Key content This article outlines how to identify the symptoms and signs associated with endometrial pathology and how these correlate with the final diagnosis., The evidence for and against intervention in asymptomatic women with a coincidental finding of endometrial pathology is discussed., This article looks at how best to investigate symptomatic women on hormone replacement therapy (HRT) and selective estrogen receptor modulators (SERMs)., Screening for endometrial pathology is discussed., Learning objectives To be able to identify risk factors associated with postmenopausal endometrial pathology, as well as symptoms and signs., To learn about the models of care for different endometrial pathology., To understand the contentious issues and the risk-benefit profile of different strategies for the management of asymptomatic women., Ethical issues Does an incidental finding of a thick endometrium in asymptomatic postmenopausal women warrant further investigation?, Should asymptomatic women receiving HRT or SERMs be routinely screened and investigated? [ABSTRACT FROM AUTHOR]