Background: Perimenopausal bleeding refers to any bleeding from the vaginal tract that deviates from the typical frequency, cyclicity, duration, and quantity of flow, occurring at or above the age of Forty. Aim: The current study aimed to examine how individuals who attended an outpatient gynecologic clinic with perimenopausal hemorrhage responded to office hysteroscopy. Patient and Methods:This prospective research was performed on 80 females had perimenopausal hemorrhage who had endometrial biopsy and office hysteroscopy, at Damanhour Medical National Institute from August 2023 till January 2024. Results: According to bleeding pattern, 26 women (32.5%) had menorrhagia, 19 women (23.8%) had metrorrhagia, 22 women (27.5%) had menometrorrhagia, 13 women (16.2%) had polymenorrhoea. According to sonographic analysis, endometrial thickness ranged from (8-25) mm with a mean±SD (13.2±2.9) mm. In 51 women (63.8%) who had a hysteroscopy, the thickness of endometrium was normal; in 49 females (36.2%), it was dense. 66 females (82.5%) had no hysteroscopically visible endometrial lesions, 5 had masses, and 11.3% had polyps in endometrium. Using a hysteroscope to assess endometrial vascularity, we discovered that 69 women (86.3%) had a normal vascularity of endometrium, while 11 women (13.7%) had endometrium hyper vascularity. For endometrial pathology, 3 women (3.7%) exhibited atypia and endometrial hyperplasia, 10 females (12.5%) exhibited atypia-free simple endometrial hyperplasia., and two women (2%) had cancer in endometrium. Conclusion: Office hysteroscopy can be regarded as a definitive and very effective method for diagnosing and treating perimenopausal bleeding.