog may experience inflammation and pain at the injection site.

2. Prostaglandins. These are a group of hormones that destroy the corpus luteum (a hormone secreting body in the female reproductive system). They have uterotonic effects, reduce the blood levels of progesterone, and are known to relax and open the cervix, allowing the uterus to contract and expel bacteria, fluid, and pus.

Again, avoidance of surgery is the benefit of prostaglandin treatment, however there are several drawbacks, including:

1. Side effects such as restlessness, panting, vomiting, defecation, salivation, and a painful abdomen.
2. If the treatment isn’t successful, your dog may become even sicker and poorer candidate for surgery and recovery.
3. Many veterinarians believe that because prostaglandins cause the uterus to contract, there’s a risk of the uterus rupturing, which can result in systemic infection and acute kidney failure and even death.

3. Aglepristone and Low Dosage Prostaglandins. These two treatments are sometimes combined. According to reproductive veterinarians, the two combined treatments offer the best solution, as long as the prostaglandin therapy is given in very low doses.

4. Estrogens. Estrogens are potentially effective, but come with worrying side effects such as further damage to the endometrium and potential bone marrow suppression. Many vets consider these risks far outweigh the benefits.

5. Transcervical Endoscopic Catheter. Normally used for intrauterine insemination, this can be used to infuse warm saline containing prostaglandin F-2a into the uterus. An ultrasound is performed two days later and if fluid is still detected, the treatment is repeated. This is a relatively new form of treatment, so many vets may not suggest it. It does not have a ton of supporting documentation and if your dog is that ill it may not be a good idea for your vet to try a new procedure they are not familiar with.

If Surgery is Recommended

Despite the various non-surgical treatment options, ovariohysterectomy (or spay), still seems to be the treatment of choice for most veterinary hospitals. 

Vets often recommend surgery because it not only eliminates the immediate

emergency, but also prevents reoccurrence in the future. But performing a spay when the uterus is filled with bacteria is more challenging than a routine spay. And if you can avoid spay, you’ll avoid the loss of hormones that can contribute to other health issues.

If you and your vet opt for an emergency spay, ask questions, and feel confident before moving forward.

First, make sure your vet is completely confident in the procedure. This is major surgery that’s riskier than a routine spay. Ask your vet how often they’ve done this surgery and if they feels comfortable with it. If your vet is not careful, the uterus can rupture and fill the abdominal cavity with infection, putting your dog in real peril. Therefore going immediately to a referral hospital may be a better choice. But you can NOT take your dog home to think about it and time truly is of the essence in this case 

Ask if your vet will do a lavage during surgery. A lavage includes filling the abdomen with a sterile solution to decrease the risk of infection. Once the uterus is removed, the solution is sucked out along with any residual infection. Even if the uterus doesn’t burst, it can still leak fluid into the abdominal cavity, so a lavage is an important step to reduce the risk of surgery post-op.

If this is an emergency and outside of regular hours, you also need to ask your vet if there is anybody there to help if the surgery goes wrong. If your vet isn’t fully staffed, it might be a good idea to take your dog to a fully staffed emergency clinic for the spay – they’ll be better prepared should anything go wrong and will have 24 hour care and not be left alone after such a critical surgery.

After-Spay Support

Following a spay, it’s important to support your dog nutritionally as much as you can. We can’t grow the testicles, ovaries or uterus back within our dogs but we can nurture the supporting glands to stay healthy and provide homeopathic and natural supports for the lack of sex hormones. If it’s possible to do that and try to follow our clinic protocol (below), you’ll be doing the best you possibly can to support and help prevent the adverse effects of sex hormone deficiency.

• Raw food with glands mixed in
• As many bioavailable amino acids as you can (our favourite is phytoplankton)
• Homeopathic remedies made from canine testes and ovaries
• Hemp oil for good quality non-GMO, clean, essential fat
• Loads of exercise in fresh air to alleviate stress
• Lots of raw meaty bones to increase endorphins and calming qualities
• Mercola glandular and hormone support 

After-Spay Homeopathic Remedies

Even if your dog ultimately has to undergo surgery, she’ll benefit greatly from getting remedies post-op. They will hasten her recovery. Most vets will be fine with you visiting your dog and giving her these remedies to help her recover faster. 

