Postmenopausal bleeding and abnormal uterine bleeding are common patient concerns in the primary care setting. Endometrial cancer is the most common gynecologic malignancy and the fourth most common cancer in women in the United States. Vaginal bleeding is the most common clinical presentation of endometrial cancer in postmenopausal patients. The endometrial biopsy is a safe, simple office procedure that can diagnose most abnormal gynecologic bleeding in patients. It has a high overall accuracy in diagnosing endometrial cancer when an adequate specimen is obtained. In most cases, the office endometrial biopsy has replaced dilatation and curettage (D&C) due to its ease of performance in the outpatient setting. This also allows for the evaluation of patients with abnormal uterine bleeding who are poor candidates for general anesthesia.