Postmenopausal bleeding (PMB) may be defined as recurrent vaginal bleeding in a menopausal woman at least 1 year after cessation of cycles. In postmenopausal bleeding, transvaginal ultrasonography (TVUS) is preferred over endometrial biopsy as an initial diagnostic tool. The use of TVUS decreases the need for invasive diagnostic procedures for women without abnormalities, and ultrasound increases the sensitivity of detecting abnormalities in women with postmenopausal bleeding. It is a less invasive procedure, is generally painless, has no complications, and may be more sensitive for detecting carcinoma than blind biopsy. Sonohysterography allows reliable differentiation between focal and diffuse endometrial and subendometrial lesions, with the most common being polyps and submucosal fibroids.