Here’s the protocol we used at our clinic:

1. Arnica 1M as soon as she’s awake to help with the physical and emotional trauma. Give this once every hour for three doses, followed by…
2. Bellis perennis 1M for deep abdominal muscle trauma and pain, given once every hour for three doses.

Tip: work with your homeopathic vet to choose further remedies that will help reduce the risk of many of the unwanted health issues that spay can cause, such as joint disease, urinary incontinence, weight gain, hormonal dysfunction, and more. These symptoms are better than losing your dog but the right supplements and remedies can greatly lessen the risk of these side effects. 

Avoiding Spay Surgery with Open Pyometra

With open pyometra, if you want to avoid an emergency spay, the best approach is to work with a homeopathic veterinarian. Otherwise, you’ll need your regular veterinarian to work with you as a team.

This protocol works, but for optimal safety, it should be done in conjunction and under full supervision with your veterinarian.

We’ve had wonderful outcomes working with open pyometra with our clients with these same remedies. But remember, we have years of experience and we had a 24 hour monitoring service. 

First Step: Aconite 1M

Give this remedy as soon as you even suspect something is off. Crush dry pellets and place them right on the tongue or gums.

The following are the remedies we’ve used with good success for open pyometra in dogs.The remedy you choose for your dog will rely greatly on what symptoms you see. But before you choose a remedy (after the Aconite) you need to be ready to give a liquid dose. 

Here’s how to do it:

1. Fill an amber bottle with distilled or bottled water and add four pellets of the remedy. Allow them to dissolve for half an hour. The pellets may look like they’re still whole, but don’t worry – most of the remedy will disperse into the water.
2. Succuss (bang the bottom of the bottle on the palm of your hand) three times. This slightly changes the dynamics of the remedy so you’re not giving the exact same potency with each dose. Succuss three times before each dose.
3. Using the dropper, place some of the liquid into the inside of your dog’s lips so it pools between her gums and lips. Try your hardest to avoid the dropper contacting her lips, as this can contaminate the bottle. If it proves difficult to avoid contact, it’s best to put a dropperful onto a teaspoon and pour it into her mouth.
4. Once you’ve made your liquid remedies, watch your dog closely and give one of the remedies below that best fits her symptoms.

Sepia

For breeders, this dog could be the one who is not very interested in breeding or has a hard time going to term in her pregnancy, either due to abortion or delivering prematurely. She’s not the best mother or she becomes very depressed post-partum. 

Often there will be a history of irregular heat cycles. If she has never been bred, then she is the dog who is usually very work oriented and confident, but becomes tired, depressed, worn out looking, and worried. She may have a history of urinary tract infections.

The labia are usually very swollen and the discharge is thick, often lumpy, coloured anywhere from white to yellow to green. It’s really itchy – even burning – so you’ll see her licking or rubbing herself on the rug or her bed. If she is nauseated, it’s often in the morning.

Modalities (what makes her better or worse): Better from exercise, and she’ll perk up if you take her for a walk. She’ll also want to be warm, seeking out the sun or fireplace. She may even want to be covered up. Worse from cold air or drafts.

Secale

This girl might normally be a timid dog in general but when she’s sick, she becomes much more fearful, reactive, or suspicious. 

She may feel very cold to touch yet she’s worse with heat and will not tolerate being covered up. May seek out cooler places in the house (such as cold tile floors). She doesn’t want attention and may be growly if touched.

The Secale dog may have never stopped discharging and has a continuous oozing of watery blood that changes to offensive smelling thick brownish red, possibly even a blackish greenish discharge. 

Modalities: She feels cold, is worse from touch, and worse from being covered up.

