First performed in the USA in the 1980s, transcervical resection of the endometrium (TCRE) is a relatively minor surgical procedure which removes the endometrium using a cutting loop under direct hysteroscopic vision in order to lighten menstrual periods.. A 2-year follow-up study found that symptoms were improved to a similar extent by either intervention, but that 93% of patients managed by TCRE judged their treatment acceptable compared with 77% of patients treated medically. Of the women managed medically for up to 2 years, 59% of women requested TCRE or hysterectomy, whereas 17% of the women managed by primary TCRE requested hysterectomy. TCRE was found to improve not only menorrhagia, but also pain, premenstrual symptoms and depression. TCRE is more effective and acceptable than medical management of menorrhagia, and is less traumatic than conventional hysterectomy. Similar to other hysteroscopic (1st-generation) methods of endometrial ablation, larger submucous fibroids and endometrial polyps may be treated and hysteroscopic sterilizations performed simultaneously. Unique among endometrial ablation techniques, TCRE provides tissue for histopathological diagnosis, and has the least requirement for endometrial preparation. Patient selection, preoperative counseling, attention to intraoperative fluid balance and hysteroscopic skill are of supreme importance in this procedure. Despite the ease and safety associated with 2nd generation endometrial ablation methods in the hands of a general gynecologist, they do not possess the above advantages and therefore operative hysteroscopy remains an important skill.