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Starting menstrual periods (menarche) before age 12 and/or going through menopause later in life raises the risk. It's usually heaviest on Day 2 and Day 3 after you've had the procedure. Endometrial regrowth and intrauterine . Read more: How Long Does Endometrial Ablation Last? . Anyway, i wish . The operative and short-term complications of endometrial ablations are well documented; however, the delayed or long-term complications and their significance are just now being understood. Purpose and Conclusions . Burning. Throbbing. Still, any delay in seeking medical help may allow the disease to progress even further. Because of that change, if you have abnormal bleeding after endometrial ablation, including postmenopausal . It is typically used after medication has failed to control the bleeding. Endometrial ablation is a procedure intended to destroy the endometrium and thereby treat heavy menstrual bleeding in women who have completed childbearing and for whom . Over-the-counter medications such as ibuprofen or acetaminophen can help relieve cramping. Starting periods early is less a risk factor for women with early menopause. Menstrual bleeding problems may be caused by hormone problems. An endometrial ablation is a procedure that destroys/ablates the lining of your uterus. LOEAF describes the complications attributable to endometrial ablation that occur beyond the perioperative period of 1 month. It may seem like your heart is speeding up or slowing down throughout the procedure. These symptoms are more common in later stages of the disease. any patient-reporting signs/symptoms that could indicate a serious complication, e.g., bowel injury, should be thoroughly evaluated wi thout delay. In the largest analysis to date looking at the extent to which vaginal bleeding is associated with endometrial cancer in women who have gone through menopause, 90% of women diagnosed with endometrial cancer reported bleeding before their cancer diagnosis. They are much safer than a hysterectomy and the recovery time is shorter. any patient-reporting signs/symptoms that could indicate a serious complication, e.g., bowel injury, should be thoroughly . This is the most common sign that cancer's on board in your uterus, says Lee. Pain in the pelvis, feeling a mass (tumor), and losing weight without trying can also be symptoms of endometrial cancer. 2014 Nov. 211 (5):556.e1-6. At first, total endometrial ablation seemed extremely safe in the short term. There are different methods of endometrial ablation including: laser beam, electricity, freezing, heating, or . Endometrial Ablation: Endometrial ablation is a procedure in which the lining of the uterus is destroyed. 10 In all, 85% of . Share in the message dialogue to help others and address questions on symptoms, diagnosis, and treatments, from MedicineNet's doctors. It's done to stop or reduce heavy menstrual bleeding. Endometrial ablation is great for those that are not afflicted by more serious endometriosis. But it's only done on women who don't plan to have any children in the future. Failure rates between 16% at 5 years to nearly 26% at 8 years have . Communities > Menopause > D & C plus Endometrial Ablation. . Pain in the pelvis, feeling a mass (tumor), and losing weight without trying can also be symptoms of endometrial cancer. The most troubling kind of late-onset endometrial ablation failure (LOEAF)! These studies also showed that previous cesarean section(s) is not associated with an increased rate of Novasure ® ablation failure. A. November 2011. in Uterine Cancer. But if you are unfortunate enough to be 1 of the ones with a more serious case of endometriosis (like me), excision maybe a better treatment option.While this procedure does not determine what stage endometriosis you are in either, it can help to alleviate symptoms by removing the effected tissue. These symptoms are more common in later stages of the disease. A doctor uses small tools that are put through the vagina to . Refrain from sexual activity for one week, particularly with an endometrial ablation 4. 