The scientific study of ageing of the uterus and placenta is clinically relevant because of the associations between advanced maternal age and outcome of pregnancy. This chapter includes some clinical observations to demonstrate parallels between the scientific observations and the clinical outcomes that are thought to be related. The subject is addressed in terms of the ageing myometrium, decidua and placenta. The chapter discusses two biological mechanisms that are thought to be important in ageing, namely telomere length and failure of autophagy. Gosden et al. examined nonpregnant human myometrium obtained at the time of hysterectomy and demonstrated the presence of cytoplasmic lipofuscin inclusions in uterine smooth muscle cells from older women. A combination of biological epidemiology and smooth muscle studies indicates a mechanistic basis for the effect of ageing on performance during labour, namely that prolonged prepregnancy stimulation of the uterus by estrogens and progestogens may adversely affect its function.