Postmenopausal bleeding (PMB) is bleeding from the vagina that occurs after a woman has stopped having regular menstrual periods due to menopause. Diagnostic tools in postmenopausal women with abnormal uterine bleeding are TVS, SIS, hysteroscopy and biopsy for histopathological examination.To compare diagnostic accuracy of saline infusion sonography with hysteroscopy in detecting intracavitary abnormalities in postmenopausal women with abnormal uterine bleeding. This prospective observational comparative study was conducted at Department of Obstetrics and Gynecology, Benha University Hospitals on 50 female patients complaining of PMB. All patients were subjected to full history taking, examination, transvaginal ultrasonography and routine preoperative investigations. In operation room under general anesthesia, patients were undergoing SIS then hysteroscopy. Biopsy was taken and sent for histopathological examination. Most commonly encountered endometrial lesions were hyperplasia (52%), myoma (16%), polyp (12%) and atrophy (12%). Diagnostic accuracy of hysteroscopy in detection of submucosal myoma was better than SIS and TVS with respect to pathological diagnosis. There was an agreement between SIS and hysteroscopy in the diagnosis of polypoid lesions of uterine cavity with sensitivity and specificity of 100%, being more accurate than TVS. The diagnostic accuracy of SIS in the detection of endometrial hyperplasia was better than hysteroscopy and better than TVS with respect to pathological diagnosis.Hysteroscopy has the highest diagnostic accuracy for diagnosing endometrial pathology. SIS may be used as the primary method for the detection of uterine abnormalities among postmenopausal women with abnormal uterine bleeding.