Uterine and adnexal lesions are relatively common conditions during the perimenopause. The risk of malignancy is considerable. Ultrasonography is currently the main imaging tool in Gynaecology. To compare the value of 3D versus 2D ultrasonography , 29 perimenopausal patients with uterine and 22 with ovarian lesions were studied in comparison to histopathological results.It was found that endometrial volume measured by 3D u/s was more accurate in the prediction of endometrial carcinoma than endometrial thickness. 3D u/s could detect and characterize focal uterine lesions (polypi and myomata) better than 2D. Although a scoring system for the prediction of malignancy among ovarian masses based on 3D u/s, without doppler , was not more accurate than 2D, combining 2D and 3D examinations is better than either. Power doppler may further improve accuracy.