Background: The causes of postmenopausal vaginal bleeding included endometrial atrophy, hyperplasia, polyps, submucosal myoma, and cancer. Every woman with postmenopausal bleeding (PMB) needs a meticulous clinical investigation since it has a 10 to 15 % of endometrial cancer. Objective: The aim of this work was to achieve an accurate evaluation of the uterine cavity in obese females with postmenopausal bleeding. Patient and Methods: A case-control study that was carried out over 6 months from March 2022 to August 2022 on 68 cases at Gynecology Outpatients in Obstetrics and Gynecology Department, Zagazig University Maternity Hospital where office hysteroscopy is performed. All patients were divided into two groups: Group A included 34 obese patients with post-menopausal uterine bleeding, while group B included 34 non-obese patients with post-menopausal uterine bleeding. All patients were subjected to full history taking, routine clinical examination, laboratory investigations and hysteroscopic evaluation. Results: There was no significant difference between the studied groups concerning the endometrial thickness, time, and amount of bleeding or histological sample distribution. They also revealed that endometrial polyps were significantly associated with non-obese group, but endometrial polyps + fibroids and proliferative endometrial hyperplasia were significantly associated with obese group. Conclusions: Obesity is a risk factor for the development of abnormal uterine bleeding in postmenopausal women considering its association with several uterine and endometrial pathologies causing postmenopausal bleeding.