Aim: To compare the sensitivity and specificity of transvaginal ultrasonography (TVS) and hysteroscopy with endometrial biopsy in patients of postmenopausal bleeding. Methods: A hospital-based cross-sectional study was performed among 40 postmenopausal women with a history of amenorrhea for more than one year. The enrolled patients underwent TVS and hysteroscopy along with hysteroscopy-guided endometrial biopsy. Histopathological findings were considered as definitive diagnosis; which was compared with presumptive diagnosis of TVS and hysteroscopic findings. Data entry and statistical analysis were performed using SPSS v21. Results: The mean age of the patients was 55.1 ± 6.5 years. Among the 40 patients, 22 (55%) had normal endometrial thickness (< 4 mm). The two most common causes of postmenopausal bleeding were found to be atrophic endometrium (37.5%) and endometrial hyperplasia (37.5%). The sensitivity and specificity of TVS in diagnosis of atrophic endometrium were found to be 66.7% and 64% respectively. Additionally, the sensitivity and specificity in endometrial hyperplasia were 60% and 76% respectively, and the sensitivity in sub-mucosal fibroid was 100%. Similarly, the sensitivity of hysteroscopy in diagnosis of atrophic endometrium, endometrial polyp, endometrial hyperplasia, sub-mucosal fibroid and endometrial carcinoma was 66.7%, 100%, 66.7%, 50% and 33.3% respectively. No any cases of endometrial carcinoma were detected in TVS, though three patients (7.5%) were biopsy proven cases of endometrial carcinoma. Conclusion: Atrophic endometrium and endometrial hyperplasia are the two most common causes of postmenopausal bleeding. TVS and hysteroscopy may be used as effective tools for evaluation of postmenopausal bleeding, however; further larger scale study is required to confirm this finding.