Uterine diseases in dairy cows can be classified as puerperal metritis, clinical metritis, clinical endometritis, and subclinical endometritis. These diseases are highly prevalent (affect between 20 and 30% of dairy cows) in high producing dairy cows and have been associated with decreased pregnancy per artificial insemination (AI), extended interval to pregnancy, increased culling, and economic losses. Puerperal metritis is characterized by the presence of an abnormally enlarged uterus, a fetid watery red-brownish uterine discharge associated with signs of systemic illness, and fever (>39.5o C) within 21 days in milk (DIM). Animals without systemic signs but with an enlarged uterus and a fetid uterine discharge within 21 DIM may be classified as having clinical metritis. Clinical endometritis is characterized by the presence of purulent (>50%) uterine discharge after 21 DIM or mucopurulent (50% pus, 50% mucus) after 26 DIM. In the absence of clinical endometritis, subclinical endometritis is defined by the presence of >18% neutrophils (PMN) in uterine cytology samples collected between 21 and 33 DIM or >10% PMN between 34 and 47 DIM. The main risk factors are dystocia, twins, retained placenta, stillbirth, abortion, prolapsed uterus, and ketosis. Metritis can be successfully treated either by systemic or intrauterine antibiotic treatment. Ceftiofur hydrochloride (Excenel®) intramuscularly or ceftiofur crystalline-free acid (Excede®) subcutaneously are effective in treating metritis, and oxytetracycline intrauterine is effective in abrogating the negative effects of metritis on milk yield and fertility. Intrauterine administration of cephapirin benzathine (Metricure®) is an effective treatment for clinical and subclinical endometritis, although not approved in the United States. Administration of PGF2α does not seem effective for the treatment of clinical or subclinical endometritis.