Objective To compare the diagnostic accuracy of transvaginal sonography and hysteroscopy for intrauterine disorders. Design 300 patients were investigated by transvaginal sonography for abnormal vaginal bleeding. Of these, 112 had subsequent hysteroscopic examination and then had concomitant surgery. Results The accuracy of findings at hysteroscopy and transvaginal ultrasonography were compared with the histopathological and surgical results as the gold standard diagnosis. The sensitivity, specificity, positive predictive value and negative predictive value of transvaginal ultrasonography were 77.4%, 50%, 49% and 78.1%, respectively, for transvaginal ultrasonography, and those of hysteroscopy were 92.3%, 97.4%, 97.3% and 92.6% respectively. Conclusion Hysteroscopy is quick, well tolerated, and more accurate in detecting intrauterine pathology than transvaginal ultrasonography. The uterine cavity can be observed directly under hysteroscopy and this examination can provide a high diagnostic accuracy. Biopsy and treatment can be done at the time of the hysteroscopic examination. Thus it is preferable to transvaginal ultrasound examination.