Office endometrial sampling is widely used as the first diagnostic test in women with abnormal uterine bleeding. Because office sampling is a blind procedure, the lesion causing the symptoms may be missed. The use of ultrasound before, during, and after office endometrial sampling im-proves relevant tissue yield. The measurement of the endo-metrial thickness informs if sampling is indicated. The evalu-ation of ultrasound features (without or with fluid instillation) may suggest a focal intracavitary lesion necessitating opera-tive hysteroscopy. The knowledge of the uterine cavity length, shape, and flexion may avoid nonrepresentative sampling. The concordance between the tissue yield and the ultrasound findings reflects the reliability of the sampling. If not concor-dant, further diagnostic steps such as fluid instillation sonog-raphy or hysteroscopy are indicated. We conclude that inte-grating ultrasound in the diagnostic algorithm for uterine intracavitary pathology optimizes office endometrial sampling