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Menstrual disorders are common, accounting for about 3% of female consultations in general practice. Although only 10% are referred to a specialist, GP referrals for dysfunctional uterine bleeding (DUB) went up by 73% between 1971 and 1981 in England and Wales. ~ First line management is usually medical, using prostaglandin synthetase inhibitors, progestagens, danazol, antifibrinolytics, ethamsylate or even LHRH analogues. However, medical treatment is frequently ineffective, may cause unacceptable sideeffects, and any therapeutic effect may be temporary. This has led to an increasing demand in the last 30 years for hysterectomy, which has until recently been the only definitive treatment. The current lifetime risk of a woman undergoing hysterectomy is 20% in the UK,-40% in Australia, and around 50% in the USA. The hysterectomy rate in Scotland has doubled since 1960 due almost exclusively to an increase in operations for menstrual disorders, mainly in women aged 35-44. 2 In Scotland in 1984, 35% of hysterectomies were for menstrual disorders; similarly 30% of hysterectomies in the Oxford region in 1988 were for disorders of menstruation) This desire by an increasing number of women for effectivetreatment of DUB has led to a need for less invasive surgical treatment than hysterectomy. This has stimulated the introduction of hysteroscopically guided destruction of the endometrium. An impression may be given by enthusiasts of so-called 'minimally invasive' surgery that hysterectomy for