The rapid advances in minimal invasive techniques have led to the recent introduction of two new surgical approaches for the management of severe dysfunctional bleeding: hysteroscopic endometrial ablation (HEA) and laparoscopic assisted vaginal hysterectomy (LAVH). We compared two groups of women with menorrhagia and a nonprolapsed uterus sized less than 14 weeks, who underwent either HEA (n = 63) or LAVH (n = 30). The operating time, hospital stay, and number of women requiring postoperative blood transfusion was significantly lower (p < 0.001) in the HEA group. Complications following HEA included uterine perforation in 3 patients, fluid overload (>2000 mL) in 2, and dilutional hyponatremia in a single patient. Laparotomy was performed for suspected bowel injury in 2 cases. The main complication in women undergoing LAVH was postoperative fever in 16.7% of the patients. In 1 patient, the hysterectomy was completed abdominally because of failure to control bleeding in the vesicouterine space. We conclude that HEA and LAVH are associated with an acceptable rate of surgical complications. LAVH offers a definite treatment for dysfunctional uterine bleeding and avoids the need for contraception and the danger of uterine malignancy. However, HEA is associated with more rapid recovery and may be preferred by women desiring to keep their uterus. (J GYNECOL SURG 11:215, 1995).