Uneven echogenicity of the endometrium is often indicative of possible endometrial pathology. 1. Uneven hyperplasia of the endometrium, which is often associated with a history of scraping and damage to the endometrium. In normal menstruation, endometrial shedding is synchronized, complete and rapid. In women with a history of endometrial injury, endometrial shedding is often irregular and incomplete, resulting in uneven endometrial echogenicity on ultrasound images. 2. Endometrial polyps. They are often formed due to inflammation and other factors. With larger endometrial polyps, patients may experience menstrual changes, such as increased menstrual flow, prolonged menstrual period, irregular vaginal bleeding, etc. If the polyps are small, patients may not have any symptoms, but ultrasound can reveal uneven endometrium, and if pathological examination is performed, the presence of endometrial polyps can be found. 3.Cancerous transformation of endometrium. This is a group of epithelial malignant tumors occurring on the endometrium, among which endometrial adenocarcinoma is the most common. It is often shown on the sonogram as parenchymal inhomogeneous echogenicity and endometrial unevenness in the uterine cavity. In conclusion, if the ultrasound examination suggests uneven echogenicity of the endometrium, it often indicates that there may be lesions in the endometrium and further diagnostic scraping or hysteroscopy is needed to clarify the diagnosis and treatment.