The purpose of this study was to evaluate the hysteroscopic appearance of the endometrium in cases with abnormal thickening (>8mm) evaluated by vaginal ultrasound. We considered postmenopausal patients who were asymptomatic and those with abnormal uterine bleeding (AUB). Hysteroscopy with endometrial biopsy revealed cancer, hyperplasia, polyps, and myoma in patients with AUB. In the asymptomatic group with increased endometrial thickening, hysteroscopy revealed hyperplasia, polyps and myoma. Our results show that vaginal ultrasound is a reliable method for evaluation of the endometrium in postmenopausal women. Hysteroscopic examination is required to assess the endometrial pathology, and to determine which patients will require biopsy or surgical intervention.