The modern hyperprolific sow is susceptible to metabolic disease and chronic inflammation. The most sensitive phase is parturition, when the sow experiences systemic inflammation and stress, and major changes in metabolism and endocrinology. Resolution of inflammation and stress needs to happen quickly to ensure good reproductive health during puerperium. If the sow fails to adapt to these changes, puerperal disease may occur. The economically most important puerperal disease complex is the postpartum dysgalactia syndrome (PPDS). Other puerperal diseases include infections of the urogenital tract. Diagnosis of PPDS and urogenital disease on‐farm is challenging but several diagnostic methods, including clinical examination, behavioral observations, ultrasonography and biomarkers are available. Ultrasonography is an excellent tool for monitoring the health of the urogenital tract, the mammary gland, and uterine involution and guide further diagnostic interventions. Biomarkers such as Chromogranin A, tumor necrosis factor‐α, and interleukin‐6 represent promising tools to monitor general health and the systemic state of inflammation and oxidative stress of the sow. Nonsteroidal anti‐inflammatory drugs, dopamine antagonists, and oxytocin are promising to address the symptoms of PPDS. Reducing of stress, improving nutrition and intestinal health, and supporting animal welfare‐friendly husbandry help in the prevention of PPDS.