The objective of this study is to review outcomes and factors predictive of patient satisfaction following NovaSure endometrial ablation in the treatment of menorrhagia. NovaSure endometrial ablation has been established as a safe and effective treatment for menorrhagia. The setting of a hospital that is the biggest user of NovaSure in Ireland, coupled with a stable population, provided a unique opportunity to obtain accurate long-term follow-up data on the largest sample size reported to date. This is a retrospective observational study of 400 women who attended for NovaSure endometrial ablation between December 2006 and December 2009. Information was collected from patient charts and followed up with postal and telephone questionnaires. Statistical analysis was performed using SPSS version 18. The mean age and parity of patients were 44 years and 2.84, respectively. Three hundred and sixty-eight patients underwent the procedure, with an average treatment time of 88 seconds’. Eighty-seven percent of patients were satisfied with the procedure, with 59% achieving amenorrhoea. Subsequent hysterectomy was performed in 7.6%. The complication rate was 14% (32 abandoned procedures and 23 in-patient admissions following the procedure). There were no uterine perforations. Women with longer uterine cavities were less likely to be satisfied with the procedure (p = 0.045). Satisfaction rate at 1-year follow-up was 95%. NovaSure endometrial ablation is a highly effective treatment for menorrhagia. We recommend outpatient follow-up of women with longer cavities as further treatment may be necessary.