Background: Suction pipelle helps for taking endometrial samples for detection of abnormal uterine bleeding. Objective: To determine if suction pipelle can be used instead of traditional dilatation and curettage (D & C) for detection of endometrial lesions among perimenopausal bleeding patients. Subjects and Methods: We conducted our cross-sectional study, at Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig University Hospitals, and Matrouh Maternity Hospital on sixty patients with abnormal uterine bleeding (AUB). Two samples were taken from women complaining of perimenopausal bleeding, one by pipelle device without need to anesthesia and the other by D & C after general anesthesia, then comparing the findings of histological analysis of both, with D & C, which is the gold standard approach for endometrial sampling. Results: When it came to detecting secretory and hormone-dependent endometrium, atypical hyperplasia and EEC grade 1 with both methods, there was a perfect match. Some cases of proliferative endometrium and simple hyperplasia were correctly diagnosed using the pipelle after D & C failed to do so (20% and 16.6% by pipelle versus 16.6% and 13.3% by D & C respectively). Endometrial polyps and disorganised proliferative hyperplasia were among the conditions that the pipelle failed to detect, and this is disappointing. Conclusion: EEC grade 1 and simple endometrial hyperplasia, as well as secretory endometrium, hormone-dependent endometrium, and simple hyperplasia were all easily diagnosed using pipelle with high sensitivity and specificity. Endometrial polyp and disorganized endometrial hyperplasia were difficult to detect with this test because of its limited sensitivity.