Postmenopausal bleeding (PMB), defined as any bleeding that occurs more than 12 months after the final menstrual period in women not on menopause hormone therapy, is a common clinical condition with significant implications. Although more than 90% of women with endometrial cancer (EC) present with PMB, over 90% of PMB cases are due to benign conditions such as endometrial or cervical polyps, vaginal atrophy, and endometrial hyperplasia. A thorough evaluation is essential, as up to 10% of women with PMB may harbor EC or premalignant lesions. Risk factors such as age, obesity, unopposed estrogen exposure, diabetes, and tamoxifen use must be carefully considered. Diagnostic modalities like transvaginal sonography (TVS), office hysteroscopy, and targeted endometrial sampling have now replaced blind dilatation and curettage (D&C), offering higher accuracy and safety. Management strategy is guided by the underlying etiology—ranging from local estrogen therapy for atrophy, hysteroscopic removal for polyps and submucous myomas, to hysterectomy for atypical hyperplasia and carcinoma. A structured, risk-based evaluation and individualized management remain essential to optimize outcomes and reduce morbidity.