Introduction: Abnormal uterine bleeding (AUB) is one of the most common symptoms with which patients visit to a gynecologist. Abnormal uterine bleeding is responsible for more than one-third of gynecological consultations and nearly two-thirds of hysterectomies.¹ Aims and objectives: • To evaluate the accuracy of hysteroscopy in diagnosing various conditions causing AUB. • To compare hysteroscopic findings with transvaginal sonography (TVS) findings. Materials and methods: A prospective study was conducted on 100 women fitting into the inclusion criteria in the Department of Obstetrics and Gynaecology at Vydehi Institute of Medical Sciences and Research Center, Bengaluru. Detailed history, clinical examination, TVS, hysteroscopy, and preoperative investigations were carried out and results were correlated. Results: In the present study, majority of the patients were in perimenopausal age group. Transvaginal sonography has showed 12% and 8.3% sensitivity in detecting polyp and submucosal fibroid when compared to hysteroscopy. Transvaginal sonography showed poor correlation with hysteroscopic findings for intracavitary pathology. Intrauterine adhesions were missed by TVS in three cases which were diagnosed by hysteroscopy. Conclusion: There is an increased incidence of intracavitary uterine pathology in patients who present with AUB. The poor sensitivity of TVS in detecting intrauterine pathology urges us to suggest that hysteroscopy can be utilized as a first-line investigation in these patients. As many cases with intracavitary lesions and carcinoma were not diagnosed by TVS, the need for number of diagnostic hysteroscopies (invasive) could not be minimized by TVS (noninvasive) examinations. Hysteroscopy can be used not only for therapeutic purpose but also for diagnostic tool in cases who present with AUB, clinically enlarged uterus, and significant anemia.