Postmenopausal vaginal bleeding is reported by 90% of patients with a diagnosis of endometrial cancer. Risk factors for endometrial cancer include obesity, increasing age, type 2 diabetes, use of unopposed estrogen, polycystic ovary syndrome, chronic anovulation, and family history of gynecologic cancers. Evaluation includes a detailed history and physical examination, focusing on bleeding characteristics, pain, and vaginal discharge. First-line diagnostic tests include transvaginal ultrasonography to measure endometrial thickness and endometrial biopsy. If thickening or irregularities are observed on ultrasonography, further workup is indicated. In postmenopausal patients, an endometrial thickness of 4 mm or less has a negative predictive value greater than 99% for endometrial cancer. The risks and benefits of deferring endometrial biopsy should be discussed with the patient because some type 2 endometrial cancers can develop from atrophic endometrium and may progress more aggressively. Persistent uterine bleeding or a change in menstrual bleeding warrants inclusion of biopsy in the workup. Endometrial intraepithelial neoplasia, previously atypical endometrial hyperplasia, is clinically significant on pathology reports because it is considered a precursor for endometrioid adenocarcinoma, requiring urgent referral to gynecologic oncology. Family physicians play a critical role in early identification of endometrial cancer, clearing patients for surgery, and long-term surveillance.