Introduction: Abnormal uterine bleeding (AUB) is the most common reason for gynecological visits for perimenopausal bleeding and may account for more than 25% of all hysterectomies. The perimenopause is often characterized by irregularities in the menstrual cycle in volume and frequency. This is due to fluctuating estrogen levels. These changes are unique for each woman and are unpredictable. Although irregular bleeding patterns are normal and expected to be part of perimenopause, the incidence of uterine pathology and associated medical complications increase in this age group [3]. The more accurate diagnosis of endometrial pathology better the chances for alternative treatment and hysterectomies could be avoided. The accuracy or the superiority of the relatively non-invasive methods like TVS, Hysteroscopy, and SIS over histopathology have not been clearly established. Thus this study was undertaken to compare the diagnostic efficiency of TVS over the histopathology study of the endometrium and to test their agreement. Materials & Methods: 48 cases of perimenopausal women above 40 yrs. age not yet attained menopause. Patient with AUB in any other age group, any vaginal or cervical cause of bleeding, Patient with blood dyscrasias, Pregnancy related causes of bleeding, Patient with h/o of drug intake (Anticoagulant & hormone replacement therapy) has been excluded. The cases were studied for a period of 11 months in Noble hospital & research Centre. Detailed history & clinical examination including per vaginal and per speculum examination carried out. All the patient then subjected to transvaginal ultrasound & endometrial sampling. Results were correlated between transvaginal ultrasound & histopathology in these patients. Results: In this study, 72.4% of women with normal endometrium had an endometrial thickness of less than 12mm below which there was no endometrial pathology. Above this cut off level of 12mm, 88.6 % were found to be associated with endometrial pathology. The sensitivity and specificity were found to be 61.9% and 77.8%. Distribution of histopathology findings differ significantly between groups of cases with less than 12mm and more than 12 mm endometrial thickness (P-value < 0.048). Conclusion: Transvaginal sonogram is a simple, non-invasive convenient way to indirectly visualize the endometrium & endometrial cavity. The vaginal probe examination if incorporated into the gynecologist office setting and when combined with bimanual pelvic examination can enhance our anatomic diagnosis. Transvaginal sonography is useful as a first step diagnostic procedure in the evaluation of perimenopausal bleeding. When combined with dilatation and curettage it can supplement the shortcomings of dilatation and curettage.