Objective: To evaluate the results of a previous study comparing bipolar radiofrequency endometrial ablation with hydrothermablation for the treatment of menorrhagia at 5-year follow-up. METHOD:: A double-blind, randomized, controlled trial was performed in a large teaching hospital in the Netherlands between March 2005 and August 2007. One-hundred sixty women with menorrhagia were randomly allocated to bipolar ablation or hydrothermablation. The results of follow-up at 12 months were previously reported. At 4-5 years of follow-up, a questionnaire was sent to all the participants to register amenorrhea rates, reinterventions, and patient satisfaction. Results: At 5-year follow-up, response rates were 90% and 83% in the bipolar group and hydrotherm group, respectively. Amenorrhea rates were 55.4% and 35.3% in the bipolar group and the hydrotherm group, respectively (relative risk [RR] 1.5, 95% confidence interval [CI] 1.05-2.3). The number of surgical reinterventions was 11 compared with 23 (RR 0.43, 95% CI 0.23-0.80). Overall, more women were satisfied in the bipolar group compared with the hydrotherm group. Conclusion: After treatment, bipolar radiofrequency endometrial ablation system is more effective at 5 years than hydrothermablation in the treatment of menorrhagia.