Background: To explore the value of transvaginal real-time shear wave elastography (SWE) in the diagnosis of endometrial lesions. Methods: A total of 140 female patients with endometrial lesions, confirmed by pathological results, were divided into three groups: 45 cases of endometrial polyps, 29 cases of endometrial hyperplasia and 66 cases of endometrial cancer. A total of 100 cases of normal endometrium were used as the control group, including 52 cases in the proliferative stage and 48 cases in the secretory stage. Transvaginal real-time shear wave elastography was performed in all four groups. Results: Emean, Emax and Esd were expressed as the average standard deviation. Among the control group, the results were 26.24 +/- 9.74, 38.09 +/- 9.18, and 4.25 +/- 2.73 kPa, respectively, in the proliferative endometrium cases and 12.51 +/- 7.46, 27.22 +/- 11.32, 4.40 +/- 2.52 kPa, respectively, in the secretory endometrium cases. Among the experimental group, the result was 15.68 +/- 8.18, 27.28 +/- 10.28 and 3.62 +/- 1.81 kPa respectively in the endometrial polyps cases; 21.20 +/- 12.57, 36.32 +/- 15.04, and 5.09 +/- 3.93 kPa in the endometrial hyperplasia cases; 49.36 +/- 25.51, 86.66 +/- 42.27 and 14.86 +/- 10.63 kPa in the endometrial cancer cases. The difference was statistically significant (P <0.05). When the truncation values of Emean, Emax and Esd were 28.50, 52.45 and 9.05 kPa, respectively, to distinguish between normal endometrium and endometrial cancer, Emax has the highest diagnostic value. Conclusion: Real-time SWE technology might be used as an auxiliary method in the diagnosis and differential diagnosis of endometrial cancer. More quantitative indicators are conducive to diagnosis.