Dr Goldstein’s review article on the role of transvaginal (TV) ultrasound (U/S) or endometrial biopsy in the evaluation of the menopausal endometrium is extremely important from a practical standpoint. He mentioned that one of the limitations of TV U/S was previous uterine surgery. In this context, the increasingly popular total or global endometrial ablation (GEA) to treat menorrhagia must be discussed since >400,000 GEAs are being performed annually in the United States. It is now evident that after a GEA, significant intrauterine scarring and contracture occur. There is concern that bleeding from persistent or regenerating endometrium behind this scarring could be obstructed and delay the diagnosis of endometrial cancer. Since cases of asymptomatic postablation endometrial cancers have already been reported, periodic postmenopausal TV U/S has been recommended to rule out obstructed endometrial growth. Unfortunately, if an abnormal endometrial echo complex (EEC) is found, it is difficult to evaluate for multiple reasons. It has not been determined what an abnormal EEC is after a patient has had an ablation. Sonographic artifact from the scar tissue may result in variations in U/S interpretation. It is not known if an endometrial thickness measuring <4 mm is also considered normal in patients who have had an ablation. Further, if an abnormal EEC is discovered, postablation scarring makes thorough evaluation of the intrauterine cavity difficult to impossible. Saline infusion sonograms, endometrial biopsies, and diagnostic hysteroscopy are also unreliable after an ablation. U/S-guided operative hysteroscopy is often necessary but dense intrauterine scarring can distort the intrauterine cavity making it difficult to access all endometrial tissue. Even if endometrial tissue is obtained, it is difficult to ascertain if the sample is complete. Often, a hysterectomy is necessary just to resolve this problem. This is becoming a major issue and we would like Dr Goldstein to suggest any solutions that will help resolve this dilemma.