Uterus -

Atrophic  endometrium

This article was reviewed and updated on December 7, 2018

by Adnan Karavelic, MD FRCPC

Quick facts:

  • Atrophic endometrium is a non-cancerous change that occurs in the tissue lining the inside of the uterus.

  • Atrophic endometrial tissue is smaller than normal endometrial tissue and has lost some of its function.

  • Atrophic endometrium is a common finding in prepubertal and postmenopausal women.


The normal uterus and endometrium

The uterus (womb) is a hollow muscular organ located in the female pelvis between the urinary bladder and the rectum (the lower end of the large bowel). The upper part of the uterus (fundus) is attached to the fallopian tubes while the lower part is connected to the vagina through the uterine cervix.  Functions of the uterus include nurturing the baby, and holding it until the baby is mature enough for birth.

The walls of the uterus are made up of three layers: 

  1. Endometrium – The endometrium forms the inner lining of the uterus. The endometrium is composed of endometrial glands lined by one layer of columnar epithelium and surrounded by endometrial stroma.

  2. Myometrium – The myometrium is the middle layer and is made up of smooth muscle which allows the uterus to change size and contract. 

  3. Serosa – The serosa is a thin layer of tissue that surrounds the outside of the uterus.


Small samples of tissue can be removed from the endometrium by several different techniques with the two most common being endometrial biopsy and endometrial (or uterine) curetting.


Common reasons for these procedures include:

  • Abnormal (dysfunctional) uterine bleeding.

  • Postmenopausal bleeding.

  • Screening for endocervical or endometrial cancer.

  • Endometrial dating.

  • Follow up of previously diagnosed endometrial hyperplasia. 

  • Endometrial or endocervical polyps.

  • Infertility.


What is atrophic endometrium?

Atrophic endometrium is a diagnosis pathologists use to describe endometrial tissue that shows features of a process called atrophy. When a tissue undergoes atrophy, it becomes smaller and no longer functions normally.


Atrophic endometrium is different from the normal endometrium in the following ways:


  • The cells in the epithelium are smaller or cuboidal in shape.

  • No or very few dividing cells (mitoses) are seen.

  • The glands become large and round (cystic dilatations).

  • The stroma between the glands becomes inactive.


Why is this important? Atrophic endometrium is a normal finding in prepubertal, postmenopausal and some perimenopausal women. However, it can also be seen with pre-cancerous or cancerous diseases and your doctor may suggest a biopsy of the endometrium to look for more serious conditions.


Some, but not all features of atrophy may also be seen in women of fertile age (between the early teens and the age of 45-55 years) who are still menstruating, but use some method of contraception, such as oral contraceptive pills or have an intrauterine contraceptive device (IUD) inserted. Common IUD products are: Liletta, Kyleena, Mirena, and Skyla.


Why is this important? The use of any method of contraception is important information for both clinicians and pathologists and it should be recorded in the clinical notes as well as on the pathology requisition form.


In pathology reports, atrophic endometrium is sometimes called non-proliferative or inactive endometrium (with atrophic changes).

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