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Introduction: Endometrial cavity is frequently studied because of abnormal uterine bleeding, pelvic pain, infertility, pregnancy complications, and suspect cases of endometrial cancer. Abnormal uterine bleeding dedicates one third of women's referral to gynecologic specialists. Transvaginal Ultrasonography is one of the diagnostic modalities of endometrial examination. The aim of this study is to compare the endometrial transvaginal ultrasonography with histopathology as a golden standard in patients complaining abnormal uterine bleeding. Methods: This descriptive-analytical retrospective study was held on of 225 patients complaining abnormal uterine-bleeding who had transvaginal ultrasonography and definite histopathological reports admitted in Shahid Sadooghi, Goodarz, and Mojibian hospitals of Yazd, Iran in the years 2006-2007. Transvaginal ultrasonography and histopathology results of the questionnaire were recorded separately. Then, the sensitivity, specificity, positive predictive value, and negative predictive value of transvaginal ultrasonography technique for diagnosis of abnormal endometrium, retained product of conception, subendometrial leiomyoma, endometrial hyperplasia, endometrial polyp, and endometrial cancer were calculated by SPSS software version 11. P value less than 0.05 was considered statistically significant. Results: The sensitivity, specificity, positive predictive value, and negative predictive value of transvaginal ultrasonography are 100%, 29.6%, 81.8%, 100% in diagnosing abnormal endometrium, 100%, 86.7%, 51% and 100% in diagnosing retained product of conception, 100%, 87.5%, 58.6%, and 100% in diagnosing subendometrial leiomyoma, 89%, 100%, 100%, and 96.6% in diagnosing endometrial hyperplasia, 44.5%, 100%, 100%, and 90.4% in diagnosing endometrial polyp, and 33.3%, 99.5%, 50%, and 99.1% in diagnosing endometrial cancer respectively. Conclusion: Transvaginal ultrasonography has enough sensitivity for diagnosis of abnormal endometrium, subendometrial leiomyoma, and retained product of conception, and also has enough specificity for rejecting endometrial polyp, endometrial hyperplasia, and endometrial cancer. [ABSTRACT FROM AUTHOR]