The malignancy risk of endometrial polyps in postmenopausal women was correlated with the presence or absence of abnormal uterine bleeding. Of 481 postmenopausal women who presented with endometrial polyps at diagnostic hysteroscopy between 2004 and 2007, 48.9% were asymptomatic and 51.1% had postmenopausal uterine bleeding. Transvaginal ultrasound revealed abnormal endometrial thickness in 60.0% vs. 57.7%, polyps in 37.9% vs. 32.9%, endometrial tumors in 1.3% vs. 0.8%, and submucosal myomas in 0.9% vs. 2.0% by the absence or presence of bleeding. Around three-fourth of the polyps were removed. Histopathologic diagnoses showed mucous polyps in 93.7 of asymptomatic women compared to 80.7% of those with bleeding, while endometrial tumors were only seen in those bleeding (7.2%). The malignancy risk within endometrial polyps in postmenopausal women varies with the presence of vaginal bleeding, and is minimal in asymptomatic women.