Background: Uterine leiomyoma represents over 75% of the amiable tumours 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