Objective: To characterize office and operating room hysteroscopy in women 70 years of age or older. Design: This was a retrospective chart analysis. Setting: A single tertiary-care medical center. Population: All women aged 70 years of age or older who underwent a hysteroscopy procedure between March 2011 and August 2018. Methods: All hysteroscopic interventions performed during the study period were reviewed. All patients had at least one gynecological examination that included an ultrasound study prior to the hysteroscopy. Main outcome measures: Primary outcomes included procedure success and histopathological findings. Secondary outcomes included short-term complications of the procedure. Results: The data of 577 patients were analyzed. The median age at the time of the procedure was 76 years. 225 office hysteroscopy procedures and 405 operating room procedures were included. Of the 236 patients with PMB, 73(30.9%) were diagnosed as having malignancy compared to 25 (7.3%) of the 341 patients with no PMB (p < .001, odds ratio (OR) = 5.66; confidence interval (CI) 3.46-9.26). The office procedure was successful in 194 (87%) patients. 53 patients required a second hysteroscopy, which revealed 12 cases of premalignant or malignant lesions. The volume of procedures in the office increased 16 times during the study period. Conclusions: Office hysteroscopy for women over the age of 70 is safe, feasible, and reliable for diagnosis of endometrial malignancy. Failed hysteroscopy and a moderate-to-high index of suspicion for malignancy indicates the need for a repeat hysteroscopy. The diagnostic yield using the office procedure has increased over time.