Background: For premenopausal women, heavy menstrual bleeding HMB) is a serious health issue that can lower their quality of life and result in anemia. First-generation procedures like transcervical resection of the endometrium (TCRE) are regarded as the benchmark by which second-generation techniques like balloon, cryoablation, thermal laser, and bipolar electrode ablation are measured. Thermablate Endometrial Ablation System (EAS) is relatively new in the market. Aim: To evaluate the short-term effects and sequelae of two conservative surgical approaches; hysteroscopic partial endometrial resection versus thermal balloon ablation for treatment of heavy menstrual bleeding (HMB) in premenopausal women Methods: This prospective randomized control trial was conducted on women who attended to Department of Obstetrics and Gynecology of Zagazig University Hospital and Aga Hospital for treatment of premenopausal bleeding. Patients were divided into two groups: group (1): 31 women with heavy menstrual bleeding who were treated by hysteroscopic partial endometrial resection and group (2): 31 women with heavy menstrual bleeding who were treated by thermal balloon ablation. Results: There was no statistical significance difference between two groups regarding unexpected bleeding and satisfaction. Hospital stay and time to normal activity in HPER group was significantly lower than TBA group. Conclusion: TBA and hysteroscopy resection had similar success rate in women with menorrhagia . After a 6-month follow-up of treatment, there was no difference between the two groups' surgical success rate or satisfaction. Despite this, TBA is superior to HPER in terms of cost, length of hospital stay, and time needed to resume regular activities .