Aim: The study aimed to compare the efficacy of saline infusion sonohysterography (SIS) in investigation of abnormal uterine bleeding in perimenopausal women with transvaginal sonography (TVS) and histopathological examination of hysterectomy specimen. Method: The study was carried in50 women with Abnormal uterine bleeding and were subjected to Transvaginal sonography, Saline infusion sonography and D and C for diagnosing underlying pathology of AUB. The comparative efficacy of TVS and SIS were correlated with HPE results from hysterectomy and the same identified as Gold standard. In the present study menorrhagia was the most common bleeding pattern. Results: Among 15 cases diagnosed as endometrial hyperplasia in TVS, 2 were found to have polyps using SIS.1 case of endometrial hyperplasia was found to have irregular hyperplasia using SIS, which was suggestive of malignancy. TVS diagnosed 1 case of endometrial polyp as a submucous fibroid. SIS correctly diagnosed 10 cases of hyperplasia and 1 case of irregular hyperplasia suggestive of malignancy.4 cases of polyps were diagnosed as endometrial hyperplasia in TVS and 1 case of adenocarcinoma as submucous fibroid. SIS diagnosed all polyps correctly and diagnosed 1 adenocarcinoma as irregular hyperplasia. Conclusion: The use of saline infusion sonohysterography to enhance the visualization of the endometrium increases the diagnostic accuracy of TVS to approach that of diagnostic hysteroscopy and may even replace it. It is an alternative to hysteroscopy with the additional advantage of evaluating Myometrial and adnexal pathology besides being less invasive and cost effective