OBJECTIVE: Our purpose was to compare office hysteroscopy with transvaginal ultrasonography for diagnosing intrauterine pathologic disorders in patients with excessive uterine bleeding, with specimens obtained from either hysterectomy or operative hysteroscopy used to represent the true diagnosis. STUDY DESIGN: A total of 149 patients underwent office hysteroscopy between January 1998 and December 1999. They were evaluated for complaints of menorrhagia, metrorrhagia, or postmenopausal bleeding. Data encompassing patients age , gravidity, parity, indication, ultrasonographic and hysteroscopic findings, comfort level, time required, and complications were gathered by resident physicians. Most hysteroscopic examinations were preceded by transvaginal ultrasonography. Sixty-five patients underwent operative hysteroscopy or hysterectomy later. The pathologic diagnoses of these specimens were compared with hysteroscopic and ultrasonographic findings, and the sensitivity and specificity of each test were calculated. RESULTS: Hysteroscopy was 79 % sensitive and 93 % specific in diagnosing intracavitary pathologic disorders , whereas transvaginal ultrasonography was only 54% sensitive and 90 % specific. One hundred forty - one patients were comfortable during the procedure, and inspection of the uterine cavity was considered adequate in 136. The majority of procedures were completed in < 7 minutes. Twenty six patients underwent operative hysteroscopy has had a recurrence of abnormal bleeding over a 12 - to 24 - month follow -up CONCLUSION: Office hysteroscopy is a rapid, safe, well - tolerated, and highly accurete means of diagnosing the cause of excessive uterine bleeding. It permits patient and physician to discuss more treatment options before surgery, including outpatient oparative hysteroscopy procedures . This means savings in time and in drug , procedure , professional , and hospital costs. (Gynecol Obstet Reprod Med 2001; 7:36-40)