Objective: To investigate the clinical characteristics of postmenopausal patients with abnormal uterine bleeding, and to analyze the risk factors for endometrial cancer. Methods: The clinical data of 168 patients with abnormal postmenopausal bleeding admitted in Wuxi Ninth People’s Hospital from March 2019 to March 2022 were retrospectively analyzed. The characteristics were analyzed according to the time of menopause and age, and the risk factors for endometrial cancer were analyzed by univariate and multivariate logistic analysis. Results: The pathological examination results of 168 patients with abnormal uterine bleeding after menopause showed that 121 (72.02%) were benign uterine lesions, and 47 (27.98%) were endometrial cancer. There were significant differences in the incidence of endometrial polyps, endometritis, submucosal fibroids, and endometrial cancer among patients with different menopause time and different ages (all P<0.05). Univariate analysis showed that the age, body mass index, menopause years, and comorbidities of endometrial cancer patients were significantly different from those with benign endometrial lesions (all P<0.05). Multivariate analysis showed that age older than 65 years old, body mass index greater than 28 kg/m², endometrial thickness greater than 10 mm, hypertension, diabetes, and uterine fibroids were independent factors for the occurrence of endometrial cancer in postmenopausal patients with abnormal uterine bleeding (all P<0.05). Conclusion: Benign uterine lesions are the main cause of abnormal uterine bleeding after menopause. With the increase of menopause years and age, the incidence of endometrial cancer gradually increases. Age, body mass index, endometrial thickness, combined hypertension, diabetes, and combined uterine fibroids are independent risk factors for the occurrence of endometrial cancer in postmenopausal patients with abnormal uterine bleeding, and clinical intervention should be early to prevent the occurrence of endometrial cancer.