Background: menopause is derived from the Greek words; men (month) and pauses (Cessation). A woman is considered menopausal after cessation of menstruation for 1 year after an average age of 46. Postmenopausal bleeding (PMB) is defined as bleeding recurring in a menopausal woman at least 1 year after cessation of cycles. It must always be investigated because many causes are premalignant or malignant. The most common premalignant and malignant causes are complex hyperplasia with atypia and carcinoma of the endometrium. These disorders are present in as many as 1/3 of the patients evaluated for PMB in many series.  Objective: this study aimed to explore the relationship between estradiol level, transvaginal ultrasound, endometrial thickness and body mass index and their correlation to endometrial pathology in women with postmenopausal bleeding. Patients and Methods: in the present study, 80 patients with postmenopausal bleeding were examined regarding BMI, ultrasonographic assessment of endometrial thickness and pathological findings of the endometrium. D&C was performed for all patients under general anesthesia using a sharp ended curette starting first with the fundus, posterior wall, anterior wall, right and left lateral wall. The patients' age ranged from 46-69 years, with a mean of 53.53 ± 4.1 years. Results: in the present study, there was a highly statistically significantdifference between benign and malignant groups as the endometrium was markedly thicker in the malignant group. Our study displayed thatthere was a statistically high significantdifference between benign and malignant groups as regard the presence of fibroid uterus (due to presence of excess unopposed estrogen in those obese women) and the presence of adenomyotic or normal uterus inbetween both groups. Conclusion: transvaginal ultrasonography is an excellent first-step diagnostic method of excluding the endometrial abnormalities in women with postmenopausal bleeding. Ideally, a non-invasive investigation is preferred over an invasive one and also an economical investigation preferred over an expensive one; this applies equally to affluent countries and third world. Endometrial biopsy is the ‘‘gold standard'' for diagnosing abnormalities in the endometrial tissue of patients with PMB.