84 perimenopausal women with uterine bleeding underwent transvaginal ultrasonography and hysteroscopy. Sonographic and hysteroscopic findings have been evaluated on the basis of specimens obtained from either endometrial biopsy, hysterectomy or operative hysteroscopy. Sensitivity, specificity, positive and negative predictive value of hysteroscopy and transvaginal ultrasonography were calculated. Hysteroscopy had 91.6% sensitivity, 83.3% specificity, 93.2% positive predictive value and 80% negative predictive value in the diagnosis of intrauterine abnormality, whereas transvaginal ultrasonography had only 67.3% sensitivity, 87.5% specificity, 89.7% positive predictive value and 62.2% negative predictive value. In consequence hysteroscopy is better than transvaginal sonography concerning only the sensitivity (p < 0.01). Transvaginal ultrasonography seems to be an excellent initial diagnostic method, but hysteroscopy is a highly accurate means of diagnosing the cause of excessive uterine bleeding.