We conducted a retrospective review of 404 cases of operative resectoscopy and endometrial ablation in women with intractable uterine bleeding, performed at our institutions between July 1990 and May 1995. After the procedure 97% of patients had experienced an improvement in abnormal uterine bleeding with 216 (58%) experiencing amenorrhea, 134 (36%) hypomenorrhea, and 7 (1.9%) eumenorrhea. Pathologic findings were normal uterus in 152 women (37%), myomata in 130 (32%), polyps in 84 (20%), adenomyosis in 46 (11%), endometrial hyperplasia in 23 (5%), endometritis in 6 (1.4%), adenomyosis in 5 (1.2%), and adenocarcinoma in 1. Only 10 women (3%) had no improvement or became worse after surgery. Twenty-eight were lost to follow-up. Follow-up ranged from 4 to 58 months. No serious complications requiring hospitalization occurred. Operative resectoscopy in conjunction with endometrial ablation is safe and effective in treating intractable uterine bleeding.