Background: Abnormal uterine bleeding (AUB) is a broad term that describes irregularities in the menstrual cycle involving frequency, regularity, duration, and volume of flow outside of pregnancy. The gold standard for diagnosis of AUB is the endometrial biopsy for accurate detection of the exact pathological cause for bleeding. However, due to the invasive nature of this procedure, most of the cases are not complaint for this technique. Ultrasonography is non-invasive technique for evaluating the endometrium. However, using this technique to measure the thickness of the endometrium itself is not sufficient. 3D Transvaginal ultrasound enables an assessment of uterine and endometrial volume. Objective: To assess the accuracy of 3D trans-vaginal Ultrasound in diagnosis of endometrial hyperplasia in women with perimenopausal abnormal uterine bleeding. Patients and methods: This was a cross sectional study that included 75 patients selected from outpatient clinic of Obstetrics and Gynecology at Al-Hussein Hospital, Cairo, Egypt, from January 2020 till January 2021. Detailed history was obtained and full examinations were done for every patient included in the study. In addition, transvaginal ultrasound was done and the endometrial volume was measured, then all patients were submitted to endometrial curettage. Results: Adenocarcinoma was the most reported findings in 27 cases (36%). The best cut-off value for classification of patients into those with benign endometrial pathology and those with endometrial hyperplasia or carcinoma using endometrial volume was an endometrial volume >12.35 ml with 74.1% sensitivity and 95.2% specificity. The best cut-off value for classification of patients into those with benign endometrial pathology or hyperplasia and those with endometrial carcinoma using endometrial volume was an endometrial volume >12.25 ml with 96.3% sensitivity and 100% specificity. Conclusion: 3D ultrasound is a reasonably accurate, helpful and non-invasive tool for assessing the endometrium that could replace the endometrial biopsy.