Time to rethink endometrial ablation: A gyn oncology perspective on the sequelae of an overused procedure

CASE New patient presents with a history of endometrial hyperplasia A 51-year-old patient (G2P2002) presents to a new gynecologist's office after moving from a different state.In her medical history, the gynecologist notes that 5 years ago she underwent dilation and curettage and endometrial ablation procedures for heavy menstrual bleeding (HMB).Ultrasonography performed prior to those procedures showed a slightly enlarged uterus, a simple left ovarian cyst, and a non ̶ visualized right ovary.The patient had declined a 2-step procedure due to concerns with anesthesia, and surgical pathology at the time of ablation revealed hyperplasia without atypia.The patient's medical history was otherwise notable for prediabetes (recent hemoglobin A 1c [HbA 1c ] measurement, 6.0%) and obesity (body mass index, 43 kg/m 2 ).Pertinent family history included her mother's diagnosis of endometrial cancer at age 36.Given the patient's diagnosis of endometrial hyperplasia, she was referred to gynecologic oncology, but she ultimately declined hysterectomy, stating that she was happy with the resolution of her abnormal bleeding.