Background: Endometrial lesions are a common cause of abnormal uterine bleeding. Ultrasound is a reliable diagnostic tool for those lesions, but not all patients exhibit definite changes in ultrasound, making additional techniques necessary. Elastography, such as shear wave elastography, can assess the mechanical properties of the endometrial lesions and provides a quantitative measure of tissue stiffness and so aids in differentiating different pathologies. Our study aimed to determine the role of shear wave elastography (SWE) in diagnosis of different benign and malignant lesions. Methods: Thirty female patients presented by abnormal uterine bleeding with pathologically proven benign and malignant endometrial pathologies were included in this prospective study and assessed with transvaginal SWE. The mean elasticity values (in Kilopascals), and the ratio of the mean elasticity of the lesion to the mean myometrial elasticity (E/M ratio) were calculated in variable lesions. Results: There was a statistically significant difference in the mean elasticity value (E mean) (P >0.001) as well as the E/M ratio of different benign and malignant lesions (P >0.0001). E mean value in endometrial carcinoma is 39.79 ± 3.65, endometrial hyperplasia is 24.24 ± 1.52, and endometrial polyp 15.74 ± 2.71., the E/M ratio of uterine polyp (0.36 ± 0.07) was statistically significantly lower than other subgroups (P >0. 1). Conclusions: Shear wave elastography is an effective additional method in differentiating between benign and malignant endometrial lesions when combined with conventional ultrasonography