Background: Excessive and abnormal menstrual bleeding is the commonest symptom that brings perimenopausal women to the hospital. This age group is more amenable to serious conditions like endometrial cancers. Therefore, this bleeding should be seriously evaluated to exclude the life-threatening conditions by easily available investigative modalities like biopsy before deciding the line of treatment. This study aimed to examine the histopathological lesions of endometrial tissue. Methods: This cross-sectional study was conducted in the Department of Pathology at a tertiary care hospital over a period of two years. 500 endometrial samples were analyzed, including hysterectomy specimens and endometrial biopsies. Clinical data such as age, symptoms, and provisional diagnosis were collected from records. Specimens were processed routinely, stained with hematoxylin and eosin, and examined microscopically. Data were statistically analyzed using the Chi-square test, with p < 0.05 considered significant. Results: The 500-woman cohort had a mean age of 40–50 years (62%), but significant age-related variations in describing presenting symptoms (χ²=214.53, p<0.001), abdominal pain (30.2%), PV bleeding (27%), and menorrhagia (20.2%) were the most common. From an actual point, uterine/cervical fibroids (39.4%) and DUB/AUB (37.2%) prevailed. Specimens were 79% hysterectomies and 21% biopsies, and specimen type was highly correlated with age (χ² = 17.02, p<0.001). Histopathology showed 98.8% non-neoplastic lesions (proliferative phase (35.8 %), atrophic (11.8 %), simple hyperplasia (8.2 %), and 1.2% malignant neoplasms), primarily endometrioid adenocarcinoma (0.6%). Specimen type was also closely associated with specific histological diagnoses (χ²=68.01, p<0.001). Conclusion: The current study found that histopathological examination plays a critical role in diagnosing endometrial lesions, especially in perimenopausal women. Most specimens, particularly those from women aged 41 – 50 years, presented with a proliferative phase of the endometrium. This study found a significant association between age, clinical presentation, specimen type, and histopathological diagnosis.