Postmenopausal bleeding is a common presentation in primary care. There is great emphasis placed on rapid referral for investigation to exclude endometrial malignancy, and it is the most common symptom for which women are referred to gynaecological rapid access clinics. However, it is widely accepted that only approximately 10% of patients at a postmenopausal bleed clinic will have cancer. Endometrial cancer is now often easily treatable with laparoscopic surgery, and certain pre-malignant changes can be managed with an intrauterine system, so it is important to deal with this common presentation effectively, while also knowing about the frequent causes.