Objective To analyze the diagnostic value of hysteroscopy for abnormal vaginal bleeding in perimenopausal women.Methods A total of 313 patients with perimenopausal bleeding who were treated in the Department of Gynecology and Obstetrics,Chengxiang District Hospital of Putian City,Fujian Province from January 2020 to December 2021 were selected as the research objects.All patients underwent vaginal B-ultrasound and hysteroscopy.The gold standard is to compare the detection rates of different methods for abnormal vaginal bleeding with different etiologies,and to compare the diagnostic efficacy of different methods.Results The results of pathological examination showed that among the 313 perimenopausal women,253 were endometrial lesions,60 were endometrial normal.90 were endometrial hyperplasia,67 were endometrial polyps,45 were endometrial polyps,27 were subendometrial fibroids,and 24 were endometrial carcinomas in endometrial lesions patients.The coincidence rate of hysteroscopy in the diagnosis of abnormal vaginal bleeding was 96.84%,which was higher than 83.40% of vaginal ultrasound,and the difference was statistically significant(P<0.05).The sensitivity of hysteroscopy in the diagnosis of abnormal uterine bleeding was 96.84%,the specificity was 90.00%,the accuracy was 95.53%,the positive predictive value was 97.61% and the negative predictive value was 87.10%,which were higher than 83.40%,75.00%,81.79%,93.36% and 51.72% of vaginal B-ultrasound,and the differences were statistically significant(P<0.05).Conclusion Hysteroscopy can accurately detect abnormal vaginal bleeding in perimenopausal women,identify the cause of bleeding,and provide a basis for the development of disease treatment,which has promotion value.