Background and purpose: Abnormal uterine bleeding is a common presenting symptom of most of the benign and malignant uterine lesions among perimenopausal women. Although age-related, systemic, iatrogenic, and hormonal causes are more common and can be diagnosed by readily available lab tests, structural causes (either benign or malignant) are of concern to the patients in perimenopausal age women, when imaging (TVS, and MRI) comes into play. This study aims to compare the role of TVS and MRI in the characterization of uterine lesions presented as perimenopausal bleeding. Results: This observational prospective study was performed at a single tertiary care centre, comprising 52 consecutive patients of perimenopausal bleeding. All patients were subjected to TVS and MRI examination and correlation with histopathology was done. Most of the patients (44.2%) in our study belonged to age group of 40 to 49 years, with mean age for benign and malignant lesions was 46.81±8.5 and 52.10 ±7.05 respectively (p = 0.025). For evaluation of malignant lesions, sensitivity and specificity of MRI (100% and 96.87% respectively) was found to be higher than TVS (60% and 93.75% respectively with false negative rate of 40%) when both were compared with histopathology. Conclusion: Although TVS continues to remain the mainstay imaging modality, MRI because of excellent tissue delineation has demonstrated its superiority to TVS, for depicting and characterizing the unique features of various uterine lesions.