Myometrium is the chief bulk-forming layer of the uterus. Abnormalities of the myometrium may lead to abnormal peristalsis and abnormalities of circulation, and both may lead to dysfunctional uterine bleeding (DUB) and/or infertility. But, many of these are detected only as incidental finding. Assessment of myometrium, therefore, requires a systematic approach, and this has been defined by morphological uterus sonographic assessment (MUSA). This helps correct localization of the lesion and also decides the surgical approach. B mode as well as Doppler plays an important role in confident differential diagnosis of the common myometrial lesions: adenomyosis and fibroids.