Objective — to specify the frequency of endometrial pathology in elderly patients and develop an optimal tactics to reduce the incidence of recurrence and the risk of malignancies. Material and methods. In 288 elderly and senile women with suspected endometrial pathology according to ultrasound screening performed hysteroscopy, dilation and curettage with morphological diagnosis verification. Results. Absence of pathological changes and endometrial atrophy detected in 30.5% of cases, submucous uterine fibroids — 5.5%, chronic endometritis — 3.5%, most frequently endometrial polyps were detected — 63.9%. Endometrial hyperplasia was not revealed in any case. Endometrial adenocarcinoma found in 6 (2.1%) patients, the incidence was 0.1%. Ultrasound sensitivity and specificity were 76.4% and 99.2%, respectively. In three cases of recurrent endometrial polyps moderately and highly differentiated endometrioid adenocarcinoma was diagnosed (7.1%). Immunohistochemical study of endometrial polyps observed increased expression of bcl-2 in combination with a decrease of Bax, suggesting the suppression of apoptosis and thus the risk of neoplastic transformation. Conclusion. The risk of endometrial malignancy in aged postmenopausal women is higher, particularly in patients with relapsed pathological processes in the endometrium, so it is advisable to perform a screening ultrasound for the detection of active endometrial changes and treatment at an early stage in primary cancer prevention.