A total of 365 women were included in this retrospective study that aimed to correlate the transvaginal ultrasound endometrial thickness and histopathology report of the fractional dilatation and curettage among those presenting with perimenopausal bleeding. The incidence of perimenopasual bleeding was 6.32%. Most were in the 46- 50 years age range and were within gravida 1 to 3 presenting with menometrorrhagia. Transvaginal endometrial thickness was mostly within 0.5cm to 1.50cm. Most common endometrial pathology were endometrial polyp, disordered endometrium and simple hyperplasia without atypia. The incidence of adenocarcinoma was 0.8%. There was no significant correlation between age, gravity and parity and the endometrial thickness as measured on transvaginal ultrasound. There was a significant difference in mean endometrial thickness when comparing patients presenting with vaginal spotting and menorrhagia, vaginal spotting and menometrorrhagia and metrorrhagia and menometrorrhagia. There was a statistically significant difference between the endometrial thickness of those with normal histopathology report, meaning endometrium with no pathology and appropriate with menstrual cycle and those with pathologic findings. Using a cut-off of greater than or equal to 1cm for endometrial thickness showed an OR of 3.57, 95%CI 1.24-10.53 for significant pathologic finding on histopathology report with 69.5% sensitivity, 61.1% specificity, 97.2% positive predictive value and a 9.4% negative predictive value.