Objective: To investigate the factors related to perimenopausal abnormal uterine bleeding (Abnormal uterine bleeding, AUB) complicated with endometrial lesions, and propose targeted early diagnosis and treatment strategies. Methods: The clinical data of 70 patients with perimenopausal AUB who were admitted to the hospital from January 2023 to December 2024 were retrospectively collected. According to pathological examination results of the endometrium, the study subjects were divided into two groups: the normal endometrium group (normal group) and endometrial lesion group (lesion group). Univariate and multivariate logistic regression analyses were used to screen the independent influencing factors of perimenopausal AUB complicated with endometrial lesions. Results: Among the 70 patients included in this study, 22 cases had normal endometrium, accounting for 31.43%, and 48 cases had endometrial lesions, accounting for 68.57%. Univariate analysis found that age, body mass index (Body mass index, BMI), endometrial thickness, duration of bleeding, diabetes, intrauterine device placement, and family history of tumor differed significantly between the two groups (P<0.05). Multivariate logistic regression analysis found that age, endometrial thickness, and diabetes were independent influencing factors of perimenopausal AUB complicated with endometrial lesions (P<0.05). The strongest correlation was observed between endometrial thickness and perimenopausal AUB complicated with endometrial lesions ,OR=4.654, 95%CI: 1.976-10.960 (P<0.001). Conclusion: High age, endometrial thickening, and diabetes are independent risk factors for perimenopausal AUB complicated with endometrial lesions. Early screening and intervention should be focused on the elderly, patients with diabetes and endometrial thickening.