Uneven echogenicity of the uterine cavity suggests that the thickness of the endometrium is not uniform, which needs to be diagnosed according to the patient’s symptoms, e.g., uterine pathology can lead to inconsistent endometrial echogenicity. Whether the endometrial thickness of 4.6mm is normal or not needs to be judged according to the different cycles of menstruation. Uterine pathology, such as adenomyosis, endometritis, endometrial polyps, etc., can cause uneven echogenicity of the uterine cavity due to uneven thickness of the myometrium or endometrium. If necessary, hysteroscopy can be performed to diagnose the condition more accurately. Normally, the endometrium of women of childbearing age changes in thickness with the menstrual cycle and hormone levels. Towards the end of menstruation, the thickness of the endometrium is only 1-2mm. During the proliferative phase, the thickness of the endometrium thickens to about 5mm, and during the secretory phase, it will continue to proliferate, but generally will not exceed 10mm, so the endometrial thickness of 4.6mm needs to be analyzed in the context of the condition. In addition, the endometrium is not all changed at the same time, in healthy or pathological conditions, there may be localized exfoliation or thickening, resulting in inconsistent thickness of the endometrium in various places, which will suggest uneven echogenicity under ultrasound. Therefore, overall, it is also necessary to combine their own relevant symptoms and medical history, other test results, diagnosis and treatment by specialized physicians.