OBJECTIVE : To compare tolerance for and feasibility of outpatient flexible hysteroscopy in premenopausal and postmenopausal women. STUDY DESIGN: A comparative, prospective study including 475 premenopausal and 216 postmenopausal women who underwent outpatient hysteroscopy without analgesia. RESULTS: Mean pain score was higher in postmenopausal patients (1.55 +/- 0.56 vs. 1.27 +/- 0.38 [P<.0001]). Outpatient flexible hysteroscopy was feasible without analgesia in 4711475 premenopausal (99.2%) and 210/216 postmenopausal women (97.2%) (P=.07). CONCLUSION. Outpatient flexible hysteroscopy was feasible and well tolerated; local anesthesia should be reserved for postmenopausal women.