Objective: To examine the trends in hysterectomy in New South Wales (NSW) from 1981 to 1999–2000 and the impact of endometrial ablation. Data: Computerised discharge summaries from private and public hospitals for the years 1981, 1991, 1994–1995 and 1999–2000 obtained from the NSW Health Department. All records listing hysterectomy in women over the age of 20 in each period were selected and those listing endometrial ablation since 1991 were also selected. Operative procedure, diagnosis, hospital type, length of stay and demographic data were recorded. Annual figures since 1988–1989 for hysterectomy and ablation were also obtained. Findings: Initially it appeared that the introduction of endometrial ablation might reduce hysterectomy rates, but the combined rate of hysterectomy and endometrial ablation continued to rise to a peak in 1992–1993 and has declined since. The hysterectomy rate in 1999–2000 was lower than in 1981. There has been a marked shift from abdominal to vaginal hysterectomy, with an increase in laparoscopically assisted operations. Overall, the mean age at operation has been rising, although the mean age for vaginal hysterectomy has fallen. The shift to private hospitals and reduction in hospital stay have continued. Conclusion: The trends are consistent with the increased use of laparoscopic and ablation techniques, improvements in hormonal contraceptive use, and better access to abortion, which have facilitated women's decisions to postpone their births and to conserve their childbearing to older ages. Further development of these techniques will have an impact on gynaecological training and practice in the next decade.