Objectives: The aim of the present study was to evaluate the efficacy of microwave endometrial ablation after endometrial curettage, in selected patients with heavy menstrual bleeding. Material and Methods: Thirty-two premenopausal women with heavy menstrual bleeding underwent microwave endometrial ablation at the Department of Obstetrics and Gynecology of the University of Patras Medical School. All patients did not respond to previous medical treatment, had completed their childbearing, and did not desire future fertility. The authors chose endometrial curettage rather than hormonal pre-treatment (GnRH analogs, danazol) for endometrial preparation. Post-treatment follow up protocol included physical and ultrasonographic evaluation at three, six, nine, and 12 months for the first year and yearly after. Results: The authors had no cases of uterine perforation, thermal injury to adjacent organs, and infection or sepsis. During follow up, there was a gradual decrease in amenorrhea rate (90.6% - 68.8%) and in satisfaction rate (90.6% - 71.9%). Moreover during follow up, eight women underwent to total abdominal hysterectomy. Among them, seven women had uterine myomas and one woman had adenomyosis. Conclusions: Endometrial preparation with endometrial curettage seems to be a good alternative to hormonal pre-treatment. It has the advantage of avoiding delays, side effects, and cost of hormonal pre-treatment. Moreover, microwave endometrial ablation after endometrial curettage is successful and highly acceptable.