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The goal of treating postpartum uterine diseases in dairy cows is to reach clinical cure in a reasonable amount of time and to improve reproductive performance while minimizing milk and meat residue issues. The ultimate goal is to reduce the economic losses caused by uterine diseases. This article focuses on postpartum uterine diseasess in dairy cows, in particular acute puerperal metritis, pyometra and endometritis. The usual treatment approach for these conditions is systemic or local antibiotic therapy to control bacterial growth. Based on clinical signs and bacteria identification using dependent- and independent-based methods, antibiotic use appears to be the most logical and effective therapeutic approach. However, despite considerable research, the treatment of uterine diseasess remains a subject of considerable controversy in the literature. Although some local and systemic antibiotic therapies are effective at mitigating the consequences of postpartum uterine diseases, antibiotic use in the current global context is a serious concern because it is associated with selective pressures on bacteria and the emergence of resistant bacteria in humans and animals. Research on mucosal immunology and the genital microbiota of cows has improved our understanding of uterine involution and how pathological agents behave during uterine diseases in dairy cows. And while antibiotic therapy remains the most common therapeutic option chosen by veterinarian practitioners to treat PUDs, complementary and alternative veterinary medicine is increasingly being considered in response to a demand from animal owners. However, because of the small number of randomized clinical trials and a lack of evidence-based medicine, there is widespread concern regarding the adequacy of evidence for the efficacy and safety of complementary and alternative veterinary medicine. The objectives of this article are to describe uterine involution and the main postpartum uterine diseases that occur during the postpartum period in dairy cows, briefly review the current approaches to treating postpartum uterine diseases, and critically review the evidence pertaining to complementary and alternative veterinary medicine in postpartum reproductive veterinary medicine.