This investigation was a prospective study performed at the Gynecological Clinic “Narodni Front” in Belgrade. In the investigated group, endometrial hyperplasia, endometrial polyp, and myoma were diagnosed as the most frequent causes of bleeding during perimenopause. The test group of patients was then subjected to hysterosonography in order to diagnose bleeding etiology, followed by hysteroscopy to confirm its etiology based on hysterosonography. Material was sent for histopathological analysis to definitely confirm the diagnosis. The aim of this study was to the compare the findings of hysterosonography and hysteroscopy to evaluate the sensitivity and efficacy of hysterosonography for diagnosing the etiology of uterine bleeding in perimenopausal women. In the diagnostics of submucosal myoma, endometrial hyperplasia, and endometrial polyps, hysterosonography has proven to be a good screening method. By its use for diagnosing intracavitary uterine pathology, and thus also the pathology of bleeding in perimenopausal women, in many cases hysteroscopy can be avoided. This is a method that is easy to perform, less invasive, less costly to perform, and is well-tolerated.