Aim: To compare the endometrial thickness with the results of the biopsy and assess the usefulness of endometrial thickness as an indicator of underlying pathology. Materials and methods: Endometrial thickness measured by ultrasound of 61 patients with postmenopausal bleeding were compared with histopathology of endometrial biopsy. Age of presentation, the duration between menopause and postmenopausal bleeding, parity, associated symptomsand association of risk factors for endometrial hyperplasia and carcinoma were analyzed. Results: The mean age of patients with menopausal bleeding was 52 years, and that of endometrial cancer was 63.7 years. About one-third of cases with postmenopausal bleeding had hyperplasia and one-tenth was diagnosed as carcinoma. The minimum thickness of endometrium was 6 mm in patients with hyperplasia with a mean of 14.3 ± 5.4 mm, and it was 12 mm in the case of carcinoma with a mean of 20 ± 6.4 mm. Mean thickness of atrophic endometrium was 7.4 ± 3.5 mm. None of the cases with less than 4 mm endometrial thickness had either hyperplasia or cancer. Conclusion: Ultrasound can be considered as an early diagnostic evaluation tool for patients with postmenopausal bleeding in predicting endometrial hyperplasia and carcinoma which could prevent un-warranted operation in patients with a thin endometrium. Clinical significance: Thickened endometrium is a predictor of endometrial hyperplasia and cancer.