8, 9. In addition, a review of randomly selected cases of successful endometrial ablation for the same period was performed. You will not have any cut (incision). Endometrial ablation in the management of abnormal uterine bleeding. The expected effect of endometrial ablation usually shows up in a few months and usually lasts for a longer time in most women. Endometrial ablation failure (defined as repeat ablation or hysterectomy) ranges from 10% to 20%. yankeerose1970. Endometrial ablation failure (defined as repeat ablation or hysterectomy) ranges from 10% to 20%. Shiraz: Aseman Street, Bessat Blvd. This information is for you if you are about to have, or you have had, a type of operation to thin or remove your endometrium (the lining of the uterus or womb) in an effort to treat heavy periods. Any bleeding from persistent or regenerating endometrium behind the scar may be obstructed and . I had endometrial ablation procedure done yesterday afternoon amongst other . When pregnancy does not occur, the endometrium is shed each month through menstrual bleeding. I prayed for this to work. I am 48 and currently am experiencing menopausal symptoms. Close . . View messages from patients providing insights into their medical experiences with Endometrial Ablation - Side Effects. Novasure Endometrial Ablation and SEVERE abdominal pain with weight gain Successful pregnancy after Nova Sure endometrial ablation viginal dryness . The problem is that after this procedure, intrauterine scarring and contracture can occur. Content. Endometrial ablation is a minor surgical procedure performed to destroy the inner lining (endometrium) of the uterus. menstrual-type cramping for several days watery, bloody vaginal discharge for several weeks nausea You should seek emergency medical attention if you experience: foul-smelling discharge fever. While some women diagnosed with adenomyosis have no symptoms, the disease can cause: Heavy, prolonged menstrual bleeding Severe menstrual cramps Abdominal pressure and bloating Who Gets. However, as time passed, certain unique long-term complications became evident. Grossly, LPD mimics . Abstract Background: Endometrial ablations are very effective in treating intractable uterine bleeding. Read more: How Long Does Endometrial Ablation Last? . You may have menstrual-like cramps for a few days. LOEAF describes the complications attributable to endometrial ablation that occur beyond the perioperative period of 1 month. Women who have atypical endometrial hyperplasia have a higher risk of developing uterine cancer. Heavy menstrual bleeding is a common gynecologic problem and can negatively affect a woman's quality of life. Signs of infection after endometrial ablation Since it's a minimally invasive procedure, things should be fine, and you should expect to recover in a week and go back to your routine. Post ablation syndrome #1. Endometrial ablation is a minor surgical procedure performed to destroy the inner lining (endometrium) of the uterus. The procedure is not considered a surgery, therefore, you will not have any incision or cut in your body. Master. A: Endometrial ablation can reduce heavy menstrual bleeding significantly. This will contribute to a more effective and individualized preoperative counseling. All these adjectives have been used to describe endometriosis pain. Short term complication may include some cramping, nausea and the urge to urinate frequently. These should be women who have . Total number of menstrual cycles. On the short term, it seems successful, long-term follow-up however, shows decreasing patient satisfaction as well as treament efficacy. 2. Intense cramping or stomach pain. . Heavy bleeding or bleeding that doesn't stop 2 days after your ablation (though spotting is normal) Trouble peeing. It is done to stop or reduce heavy menstrual bleeding. [QxMD MEDLINE Link]. Endometrial Ablation. Endometriosis is a condition that, for some women, can cause such excruciating uterus pain that some describe it as feeling as if their insides are being pulled out of their body. I am 40 years old now but 3 years ago I had an endo ablation because I was having severe pain and erratic bleeding with my periods. In fact, abnormal bleeding happens in 90% of endometrial cancer cases. • a patient with undiagnosed vaginal bleeding . I am currently awaiting results of a biopsy I had yesterday and I'm terrified and the wait is torture . Although techniques vary, the procedure usually is conducted using instruments that deliver heat or extreme cold to the endometrium. Approximately 9% of postmenopausal women who saw a . This is especially true for women nearing menopause or after menopause. Design: Prospective, single-arm study. Although the failure rate is low, continued bleeding or development of pelvic pain after ablation does occur. Generally, the pregnancy rate after ablation is 0.25%‐5.2% depending on the ablative procedure used. J Obstet Gynaecol Can. This treatment is done without making any visible cuts on the body. After endometrial ablation, you might experience: Cramps. The results of endometrial ablation don't . The procedure works by destroying (ablating) the lining of the uterus, known as the endometrium, that is shed each month through menstrual bleeding. Study objective: Endometrial ablation using the NovaSure system (Hologic Inc., Marlborough, MA) is 1 of the treatment options for heavy menstrual bleeding (HMB), which has a reported success rate of 