Dilatation and curettage (D + C) is the most common operation performed in Britain. The liberal use of D + C has been criticised. The objective of this study was to evaluate the use of outpatient endometrial pipelle biopsy and determine its safety in terms of detecting abnormalities. Complications and financial costs were also evaluated. Data were reviewed from an active gynaecological unit from February 1993 to January 1995. A total of 303 D + Cs and 104 endometrial pipelle biopsies were performed in this period. Nine malignancies were detected by D + C and 1 by pipelle biopsy. A total of 24 and 3 benign abnormalities were detected by each method respectively. There was a higher complication rate in the D + C group but the failure rate was higher in the endometrial pipelle biopsy group. The monetary savings over this period is estimated at 20,307 pounds. There were no missed malignancies to our knowledge over the 8 yr period since endometrial pipelle biopsy was introduced to the hospital.