Introduction: Postmenopausal bleeding (PMB) is defined as bleeding from the genital tract, more than 12 months after the last menstrual period in a woman, not on hormone replacement therapy (HRT). PMB occurs in approximately 10% of Postmenopausal women. Endometrial cancer is the most common gynaecological malignancy but, in India, 80-90% of the women have benign conditions like endometrial or cervical polyps, endometrial atrophy, infection or simple endometrial hyperplasia. Every woman of PMB requires thorough evaluation, clinically and pathologically to exclude malignancy. Aims and Objectives: To find out causes of PMB on the basis of history and clinical examination and to correlate the clinical findings with imaging studies, mainly Endometrial thickness (ET) on Transvaginal sonography (TVS) and Histopathological examination (HPE), if required. Materials and Methods: This study was a prospective study carried out on outdoor/indoor patients admitted in Department of Obstetrics and Gynaecology at tertiary care hospital from January 2020 to June 2021. Result: Majority (28.57%) of the patients with PMB were from 46-50 years age group. Diabetes mellitus (22.85%) and Hypertension (21.42%) were the major risk factors associated with PMB. On TVS, 44.28% patients had ET between 5-10mm. Majority of patients had no pathology (51.43%) while remaining had fibroid (15%), adenomyosis (11%), Endometrial Hyperplasia (8.57%), Fibroid polyp (1.42%) and cervical polyp (1%). Atrophic endometritic was the most common benign cause, seen in 30% of the patients. Malignant etiology for PMB was seen in 11.47% of the patients. Out of 70 patients, 68.57% of the patients underwent surgical management, 30% patients underwent Conservative Management and 1.4% patient had radiotherapy. Conclusion: PMB is a symptom of varied aetiologies, benign and malignant. Therefore, careful histologic examination to identify the aetiology should be emphasized. Accurate diagnosis makes it much easier to counsel the patient about further course of management.