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Aim: To compare the single-layer endometrial thickness (obtained with sonohysterography [SHG]) with double-layer endometrial thickness (obtained with transvaginal sonography) in women without endometrial malignancy. Methods:We retrospectively studied consecutive patients from July 1, 2006, through June 30, 2007, who underwent SHG. The double-layer endometrial thickness was measured on longitudinal images of the uterus in the thickest portion of the fundus before saline infusion. The single-layer endometrial thickness was measured during SHG in the longitudinal-axis view in the thickest fundal portion anteriorly and posteriorly.Results: During the study period, 303 women underwent SHG. Pathology results were available for 128 women. In the 124 women with normal benign endometrium, the mean anterior endometrial thickness was 0.37 cm and the mean posterior endometrial thickness was 0.39 cm. The thickness of the mean anterior endometrium was not significantly different from the mean posterior thickness (P=.12). The difference between the mean double-layer endometrial thickness and the mean sum of single-layer thickness measures (i.e, sum of anterior and posterior layers) was 0.06 cm, even when intracavitary masses were excluded (P<.01). Conclusions:In women with histologically normal endometrium, the anterior and posterior endometrial layers appear symmetric in thickness. Further study characterizing endometrial thickness during SHG in women with endometrial neoplasia is needed.