Endovaginal ultrasound scanning was used preoperatively in 100 women with postmenopausal vaginal bleeding referred for dilatation and curettage. The ultrasonographic appearance of the endometrium was related to the histologic diagnosis. Endometrial malignancy was found in 15 patients, in 2/45 (4.4%) of women aged less than 60 years and in 13/55 (23.6%) of women aged 60 years or more. Out of 54 patients with an endometrial thickness of less than 5 mm as measured by ultrasound, 3 had an endometrial malignancy, and 12 of 45 with an endometrial thickness of 5 mm or more, had an endometrial malignancy. The sensitivity of ultrasound to detect malignancy was 80%, the specificity was 60%, the positive and negative predictive values were 26% and 94.4%. The sensitivity and the negative predictive value was not high enough to replace histologic examination of the endometrium.