Pulsatilla

This is the cute, sweet dog who, on a good day, wants attention and to be smothered in kisses – but if she’s sick, she sticks to you like glue! She wants to be carried and even if she’s too big, she wants to sit on your lap, your feet, as close as she can be, clingy and always touching you. She may have been the puppy that had submissive urination or could have had puppy vaginitis.

The discharge is usually very thick but milky or yellow in color and acrid, so the skin around the discharge and her vulva can be red and sore. Because it’s so sore, your dog probably won’t rub herself on the rug or bed as you might see in the Sepia case.

Modalities: Worse from the heat or stuffy rooms. You may see her lying down by a window to get open air, or even though she is clingy she may want to be outside then come inside then go out again. 

Don’t confuse this with restlessness: she just wants to be with you but also needs fresh air.

Pyrogenium

This remedy is for extreme septic states, but if your dog has these symptoms you must work very closely with your veterinarian! In a case with these symptoms, your dog will need to be hospitalized and on IV fluids; she should continue to fully discharge and her vitals should be good.

Pyrogenium is a homeopathic preparation made from rotten meat pus. Yes, it’s disgusting, but that’s why it’s used for septic states. It’s a good remedy to have on hand and you can ask your veterinarian to use it. I’ve seen it help with septic situations prior to surgery.

The mental state is restlessness, as if your dog can’t find a comfortable place to lie down. The opposite may also occur and she’s too sick to even get up. Again, if your dog is like this she must go to your veterinarian to be monitored.

The discharge, as you can imagine, has been described as carrion-like: “a plant that smells like rotting flesh” and is thick, dark, and bloody.

Along with the above remedies, it’s also a good idea to give Carduus marianus 6c, along with Berberis 6c, three times a day. These remedies are used for organ drainage and will support the liver and kidneys during the infection. Give them for two weeks, in the liquid dose.

After You Give The Remedy

Watch your dog’s symptoms after you give the chosen remedy. She may go into a very peaceful, relaxed sleep – and this is a good thing.

When she wakes up, she should look brighter or the same, but not worse. If she looks worse at any point, it’s not the right remedy and you need to choose a different remedy.

Repeat the remedy in the following sequence:

1. Give one dose per 1/2  hour, twice
2. Then give one dose every 1 hour, twice
3. Follow with one dose every 2 hours, twice

If, after the third dose, she’s not showing improvement, switch to the next choice of remedy and start over. 

Always use a new bottle to avoid contamination (and always sterilize used bottles before re-using them). Within 24 hours your dog should be well on her way to recovery.

Once you see your dog is on the mend, continue to use that same remedy three times per day for a total of five days. Don’t forget to succuss the remedy before each dose!

How to Tell the Remedy is Working

Once you give the remedies, how do you know your dog is on the mend? 

Some of the positive signs to watch for include:

• Deep relaxed sleep
• More energy
• Discharge becoming clearer
• Less offensive odor
• Less irritation (less red around the vulva)
• More profuse discharge combined with your dog getting stronger and displaying better energy (a good thing)
• Wanting to drink less
• More engaged

These are the negative signs to watch for:

• Weaker
• Restless
• Ceasing to eat
• Discharge more offensive smelling

If the discharge stops and she is worse in any way, immediately take her back to your veterinarian! This could be a sign that she’s moving into a closed pyometra, which is life threatening.

Pyometra in Dogs: Final Thoughts

Keeping your dog intact brings huge benefits to her overall health, but it also comes with the responsibility of being a diligent guardian to your dog. You can do this by watching closely for signs and symptoms two to eight weeks post heat, supporting her holistically to prevent this disease from happening, and avoiding all contact with intact males to decrease the natural urge to become a mother. 

Getting ahead of all of it is ultimately the best approach! At the end of the day, you can NOT take this lightly and even if you have to spay there are SO many wonderful things you can use to mitigate the side effects of the lack of hormone.

My number one goal in this is to save your dog’s life – it’s not so you are able to rebreed or not be worried about hormones. If your dog has pymometra, she has already had way more beneficial sex hormones than the average dog, so please don’t try and be a “save the uterus at all cost” pet parent. Do what is ultimately the best for your dog in her scenario and save her life.