Uterine bleeding in postmenopausal women is caused by endometrial atrophy, endometrial hyperplasia, endometrial polyp, submucosal leiomyoma, and endometrial cancer. Although most postmenopausal uterine bleeding is attributed to benign causes, the most common presenting symptom of endometrial cancer is uterine bleeding. Endovaginal sonography is generally accepted as an initial diagnostic tool to evaluate endometrium. It allows triaging patients who need endometrial biopsy and histologic diagnosis versus hysterosonography and hysteroscopy. Hysterosonography can be useful not only in the confirmation and characterization of focal endometrial pathologic conditions but it can also provide guidance to localize and treat focal endometrial pathologic conditions.