Beginning in the mid 40s most women s hormones levels tend to fluctuate a great deal which is why your cycles maybe heavier and you ablation less effective. Oral contraceptive pills will decrease menstrual flow however there are several other things you could consider. Since you don t need contraception there is a procoagulant medication on the market that should decrease heavy menstrual bleeding and is nonhormonal. You can ask your gynecologist for prescription called Lysteda. Another alternative if you wish to avoid systemic hormones such as you would get with birth-control pills, is the Mirena IUD. It will be like having a second surgical ablation and over time will decrease your menstrual flow over 90%. Depending on what type the side effects you are trying to avoid by not taking oral contraceptive pills, there is an oral progesterone only pills sometimes called the mini pill which will also decrease menstrual blood flow though not as much as the IUD and not as quickly as the combination pills. I hope you find these answers helpful