OBJECTIVE. To compare the efficiency of transvaginal sonography and outpatient hysteroscopy in the diagnosis of intrauterine pathology in postmenopausal women. METHODS. Two-hundred and forty-three postmenopausal women were selected. All women had undergone outpatient hysteroscopy in the year 2006. These women were referred from the Basic Healthcare Units in Campinas, where they underwent ultrasonography for the evaluation of the endometrial cavity. RESULTS. The mean age of these women was 61 +/- 9.4 years, These women were menopausal for 11 +/- 8.3 years.. We observed 6.6% cases of endometrial hyperplasia and cancer The ultrasonography had a sensitivy of 95.6%, a specificity of 7.4%, a positive predictive value of 53.3% and a negative predictive value of 60%, while the hysteroscopy had 95.7%, 83%, 82.2% and 95.9% respectively. CONCLUSION. Hysteroscopy was a more accurate method for the detection of intrauterine pathology than ultrasonography. [Rev Assoc Med Bras 2009; 55(5): 553-6]555553556