Endometrial atrophy is a response to a hypo-oestrogenic state. If it occurs after menopause it can be more specifically termed postmenopausal endometrial atrophy.
While most patients are asymptomatic, endometrial atrophy is one of the commonest cause of postmenopausal bleeding, accounting for approximately 60-75% of cases 1).
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
The endometrial thickness should measure:
- <4-5 mm on a transvaginal ultrasound scan
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.
Similar to ultrasound, there is a decrease in endometrial thickness. The junctional zone may no longer be evident.
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- 2. Ferrazzi E, Torri V, Trio D et-al. Sonographic endometrial thickness: a useful test to predict atrophy in patients with postmenopausal bleeding. An Italian multicenter study. Ultrasound Obstet Gynecol. 1996;7 (5): 315-21. doi:10.1046/j.1469-0705.1996.07050315.x - Pubmed citation
- 3. Dubinsky TJ. Value of sonography in the diagnosis of abnormal vaginal bleeding. J Clin Ultrasound. 2004;32 (7): 348-53. doi:10.1002/jcu.20049 - Pubmed citation
- 4. Atri M, Nazarnia S, Aldis AE et-al. Transvaginal US appearance of endometrial abnormalities. Radiographics. 1994;14 (3): 483-92. Radiographics (abstract) - Pubmed citation