Introduction: The most prevalent menstruation problem during the perimenopause is abnormal uterine bleeding (AUB). A method of categorization (PALM–COEIN) for the etiology of the AUB in non-gravid women has been created by the International Federation of Gynecology and Obstetrics working group on menstrual disorders. The current study's objectives were to investigate the two parts of this system in clinical practice generally and, in particular, to demonstrate a clinico-pathological association between the AUB and the PALM component. Materials and Method: This study was conducted on 100 perimenopausal women with symptoms of abnormal uterine bleeding. The subjects were aged 40 years and above and till one year after menopause. A clinical diagnosis was established using the PALM–COEIN classification following a comprehensive history and examination, followed by pelvic ultrasound.Analysis was done on the relative contributions of the different causes of the structural (PALM) and functional (COEIN) components. Histology evaluated the hysterectomy specimen and endometrial sample following all recommended investigations. A statistical analysis was performed on a clinicopathological connection. Results: When evaluated clinically, the contributions of the COEIN and PALM components to AUB were almost identical. Conversely, the histological analysis demonstrated a notably higher number of instances of the PALM (structural) component of AUB, namely 63%versus 48% (p < 0.05). AUB-L was the most prevalent (43%) aetiology overall. The discrepancy was primarily explained by the discovery of more instances of AUB-M (malignancy and hyperplasia) in highly significant proportions (p ≤.01) and coexisting cases of AUBA;L.Conclusion: Since the two diagnostic modalities are complementary, the PALM– COEIN classification system should consider both the clinical and histological diagnoses in women with AUB around perimenopause. This will optimize the outcome by placing the clinical impression in the appropriate context of the classification.