Endometrial atrophy is a response to a hypo-oestrogenic state. If it occurs after menopause it can be more specifically termed postmenopausal endometrial atrophy.
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Clinical presentation
While most patients are asymptomatic, endometrial atrophy is one of the commonest cause of postmenopausal bleeding, accounting for approximately 60-75% of cases 1.
Pathology
The most common reason for a hypo-oestrogenic state is menopause. Other factors that can cause endometrial atrophy include
- prolonged oral contraception
- ovarian dysfunction
- tamoxifen use
Radiographic features
Ultrasound
The endometrial thickness should measure:
- <4-5 mm on transvaginal ultrasound
The uterine body-to-cervix ratio will also tend to decrease and may approach 1:1.
Often the atrophic endometrium is associated with cystic dilatation of the endometrial glands. This is termed endometrial cystic atrophy 4.
MRI
Similar to ultrasound, there is a decrease in endometrial thickness. The junctional zone may no longer be evident.
Differential diagnosis
If there is cystic dilatation of the endometrial glands, this can be confused for endometrial polyp or endometrial hyperplasia.
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