Background: Abnormal uterine bleeding (AUB) indicates abnormalities in the menstrual cycle, involving volume, frequency, regularity, and length that occur outside of pregnancy. Aim: To evaluate endometrial cavity illnesses in premenopausal and postmenopausal females in a scenario with restricted resources, it is necessary to compare the diagnostic efficacy of saline infusion sonohysterography (SIS) and transvaginal ultrasonography (TVS) with diagnostic hysteroscopy (DH). Patients and methods: This investigation has been performed on 50 premenopausal and post-menopausal women aged 18-70 year diagnosed with abnormal uterine bleeding between May 1 and September 30, 2022 in a hospital with little access to daycare; Damanhur Medical National Institute. The clinical presentation determined the ideal scheduling for TVS and SIS. Results: TVS had sensitivity of 37.2 percent and specificity of hundred percent, positive predictive value (PPV) was hundred percent, negative predictive value (NPV) was 20.5% and accuracy was 46% with little significance in detecting endometrial finding, while saline infusion sonohysterography had sensitivity of 90.7% and specificity of 85.7%, PPV was 97.5%, NPV was 60% and accuracy was 93% with highly significance in detecting endometrial finding. Conclusion: saline infusion sonohysterography, in assessing endometrial pathology in pre-menopausal and post-menopausal females, had a diagnostic accuracy parring with hysteroscopy and greater than TVS. In low-resource settings, when hysteroscopy is either unavailable or too expensive, SIS is a safer alternative method that is better appropriate for examining AUB in pre- or post-menopausal females.