Objectives: The aim of the study was to evaluate serum leptin / adiponectin ratio as a marker for mdometrial pathologies in patients with postmenopausal bleeding. Study design: Cross section controlled study. Patients and Methods: The study included three groups 15 patients each with postmenopausal bleeding diagnosed endometrial biopsy as: atrophic endometrium, endometrial hyperplasia and endometrial carcinoma. Fasting ;erupt leptin and adiponectin were measured by enzyme-linked immunosorbent assay. Outcome measure: Serum eptin and adiponectin levels in the three studied groups and the value of leptin / adiponectin ratio were investigated is a marker for endometrial pathologies. Results: Serum leptin level was significantly higher and serum adiponectin was significantly lower in patients with endometrial hyperplasia and endometrial carcinoma compared to patients with atrophic endometrium (/>1.1 was a good test that indicated endometrial typerplasia and endometrial carcinoma with an accuracy of 83.3% and 90% respectively. Conclusions: Serum eptin/adiponectin ratio may help in differentiation between atrophic and other endometrial pathologies in cases of nconclusive endometrial thickness and when general anesthesia is risky especially in obese, hypertensive patients. -lowever, endometrial biopsy still remains the gold standard diagnosis for endometrial carcinoma.