Aim of work: To determine usefulness of measurement of endometrial thickness, volume, and blood flow indices of endometrium in predicting the nature of endometrial lesions causing premenopausal bleeding as compared to endometrial histopathology. Patients and methods: The current study was done on 40 patients complaining of perimenopausal bleeding in the age group 40-50 years old. They were evaluated by 2D and 3D endovaginal sonography. The gold standard in this study was histopathological examination of endometrium following endometrial curettage .Results: There is a strong correlation between endometrial thickness and endometrial volume (p < 0.001). Endometrial volume of 12 cm³ or more seems diagnostic of complex endometrial hyperplasia in this group of women with abnormal uterine bleeding. Endometrial pathology considered as a gold slandered for diagnosisConclusions: 3D endovaginal measurements of endometrial volume and flow indices may be promising in prediction of the nature of endometrial pathology and avoiding unnecessary D&C.