We evaluated the interpretation of atrophic endometrium (AE) histology as a common cause for postmenopausal bleeding (PMB). In our opinion, AE is physiologic and ubiquitous in postmenopausal women, but is not a cause of PMB. Referring to AE as a cause of PMB may result in misdiagnosis of cancer and delay in management. Endometrial sampling are notorious for missing focal lesions and transvaginal sonogram should be considered in cases of PMB and AE histology. If endometrial thickness is found, it is not compatible with AE and further workup is warranted to exclude focal lesions which are common cause for PMB.