Background: Menopause is the loss of ovarian follicular activity, which results in a permanent cessation of menstruation. Postmenopausal bleeding (PMB) is defined as bleeding that starts twelve months following the last menstrual period. Hysteroscopy enables (see and treat) approaches by allowing macroscopic diagnosis of benign lesions and their excision, but histological samples must always be taken. Objective: This study aimed to assess the accuracy of hysteroscopy use in the diagnosis of the causes of bleeding in women with postmenopausal bleeding. Methodology: The current prospective cohort study was carried out on 237 postmenopausal women with postmenopausal bleeding recruited from Ain Shams University Maternity hospital (Hysteroscopy Unit) during the period between December 2016 and October 2017. Results: One of the difficulties that we have faced, there was no single operator assigned to perform the whole study population.  In this study we found that the mean age of the studied population was 56±6 years, whilethe mean body mass index was 30±4 (kg/m²) also themean duration of menopause was 7±5years. This study showed that the accuracy of hysteroscopy in diagnosis of endometrial carcinoma was 97.9%, sensitivity of hysteroscopy in diagnosis of endometrial carcinoma was (82.6%), and specificity was (99.5%). Conclusions: Hysteroscopy is the fundamental tool for accurate identification of various endouterine diseases in women with PMB. Hysteroscopy is useful in lowering the number of hospital visits, admissions, and overall expenses in older individuals who are at high risk for any invasive operation like a hysterectomy.