Background: Abnormal uterine bleeding (AUB) is defined as any type of bleeding in which the duration, frequency, or amount is excessive for an individual patient. Aims: To evaluate the diagnostic accuracy of TVS and hysteroscopy in order to examine if the number of hysteroscopic procedures can be reduced. Materials and Methods: The study selected 80 women with abnormal uterine bleeding randomly among the patients attending the Gynaecology OPD who met the inclusion criteria. Detailed history and general and gynaecological examination was followed by TVS, hysteroscopy and curettage and removal of abnormal lesions like polyps and submucous fibroid and the material was sent for histopathological analysis. Results: Hysteroscopy reported 75% findings as abnormal while in 25% cases no abnormality was detected. The commonest lesion detected by hysteroscopy was endometrial polyp – 41.25%. The overall sensitivity, specificity, PPV, NPV for hysteroscopy was 98.24%, 82.61%, 93.33% and 95% respectively. TVS reported 85% as abnormal findings and in the remaining 15% no abnormality was detected. Most common abnormal lesion detected by TVS was Endometrial Hyperplasia (58.75%). The overall sensitivity, specificity, PPV, NPV for TVS was 96.49%, 43.48%, 80.88% and83.33% respectively. Overall accuracy of hysteroscopy in this study was 93.75% and that of TVS was 81.25%. Conclusions: Both TVS and hysteroscopy can detect endometrial abnormalities with varying accuracies. These can supplement and enhance the accuracy of tissue diagnosis. Transvaginal ultrasonography should be the first procedure for evaluation of AUB and if necessary, a hysteroscopy with directed biopsy should be performed.