Background: In the peri- and postmenopausal years, abnormal uterine bleeding (AUB) is the most prevalent reason for gynecological appointments. Aim of the work: To detect the role of office hysteroscopy and three-dimensional (3D)  endometrial volume measurement in the evaluation of women with perimenopausal bleeding. Patients and methods: This study was conducted at Al-Azhar University in Al Hussein university hospital from March 2017 to October 2019 Obstetrics and Gynecology department. The research included 100 studied cases complaining of perimenopausal bleeding at the outpatient clinic. Results: hyperplasia followed by complex endometrial hyperplasia and only 1 case of endometrial carcinoma was discovered. In group 2 most common endometrial histopathology was discovered proliferative endometrium then secretory endometrium and 6 cases of atrophic endometrium. Conclusion: In cases of perimenopausal bleeding, this study demonstrated the diagnostic value of office hysteroscopy and three-dimensional (3D) ultrasonographic endometrial volume measurement, and showed that combining those 2 modalities of diagnosis had led to increase the ability & sensitivity of diagnosis and With perimenopausal women with irregular uterine bleeding, the capacity to rule out significant intrauterine disease to minimize further operative interventions, especially for surgically high-risk patients.