Background: Perimenopausal bleeding is a real clinical challenge facing gynecologists, which should indicate suspicion of endometrial malignant changes development and needs accurate evaluation of endometrium and uterine cavity. Objective: To provide a clear understanding of the value of office hystroscopy as a diagnostic tool during assessment of women with perimemnopausal bleeding. Patient and Methods: This prospective study included case records of 50 women with perimenopausal bleeding undergone office hysteroscopy and endometrial biopsy between 2017 and 2019 at Al Sayed Galal Hospital, Al-Azhar University, Cairo, Egypt. Results: Sonographic findings of malignant or premalignant endometrium showed 25% sensitivity and 100% specificity for endometrial thickness ≥ 17 mm and 100% sensitivity and 58.7% specificity for endometrial thickness ≤ 10 mm. Sonographic findings of abnormal endometrial pathology showed 37.06% sensitivity and 100% specificity for endometrial thickness ≥10 mm and 88.24 % sensitivity and 57.14 specificity for endometrial thickness ≤ 7 mm. Hysteroscopic findings of malignant or premalignant  showed 100% sensitivity and 76.09% specificity for endometrial thickness, 60% sensitivity and 93.48 specificity for endometrial polyp , 100% sensitivity and 100% specificity for endometrial mass and 50% sensitivity and 95.6% specificity for hypervascular endometrium .Hystroscopic findings of abnormal endometrial pathology showed 77.8% sensitivity and 92.7% specificity for thick endometrium , 80% sensitivity and 92.6% specificity for endometrial polyp , 22.2% and 100% specificity for endometrial mass, 22.2% sensitivity and 95.1% specificity for hypervascular endometrium. Conclusion: Office hysteroscopy can be considered as a golden standard tool in diagnosis and management of perimenoipausal bleeding. It is valuable in assessment of endometrium and helpful in management planning.