Objective To compare outpatient hysteroscopy with day case hysteroscopy in terms of patient satisfaction and acceptability. Setting Gynaecology clinic of a teaching hospital. Participants 100 women. Design and interventions Patients were randomly allocated to outpatient hysteroscopy or day case hysteroscopy provided they had no preference for either procedure. Main outcome measures Satisfaction rate, requirements for postoperative analgesia, speed of recovery, time away from home, and time off work. Results The outpatient group recovered preoperative fitness more quickly than the day case group (2 days (range 1-2.7) versus 3 days (2-4), P < 0.05). After the procedure, the outpatient group were also fully mobile more quickly than the day case group (0 minutes (0-5) versus 105 minutes (80-120), P < 0.001). Requirements for postoperative analgesia were similar in both groups. Overall, 78% of patients considered that the pain from outpatient hysteroscopy was less than that usually experienced during menstruation. Patient satisfaction was similar in both groups (83.6% in the outpatient group versus 77.0% in the day case group). Conclusions Outpatient hysteroscopy and day case hysteroscopy were equally acceptable to patients. Patients recovered significantly more quickly from outpatient hysteroscopy than from day case hysteroscopy.