Background: Hysteroscopy is a minimally invasive procedure that may be used to analyse data and treat a variety of intrauterine and endocervical issues. The purpose of this work was to evaluate the hysteroscopic diagnostic findings and therapeutic efficacy of hysteroscopy in females with premenopausal uterine bleeding at Tanta University Hospitals. Methods: This was a prospective cohort observational research enrolled 60 premenopausal females aged from 40 to 52 years and presented with abnormal uterine bleeding. All patients were subjugated full history taking, clinical examination (general examination, pelvic examination and abdominal examination) and investigations (laboratory tests including full blood count, thyroid, iron studies, hemostasis disorders, transvaginal ultrasound to evaluate any organic lesion and hysteroscopy).  Results: The success rate of hysteroscope was 100% in in grade I fibroid uterus and was 30% and 0% in grade II and grade III fibroid uterus. 75% of atrophic endometrium, 71% of secretory endometrium, 50% of proliferative endometrium, 100% of hyperplastic endometrium and 100% of endometrial polyp. Conclusions: The gold standard for diagnosing and treating abnormal uterine bleeding is hysteroscopy in the premenopausal period especially of fibroid uterus and endometrial polyp.