To study the incidence of different gynaecological conditions leading to vaginal bleeding in postmenopausal women and to investigate its clinical significance in terms of malignancy and histopathological evaluation. This is a prospective study conducted in the department of Obstetrics and Gynaecology PMCH, Patna in postmenopausal women with complaints of vaginal spotting, bleeding or blood-stained vaginal discharge over 2 years. 200 patients with postmenopausal bleeding who were on total follow up including admission if necessary were taken up for study. The result shows the average age of menopause was between 45-and 49 years (53%). The majority of women with postmenopausal bleeding belonged to the age group 51-60 years constituting 58%. 44.5% of cases had a parity of 3-4. 30.5% of cases presented with bleeding more than 10 years after menopause. 48% of cases had benign lesions whereas malignancy was found in 52% of cases of postmenopausal bleeding. Carcinoma cervix was found to be the most common malignancy representing 69% followed by carcinoma endometrium (24%). The histopathological analysis showed atrophic endometrium in 25.5% of cases, and proliferative endometrial hyperplasia in 16% of cases. Apart from benign lesions, carcinoma cervix and carcinoma endometrium are commonly seen in postmenopausal women with complaints of vaginal bleeding. Early detection of cases can certainly improve quality of life and reduce mortality and morbidity. Postmenopausal women need to be educated about the importance of seeking attention if any vaginal bleeding occurs