Introduction: Postmenopausal bleeding is a concerning symptom that necessitates thorough evaluation due to its association with endometrial pathology, including hyperplasia and malignancy¹. Hysteroscopy and curettage are commonly employed diagnostic tools that facilitate direct visualization and histological assessment. Objective: This study aims to evaluate the diagnostic accuracy and clinical outcomes of hysteroscopy and curettage in assessing endometrial pathology in postmenopausal women. Material and Methods: A retrospective cohort study  was conducted in  the  Department of OBG, Ayaan Institute of Medical Sciences, Teaching Hospital & Research Centre over a period of 6 months. A total of 200 postmenopausal women presenting with abnormal uterine bleeding were included. Hysteroscopy was performed, followed by endometrial curettage. The histopathological findings were analyzed, and statistical methods were applied to determine sensitivity, specificity, and predictive values. Results: A total of 200 patients were analyzed. Hysteroscopy demonstrated a sensitivity of 90% and specificity of 85% in detecting endometrial hyperplasia. Endometrial carcinoma was identified in 15% of cases. The presence of normal tissue in 28% of cases indicates that a significant proportion of postmenopausal women with abnormal uterine bleeding may not have detectable pathological changes upon histological examination. Atrophic changes, observed in 27% of cases, are consistent with the estrogen deficiency characteristic of postmenopausal women and are a common benign cause of bleeding in this population. Endometrial hyperplasia was identified in 22% of cases. Endometrial polyps accounted for 8% of cases. Conclusion: Hysteroscopy and curettage provide reliable diagnostic accuracy in evaluating endometrial pathology, aiding in the timely management of postmenopausal bleeding.