Atrophic endometrium

by Adnan Karavelic, MD FRCPC
March 6, 2023

What does atrophic endometrium mean?

Atrophic endometrium is a term used to describe endometrial tissue that is smaller and less active than normal endometrial tissue. It is a non-cancerous change and is very common in post-menopausal women. This change results from a process called atrophy. Pathologists also use the term inactive endometrium to describe an atrophic endometrium.

What causes atrophic endometrium?

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.

The use of any method of contraception is important information for both clinicians and pathologists. It should be recorded in the clinical notes and on the pathology requisition form.

How do pathologists make the diagnosis of atrophic endometrium?

The diagnosis is usually made after a sample of endometrial tissue is removed in a procedure called a biopsy or a curettage. The tissue is then sent to a pathologist who examines it under the microscope.

How is atrophic endometrium different from normal endometrium?

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

• The cells in the epithelium are smaller or cuboidal in shape.
• No or very few dividing cells are seen. These cells are called mitotic figures.
• The glands become large and round. Pathologists describe this as cystic.
• The stroma between the glands becomes inactive.