STUDY OBJECTIVE To compare the results of endometrial ablations performed either with the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser or electrosurgically. STUDY DESIGN Retrospective study, with 4-year follow-up of 82 of 98 patients. SETTING Gynecology departments of teaching, community, and proprietary hospitals. PATIENTS One hundred sixty-six women requiring surgical treatment for menorrhagia between March 1986 and October 1992. INTERVENTIONS Fifty-eight women were treated with a Nd:YAG laser, 11 with a rollerball electrode, and 97 with a wire loop electrode. Concomitant resection of submucous leiomyomata was performed in 54 (32.5%) of the patients. MEASUREMENTS AND MAIN RESULTS The mean operating times, complication rates, mean volume of fluid absorption, concomitant surgery, morbidity, duration of hospital stay, and results of laser and electrosurgical endometrial ablations were similar. Thirty-nine women (69.9%) undergoing laser endometrial ablation became amenorrheic and 54 (96.4%) had satisfactory results after 6 months. Seven (63.3%) of the women who had a rollerball ablation became amenorrheic, and 10 (90.9%) had satisfactory results. Sixty-one women (70.9%) who underwent wire loop resection became amenorrheic, with 83 (96.5%) attaining satisfactory results. Four years postoperatively, 85.4% of the patients continued to have satisfactory results. CONCLUSIONS Laser and electrosurgical endometrial ablations are similarly effective treatment for patients suffering from chronic menorrhagia. This preliminary study should be followed by a randomized, controlled, prospective study to evaluate the two techniques more fully.