Back ground: Uterine leiomyoma represent over 75% of the amiable tumors in ladies of conceptive age amass. Endometrium is a hormonally responsive tissue . The reaction of endometrium to incitement by endogenous or exogenous steroid hormones is unsurprising Endogenous reaction is an impression of the hypothalamic–pituitary-ovarian pathway. Aim of this study : to assess serum level of E2 and study endometrial histological changes in instances of fibroid uterus .Patients and methods: This study included forty ladies have symptomatic fibroid uterus. history was taken, general examination, ultrasound examination, measuring serum estradiol and endometrial biopsy was taken by D&C or hysterectomy sent for histopathological examination. Results : endometrial thickness was ˃10mm in 69.2% of premenopausal and ˃5mm in 83%of postmenopausal . endometrial hyperplasia is the commonest glandular endometrial change represent(37.5%) ,complex hyperplasia without atypia 5%,simple hyperplasia with atypia 5% and proliferative endometrium 22.5%of all review bunch . in premenopausal patients hyperplasia with atypia related with the most elevated E2 level ( 252,6 pg) , complex hyperplasia without atypia with E2 level (221.6 ±6.22 SD), hyperplasia without atypia with E2 level (184.84 ± 12,11SD) and in postmenopausal patients hyperplasia with atypia with E2 level (245.3 pg), hyperplasia without atypia (145.68 ±33.53 SD) .Conclusion : there is correlation between serum oestrogen level , histopathological changes of endometrium and symptomatic fibroid uterus at perimenopausal age .