Background: Abnormal uterine bleeding is a leading cause of health-care problems for women, their families, and society in general with an estimated prevalence of 90% in perimenopausal women. The wider accessibility of ultrasonography allows faster diagnosis of different causes of abnormal uterine bleeding, helping gynaecologists in planning an effective early management for patients. Objective: To find prevalence of different causes of abnormal uterine bleeding using ultrasonography as a diagnostic tool in perimenopausal women. Material and method: This study was conducted at government hospital, Sialkot, Pakistan, on 100 peri-menopausal female patients of 40-55 years of age who attended the hospital OPD with the complaint of abnormal uterine bleeding during the period of August 2020 to February 2021. Results: Majority of the peri-menopausal women observed were found in the age group of 40-44 years (50%). Most of the peri-menopausal women were multi-parous with mean parity of 4. Menorrhagia (43%) was the most common patient complaint in peri-menopausal women followed by metrorrhagia in 21% and menometrorrhagia in 13%. On ultrasound, fibroids were the most frequent findings diagnosed in 24% of the sample population, endometrial hyperplasia in 17% and PID in 14%. Conclusion: For abnormal uterine bleeding in peri-menopausal women, ultrasonography should be considered as a primary imaging tool as it has proven to be an excellent, inexpensive, non-invasive and safe imaging modality to rule out any structural abnormality.