Objective — to evaluate the efficiency and safety of microwave endometrial ablation used immediately after endometrial curettage without prior hormonal preparation. Material and methods. Organ-sparing surgery using microwave endometrial ablation was performed using the Micrоsulis technology in 36 women. All the patients were found to have an endometrial hyperplastic process. Abnormal uterine bleeding, including hyperpolymenorrhea, was noted in 29 (80.5%) patients. All the patients underwent hysteroscopy under intravenous anesthesia, followed by separate endometrial and endocervical curettages. Then hysteroscopy was repeated to monitor the adequacy of endometrial removal with uterine cavity aspiration. Further ablation was performed. Ultrasonography was carried out at 14 days, 6 months, and 1 year postoperatively. Results. Among the 19 patients followed up during a year and more, 17 (89.5%) were satisfied with treatment results, which is comparable with those obtained in other trials (78—94%). Ten (52.6%) of the 19 patients were observed to have postoperative amenorrhea. The remaining patients were noted to have regular scanty menstrual periods within 1—2 days, which was also regarded as a successful result of surgical treatment. Conclusion. Thinning of the uterine lining before microwave ablation is a reasonable alternative to hormone replacement therapy and permits a histological diagnosis of an endometrial hyperplastic process.