Postmenopausal bleeding (PMB) accounts for 5% of all gynecologic office visits. PMB must always be investigated because many causes are premalignant or malignant. The current study is designed to explore the value of three-dimensional ultrasound versus hysteroscopy in correlation to postoperative histopathology in cases of post menopausal bleeding. Material and methods: 50 cases, recruited from the outpatient gynecological clinic, Kasr El-Ainy Hospitals, were included in the study. All cases presented with postmenopausal bleeding. All patients were subjected to 3D transvaginal ultrasonographic evaluation of the endometrium, hysteroscopy and the results were correlated to the histopathological picture of the endometrium. Results: The age ranged between 49 and 70 years with a mean of 57.44 years. They had a mean parity of 4.52. The most common endometrial histopathology was atrophic endometrium (25 cases, 50%) then endometrial hyperplasia (10 cases, 20%) then endometrial polyps (8 cases, 16 %) then endometrial carcinoma (7 cases, 14%).Endometrial volume measurement was significant investigations to differentiate between atrophic endometrium, benign endometrial pathology and endometrial carcinoma in postmenopausal patients but not a significant tool in differentiating hyperplasia from polyp. Hysteroscopy is the best single investigation to use, to predict the endometrial pathology. However, histopathological diagnosis is always needed to confirm the suspicion.