The study developed and validated a multivariable model to predict endometrial atypical hyperplasia (EAH) and endometrial cancer (EC) in asymptomatic postmenopausal women. She analyzed 928 patients with a median age of 59 years and a prevalence of EAH or EC of 2.59%. Key risk factors were endometrial thickness (EMT) over 8 mm, diabetes and elevated platelet count. EMT > 8 mm was the strongest predictor with a relative risk of 11.34. The combination of EMT > 8 mm and diabetes was associated with the highest prevalence of 33.33%. The model makes it possible to stratify the risk and recommend a biopsy only in patients with a higher risk, thereby reducing the number of unnecessary biopsies. At a risk threshold ≥ 5%, biopsy would be recommended in 17% of patients with a sensitivity of 70.8% and a specificity of 84.4%. This approach supports personalized decision-making for biopsy and management of asymptomatic postmenopausal women.