Leptin and adiponectin play an important role in the regulation of body weight and energy homeostasis. The purpose of the present study was to ascertain the relationship between leptin to adiponectin ratio (L:A) and metabolic risk factors in postmenopausal women.This is a cross sectional case-control study. A total of 523 postmenopausal women were recruited for the study 270 postmenopausal women with metabolic syndrome and 253 apparently healthy control postmenopausal women without metabolic syndrome. Biochemical and Anthropometrical parameters were measured. Leptin and adiponectin levels were determined by sandwich enzyme-linked immunosorbent assay, insulin resistance was determined by homeostasis model assessment for insulin resistance (HOMA-IR). Results of this study indicate that leptin (15.92 ± 10.50 vs.9.43 ± 4.39 pg/ml, p 0.001), L:A ratio (1.08 ± 1.06 vs.0.42 ± 0.38 pg/ml, p 0.001), HOMA-IR, the lipid profile, and other metabolic risk factors (waist circumference (WC), waist-to-hip ratio(WHR), body mass index((BMI)), fasting plasma glucose (FPG) level and fasting plasma insulin(FPI)) were significantly higher but HDL, HDL/LDL and adiponectin level (20.55 ± 10.76 vs.30.08 ± 13.08 pg/ml, p 0.001)were significantly lower in postmenopausal women with metabolic syndrome than in women without the syndrome (p 0.001). Further, in postmenopausal women with metabolic syndrome, L: A ratio was significantly positive (p 0.05 or p 0.001) correlated with WC, BMI, WHR, TG, FPG, TC/HDL, LDL/HDL, FPI and HOMA-IR (p 0.01), and negatively correlated with HDL and HDL/LDL (p 0.001). Conclusively L: A ratio was found to be significantly associated with central obesity and other metabolic risk factors so that high L:A ratio may act as a diagnostic marker for metabolic syndrome in postmenopausal women.