Background: Gestational trophoblastic disease occurs rarely in postmenopausal women. Case Report: We report on a 65-year-old woman with uterine choriocarcinoma developing 16 years after menopause and 25 years after her last pregnancy. She was found to have a uterine tumor on laparotomy after presenting with uterine bleeding and abdominal pain. Histopathological examination demonstrated malignant syncytiotrophoblastic and cytotrophoblastic cells with extensive necrosis and hemorrhage, consistent with pure choriocarcinoma. Chemotherapy consisting of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA-CO) was started. The treatment was changed to methotrexate and folinic acid because of severe hypersensitivity reaction after etoposide infusion. After 4 cycles, the serum beta-human chorionic gonadotropin (beta-hCG) level had decreased to normal. The patient remains disease free 20 months after the treatment. Conclusions: This case further illustrates that choriocarcinoma may be seen in older women after a long menopausal period. Accurate diagnosis and treatment are essential, because the tumor is very chemosensitive and curable even in advanced stages.