Endometrial osseous metaplasia (EOM) is a rare clinical entity that should be considered in the differential diagnosis of menstrual irregularities, chronic pelvic pain and infertility. Its pathogenesis is still widely debated. Two prominent theories include metaplastic transformation and persistence of embryonic or fetal tissue. Ultrasonographic imaging is often first-line in suspecting EOM with hyperechoic linearities seen within the cavity. Further diagnostic and therapeutic benefit can be achieved through hysteroscopic techniques to remove this tissue. Removal has been shown to improve fertility and menstrual symptoms and can provide patients and providers with a diagnosis.