Background: Postmenopausal bleeding (PMB) is one of the most common reasons for referral to gynecology services. This is due to the concern of possible underlying malignancy, as approximately 10% of women with PMB will have endometrial carcinoma. Objective: Early diagnosis of endometrial changes in women with postmenopausal bleeding and thickened endometrium.  Patients and Methods: A cross sectional study was conducted at Obstetrics and Gynecology Department, from December 2018 to January 2020 at Zagazig University Hospitals. The study included 56 women with post-menopausal bleeding and thickened endometrium (> 4 mm). They underwent vaginal sonography for endometrial thickness and ovarian volume measurement; endometrial sampling was done for definitive histologic diagnosis. Results: There was statistically significant difference between normal, over weight and obese females as regards mean ovarian volume and endometrial thickness (p = 0.001and p = 0.01) respectively. Where, over weight and obese females had large mean ovarian volume (median = 1.80 and 2.350) respectively and larger endometrial thickness (median = 9.0 and 14.0) respectively compared to normal ones. We found that 51% of studied females were having hyperplasic lesions followed by 37.3% of them were having benign lesions then 11.8% of them were having malignant lesions. Conclusions: That enlarged ovaries in women with postmenopausal bleeding and thickened endometrium are associated with endometrial adenocarcinoma risk. Whereas obesity represents a marker of risk for that endometrial change.