Introduction: Postmenopausal bleeding is the most common reason for office hysteroscopy in postmenopausal women. While transvaginal ultrasonography (TV-US) systematic screening is not recommended for postmenopausal women, it is often performed and leads to the diagnosis of asymptomatic intra-uterine abnormalities, most often polyps. While dilatation and curettage is no longer recommended TV-US is often performed as a first measure of endometrial thickness. Material and Methods This is a retrospective study involving case records of women undergone outpatient hysteroscopy and endometrial biopsy between July 2022 and June 2023 in the Department of Obstetrics and Gynaecology at the Ayaan Institute of Medical Sciences, Teaching Hospital & Research Centre. The patients were all postmenopausal and asymptomatic. None of them had positive personal history of cancer of the genital tract. None took hormone replacement therapy. Results In the bleeding group, 40% had a bulky uterus compared to 15% in the non-bleeding group, which was statistically significant (p = 0.05). The difference in endometrial thickness (ET on TVS) was also significant (p = 0.029). At diagnosis, the bleeding group had a larger uterus but a thinner endometrium compared to asymptomatic women. Hysterectomy was performed for one case of complex hyperplasia with atypia and two cases of simple hyperplasia with atypia. Operative hysteroscopy was done in 24 (60%) PMB cases and 15 (75%) asymptomatic postmenopausal women with increased endometrial thickness due to benign polyps. Conclusion Hysteroscopy plays a crucial role in evaluating postmenopausal women, especially those with PMB, as it provides superior diagnostic accuracy compared to endometrial curettage. Given its high sensitivity and specificity, hysteroscopy should be the first-line investigation for postmenopausal bleedings.