Objective: To explore the effect of transvaginal ultrasound (TVS) combined with hysteroscopy (HS) in the etiological diagnosis of perimenopausal abnormal uterine bleeding (AUB). Methods: A retrospective study was performed on the clinical data of 90 patients with AUB in the hospital between May 2021 and May 2024. All patients underwent TVS combined with HS. Taking pathological results as the golden standard, value of TVS and HS in the etiological diagnosis of AUB was analyzed. Results: According to pathological diagnosis, proportions of benign lesions and malignant lesions were 88.89% (80/90) and 11.11% (10/90), respectively. The diagnostic sensitivity of TVS and HS was 60.00% and 80.00%, specificity was 73.75% and 90.00%, respectively. The sensitivity and specificity of TVS combined with HS were 100.00% and 95.00%, respectively. The diagnostic accuracy of TVS combined with HS was 95.55%, higher than that of HS and TVS (88.89%, 71.11%, P<0.05). Conclusion: TVS combined with HS has high value in the etiological diagnosis of AUB, and combined detection can improve diagnostic sensitivity and specificity.