Objective:Currently, there is no established preoperative evaluation standard for direct hysterectomy in CINIII patients who are unable to undergo conectomy.We have developed a nomogram that can be used to predict surgical modalities for initial treatment of CINIII after menopause,and estimated the performance of the nomogram by internal validations. Design：Case-control design within retrospective study. Setting：Shengjing Hospital of China Medical University. Population or Sample：A total of 454 postmenopausal participants diagnosed with CINIII. Methods: Group A and group B were divided into two cohorts based on different initial treatment modalities. Group A underwent direct hysterectomy (88 cases), while group B underwent conization followed by hysterectomy (366 cases). Based on the postoperative pathological findings, the patients were categorized into the upgraded pathological grope (105 cases, with 8 in group A and 97 in group B) and the non-upgraded pathological grope (349 cases, with 80 in group A and 269 in group B).Multiple logistic regression analysis was used to identify predictors and establish nomogram.The performance of the nomogram was evaluated by using the area under the curve (AUC),calibration curve and the decision curve analysis(DCA). Main Outcome Measures：Pathological upgrade. Result:The independent risk factors identified in this study include menopause years,post-coital bleeding, HPV16/18 infection,cervical lesion counts, SCCAg and TCT (P<0.05). The six indicators were used to create a nomogram for predicting pathological upgrade. The training set yielded an AUC of 0.959 (95% confidence interval [CI], 0.936-0.982), while the validation set showed an AUC of 0.850 (95% CI, 0.775-0.926).The nomogram was well-calibrated.The DCA results demonstrate a higher net gain value. Conclusion：The nomogram model predicts postoperative cervical cancer risk in postmenopausal CINIII patients based on menopause years, HPV16/18 positivity, TCT results, SCCAg levels, cervical lesion counts, and post-coital bleeding. In cases of low risk, direct hysterectomy may be considered as initial treatment. Our scoring system offers safer and more efficient treatment options for patients.