Cystic endometrial atrophy

Last revised by Francis Deng on 12 Jun 2019

Cystic endometrial atrophy is a benign process that can occur as part of tamoxifen-associated endometrial change


It is diagnosed histologically when multiple cystic spaces (dilated glands) lined with atrophic epithelium are present within a dense fibrous stroma. 

At hysteroscopy, the endometrium appears white but hypervascularised, with scattered protuberances. This “tamoxifen-like” mucosa can be seen as early as 6 months after the start of tamoxifen therapy. At histopathologic examination, these protuberances are identified as cystic glandular dilatation.

Differential diagnosis

In certain situations, the changes of endometrial cystic atrophy can be so extensive that the appearance of a cystic endometrium may be mistaken for diffuse or focal areas of endometrial thickening (e.g. endometrial polyp or endometrial hyperplasia) This may even occur at hysterosonography.

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