Abnormal uterine bleeding (AUB) is overall the most common causes of gynecological visits in the perimenopausal age, involving about 15% of women. Endometrial assessment has traditionally been achieved by obtaining tissue for histological analysis utilizing blind in-patient dilatation of the cervix and curettage of the endometrium under general anesthesia Diagnosis and treatment of endometrial pathology can nowadays benefit from well-established techniques, ranging from clinical examination to transvaginal ultrasound (TVS), 3D ultrasonography and hysteroscopy. Patients and methods: This study included 100 patients complaining of perimenopausal bleeding. All the selected patient had subjected to careful history taking and then underwent general examination, local pelvic examination, office hysteroscopy transvaginal 2D pelvic ultrasound, 3D endometrial volume measurement and then dilatation and curettage (D and C) or hystroscopic guided biopsy for focal endometrial. Those patients were divided into 2 groups based on the endometrial histopathology into: Group A patients with hyperplasia and malignant conditions ; Group B patients with other causes of abnormal uterine bleeding.Results: The age ranged between 41 and 50 years with a mean of 49.4 ± 1.22 years. They had a mean parity of 3.2. The most common bleeding pattern was menorrhagia In group 1 the most common endometrial histopathology was simple endometrial hyperplasia. In group 2, the most common endometrial histopathology was disordered proliferative endometrium. In our study there was a high statistical significance as regard endometrial thickness in comparison of both groups; In group 1 endometrial thickness was 15.37 ± 2.27mm ; while in group 2, it was 11.90 ± 2.97mm. As regards the measurement of endometrial volume, in our study there was a high statistical significance in comparison of both groups; in group 1 endometrial thickness was 14.11 ± 2.1cc, while in group 2 it was 7.67 ± 1.81cc. Also endometrial volume was significantly different when used to compare between atrophic endometrium and other benign endometrial pathology. As regards the results of hysteroscopy, it showed the highly statistical significance in the ability to differentiate between group 1 and 2. In group 1 it was able to detect 82% of hyperplasia cases and 100% of endometrial cancer cases while in group 2 it was able to detect 76% of cases.