The inner myometrial layers underlying the endometrium have been termed the uterine junctional zone and appear to be a distinct anatomical structure. Visualisation of an abnormal junctional zone on imaging by USG may indicate disease – notably adenomyosis and endometrial cancer.  

This is a series of three cases; two with postmenopausal bleeding and the third with abnormal uterine bleeding. All of them had an interesting clinical history; multiple comorbid conditions - which made their management a challenge; and were distinguished by an abnormal endometrium–myometrium junction visualised on ultrasonography. 

The endometrial-myometrial zone is an important USG marker for disease; however widespread use is hampered by subjective nature of evaluation, low sensitivity and lack of standard criteria. Development of standard criteria may help increase the utility and ease of junctional zone evaluation. More research is required as to the next best step in evaluation of symptomatic patients in whom imaging shows abnormality of the endometrial-myometrial junction.