This study was undertaken to evaluate the role of thermal balloon endometrial ablation (Thermachoice), in the management of perimenopausal menorrhagia. The study included thirty patients presenting with perimenopausal menorrhagia. They were divided into two groups. Group A patient (20), were treated by thermal balloon endometrial ablation. Operative and postoperative complications and results of the procedure during a one year follow up period, were thoroughly studied and evaluated. The success of the procedure was 85% which was assessed by the improvement of the menorrhagia after the one year follow-up. Group B patients (10), were treated by thermal balloon ablation followed by hysterectomy in the same setting for histopathologic examination of the removed uteri to study the thermal effect on the endometrium and success was assessed by the extent of destruction of the endometrium. It was concluded that the procedure is safe and effective however long-term sequelae of thermal balloon endometrial ablation have yet to be determined. Only longer careful follow up can accurately measure the risks of the procedure and address the true role of this form of therapy for menorrhagia.