Abstract Objective: Abnormal uterine bleeding (AUB) is a frequent gynecological complaint that significantly affects quality of life and healthcare resources. Radiofrequency ablation offers a minimally invasive alternative to hysterectomy for the management of AUB, but long-term outcome data remain limited. Methods: This single-center study combined retrospective and prospective components to assess the efficacy and patient satisfaction after endometrial ablation. We analyzed data from 1,757 patients treated for AUB at the Medical University of Innsbruck between 2004 and 2022, including 609 patients who underwent radiofrequency ablation (NovaSure) between 2014 and 2018. Patient-reported outcome was evaluated through standardized telephone interviews. Results: NovaSure was the most commonly used method (63%), followed by ThermaChoice balloon ablation (29%) and hydrothermoablation (1,6%), due to its reduced treatment times and minimal post-operative discomfort. The median patient age was recorded as 46 years. Hysterectomy was required in 13% of cases, but only 7.2% were due to persistent or recurrent AUB. Among 431 patients contacted for follow-up, 90% reported satisfaction (74.5% very satisfied, 15.5% satisfied), 64% experienced complete amenorrhea, and 83% required no further surgery. A hysterectomy post-ablation was mainly associated with fibroid-related bleeding. Long-term follow-up confirmed sustained bleeding reduction and high satisfaction levels, consistent with prior studies. Conclusion: Endometrial ablation is a highly effective and well-tolerated treatment for AUB, achieving high patient satisfaction and significant bleeding reduction over a long follow-up period. Careful patient selection and preoperative assessment are crucial to optimize outcomes and minimize the need for secondary interventions. Keywords: endometrial ablation, radiofrequency ablation, patient satisfaction, hysterectomy