Background: A significant proportion of women who have endometrial ablation require hysterectomy. The aim of the current study was to identify indications for hysterectomy following endometrial ablation, describe the surgical outcome of minimally invasive hysterectomy (MIH), and report on the ultrasound and pathologic findings among these patients. Material and Methods: We conducted a retrospective chart review study of all patients who had hysterectomy following endometrial ablation between January 2010 and October 2022. The medical records were reviewed and patients characteristics, indications for the hysterectomy, method of hysterectomy, surgical outcome, ultrasound findings before and pathologic findings after the hysterectomy were recorded. Results: 130 patients were included. The median age of these patients was 45 (range 26-74), and the median duration between the ablation and the hysterectomy was 2 years (range <1-25). The most common indications for hysterectomy were abnormal bleeding (36.1%), pelvic pain (32.3%), and both pelvic pain and abnormal bleeding (33.8%). The hysterectomy was performed using MIH techniques in 115 (88.5%) with a median estimated blood loss of 75 mL, and conversion rate of 2.6%. Operative and postoperative complications were 1.4% and 3.9%, respectively, and the median hospital stay was one day (range 0-5). The most common ultrasound findings were uterine fibroids (38.5%), indistinct endometrial lining (30%), myometrial cysts 30 (23%), and adenomyosis (15.4%). The most common pathologic findings were uterine fibroids (50.1%), adenomyosis (35.3%) and endometriosis (17.6%). Conclusions: Half the patients who undergo hysterectomy following ablation do so in the first two years following the ablation. MIH is a safe technique for these patients with excellent surgical outcome. Uterine fibroids are the most common ultrasound and pathologic findings among these patients.