81% to 90%. During an endometrial ablation, the endometrium (lining of the uterus) is destroyed, however, it . Avoid lifting anything heavier than 10 pounds for one week. Endometrial ablation lessens menstrual bleeding or stops it completely. Endometrial ablation treats excessive menstrual blood loss, which may be indicated by: Unusually heavy periods most months. A Brief Guide To Cervical Rhizotomy Premature ovarian failure Are You Suffering From The Symptoms Of A Yeast Infection, Or Plagued By Another Kind Of Vaginitis . Other causes include abnormal tissues such as fibroids, polyps, or cancer of the endometrium or uterus. One consequence of endometrial ablation is that scar tissue forms within the uterus after the procedure, changing the structure of the uterine cavity. Endometrial ablation is a procedure to remove a thin layer of tissue (endometrium) that lines the uterus. 3,4 Two consistent reasons for failure are persistent bleeding and new or worsening pain. 37 (4):362-79. This treatment is done without making any visible cuts on the body. (Canadian Task Force Classification II-2.) When to see a doctor: Foul-smelling discharge Fever Chills Of 10 . A watery discharge, mixed with blood, may occur for a few weeks. On the other hand, getting pregnant after an endometrial ablation brings equal health risks for the mother. Symptoms of an Endometrial Ablation Infection Vaginal Discharge Feeling Ill Painful Urination Lower Back Pain Written by Elizabeth Otto 14 August, 2017 Uterine ablation, also called endometrial ablation, is a medical procedure that destroys the inner lining of the uterus 1. INTRODUCTION. These symptoms can be uncomfortable and disruptive. We aimed to identify predictors for NovaSure endometrial ablation failure. Endometrial ablation is a minimally invasive surgical procedure used to treat . viola682 Member Posts: 2. There even is a post-ablation hysterectomy rate up to 21%. But even a minimally invasive procedure like this might include some chances of infections. Depending upon the technique used, the actual procedure takes around anywhere between 2 and 10 minutes. Of 10 factors analyzed, younger age (defined using cut-offs of 35, 40, or 45 years) and prior tubal sterilization were found to be modestly associated with failed ablation (odds . Nearly 50% of women who undergo this treatment will have their menstrual periods stopped permanently. I had endometrial ablation at the age of 56 after failure to control excessive bleeding with hormones. Depending upon the technique used, the actual procedure takes around anywhere between 2 and 10 minutes. You're bleeding the uterus lining that was destroyed so that you don't have a heavy period later. Endometriosis 101: Covering the Basics. They'll also find information about the dangers of getting pregnant following an ablation; common post-procedure complications like discharge, cramping, nausea, vomiting, and signs of perforation. Investigators performed a review and meta-analysis of 21 studies that reported failure rates for second-generation ablation as well as factors associated with failure. Many women find relief through progestin hormone treatments. Endometrial Ablation. But it is only done on women who do not plan to have any children in the future. • Centers for Disease Control and Prevention . The scarred tissue of the uterus can result in abnormal placental attachment. The procedure is not surgery, so you will not have any cut (incision). condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. • Endometrial ablation does not eliminate the potential for endometrial . LOEAFs present in one of 3 ways: persistent or recurrent vaginal bleeding, the development of cyclic pelvic pain (CPP), and the inability to adequately assess the endometrium in women who later require evaluation. 2009 Oct 7; [4]:CD001501 ). METHODS: A review was conducted on patients who underwent hysterectomy for failed endometrial ablation. Avoid exercise for one week 1. August 2018. in Uterine Cancer. Anemia from excessive blood loss - The Mayo Clinic. But if you are unfortunate enough to be 1 of the ones with a more serious case of endometriosis (like me), excision maybe a better treatment option.While this procedure does not determine what stage endometriosis you are in either, it can help to alleviate symptoms by removing the effected tissue. Investigators performed a review and meta-analysis of 21 studies that reported failure rates for second-generation ablation as well as factors associated with failure. Endometrial ablation is a procedure to remove a thin layer of tissue (endometrium) that lines the uterus. Pelvic pain, a mass, and weight loss. Vaginal discharge. . Endometrial hyperplasia is a condition that causes abnormal uterine bleeding. 