Background Adenomyosis is a gynecological disorder characterized by hypertrophy and hyperplasia of the surrounding myometrium and the presence of ectopic endometrial glands and stroma inside the myometrium. Aims To compare the accuracy of preoperative ultrasound (US) features with the histopathological results for the diagnosis of adenomyosis, and to determine its sensitivity for diagnosis. Patients and methods A total of 100 perimenopausal and postmenopausal patients (aged 40 to 60 years old) presented with abnormal uterine bleeding. Every patient underwent a thorough history taking, general examination, and pelvic examination. The selected patients were subjected to all laboratory investigations, abdominal and vaginal US, and abdominal or vaginal hysterectomy followed by histopathological examination. Results 45 (45%) patients had adenomyosis by transvaginal US and 52 (52%) patients had adenomyosis by histopathology with a P value of 0.105 which means that there is no significant difference between transvaginal US and histopathology in the diagnosis of adenomyosis. Transvaginal US had an 89.0% diagnostic accuracy for adenomyosis, with 82.7% sensitivity, 95.8% specificity, 95.6% positive predictive value, and 83.6% negative predictive value. Conclusion Transvaginal US is an important diagnostic technique for adenomyosis, and there is no significant difference between ultrasound and histology in the diagnosis of the condition.