A retrospective review was done to evaluate the importance of degenerative endometrial debris accompanied with benign-looking endometrial cells in Papanicolaou (Pap) smears. In total, 306 patients were divided into 2 groups according to the absence (group 1) or presence (group 2) of endometrial debris. Eighty-one (26.5%) patients received histologic follow-up. The biopsy rate for premenopausal patients in group 2 was the highest (24/48 [50%]). Multivariate analysis showed that presence of endometrial debris rather than menopausal status was more related to the biopsy procedure. Malignancy was found more often in group 2 (16/39 [41%]) than in group 1 (2/42 [5%]). A malignant result was also more closely related to endometrial debris rather than menopausal status. Thus, we suggest that benign endometrial cells in Pap smears should be reported and the presence of degenerative endometrial debris is important. Patients with degenerative endometrial debris need comprehensive evaluation, regardless of menopausal status.