Abstract: Objective To analyze the causes of PMB disease in our hospital retrospectively, and discuss the diagnostic methods for endometrial carcinoma (EC). Methods Clinical data about 1 029 postmenopausal bleeding patients in our hospital from January 2013 to December 2017 were analyzed. Incidences of various diseases causing PMB and their constituent ratio during different period of menopause were analyzed, and the diagnostic values of transvaginal ultrasonography, diagnostic curettage and hysteroscopy for endometrial carcinoma were compared. Results Of the 1 029 PMB patients with average age of (56.3±7.7) years, 182 (17.7%)cases were diagnosed with endometrial carcinoma. In benign lesions, endometrial hyperplasia accounted for 38.6%, uterine bleeding/atrophic endometrium accounted for 23.4%, uterine myoma and polyp accounted for 6.6% and 5.2%, and intrauterine device (IUD)accounted for 8.5%. The total number of PMB patients during the first 5 years after menopause was 506 (49.2%), and the incidence of PMB decreased gradually over time 18.4% (6-10 years), 14.2% (11-15 years), 10.7% (15-20 years), 7.6% (> 20 years). The accuracy rate of hysteroscopy (97.7%) for diagnosing EC was significantly higher than those of diagnostic curettage (94.4%) and transvaginal ultrasonography (90.7%) (P< 0.05, respectively). Conclusion The incidence of endometrial hyperplasia, endometrial cancer, IUD, uterine fibroids and polyps are high in the first 5 years after menopause, and it decreases gradually over time.Hysteroscopy can be an optimal choice for cases with postmenopausal bleeding.