2015 Apr. pain when urinating. Signs that you may have heavy menstrual bleeding include if you . The goal of course being to permanently end or at least lessen the severity of a woman's menstrual cycle. I was also told later that this could prevent any warning signs showing up for endometrial cancer (no bleeding). Signs of endometriosis include a fixed . Aching. After endometrial ablation, many women still have periods, but they are much lighter. Endometriosis is a very common debilitating disease occurring in 1-50% of premenopausal women (Weeler, 1989) with a prevalence of 38.5% in infertile women and 5.2% in fertile women (Verkauf, 1987).Patients with endometriosis seek medical care because of pelvic pain, dysmenorrhoea and dyspareunia (Rock and Markham, 1992).The goals of therapy include relief of symptoms . A hysterectomy stops symptoms and eliminates cancer risk. Over time however, the rate of failure increases. In this topic review, endometrial ablation will refer to either non-resectoscopic ablation or resectoscopic ablation, or resection of the endometrium. Endometrial ablation (EA) traces its history to 1898 when Albert Dührssen 1 described the first case of selective endometrial destruction in an attempt to provide relief for a 37-year-old woman "exhausted by profuse and persistent menorrhagia by introducing steam into the uterine cavity for 2 minutes." Dührssen noted that "as a result, the uterus underwent complete . But no signs of any discharge like most have mentioned, only watery bloody discharge, not sure if this is normal. Endometrial Ablation and Menopause. #1. A. But you should consider the potential risks associated with this procedure, especially if you are suspected to have endometriosis based on pelvic pain. Endometrial ablation is a minimally invasive surgical procedure that involves the destruction of the uterine endometrium commonly performed for menorrhagia in premenopausal or perimenopausal women.. It has evolved as an alternative to hysterectomy and is associated with good outcomes and patient satisfaction 1.. Radiologists may encounter complications of ablation on pelvic imaging and so need . It may also be helpful if you are a partner, relative or friend of . [QxMD MEDLINE Link]. Endometrial ablation destroys the uterine lining. Iranian Surgery Address. Enough blood loss to soak through a pad or tampon every hour on the heaviest days. You may have period-like cramps for one to three days after an endometrial ablation. Easy, fast, thorough, and no side effects. Endometrial ablation should be used to treat premenopausal women with normal endometrial cavities who have menorrhagia or patient-perceived heavy menstrual bleeding. Urgh, I'm really disappointed. Still, any delay in seeking medical help may allow the disease to progress even further. Stabbing. Of the various kinds of endometrial ablation failure listed above the most troubling is cyclic pelvic pain (CPP). The opposing walls of the myometrium collapse onto each other, and the damaged tissue . Of 10 factors analyzed, younger age (defined using cut-offs of 35, 40, or 45 years) and prior tubal sterilization were found to be modestly associated with failed ablation (odds . You may have light bleeding or pink discharge for a few weeks after. Instead your healthcare provider puts small tools through your vagina . Since then I have not had a period and it has been a heaven sent - no period = no pain. Of 10 . With cyclic pelvic pain women often experience cyclic pain-once a month at the time of their cycle-that may last anywhere from a day or two up to 2 weeks. Jamiek Member Posts: 25. These are warning signs of infections or complications after your endometrial ablation: A fever Increased pain and swelling after a few days Trouble passing gas and/or stool Being sick to your stomach Trouble drinking fluids Trouble urinating A change in the vaginal discharge in color or smell tified. There are different methods used for endometrial ablation, but they all involve destroying a layer of . Having more menstrual cycles during a woman's lifetime raises her risk of endometrial cancer. pelvic pain (usually a symptom of later stages of disease) unexplained weight loss (usually a symptom of later stages of disease) While these and other symptoms do not necessarily indicate cancer, you should consult your doctor for examination, since early detection of many types of uterine . Mashhad: W Danesh st . RF Uterine Ablation can cause uterine cancer. Endometrial ablation recovering well patient information leaflet. Endometrial ablation (EA) is a frequently used treatment for abnormal uterine bleeding, mainly due to the low risks, low costs and short recovery time associated with the procedure. Preoperative uterine bleeding pattern and risk of endometrial ablation failure. The endometrium must be destroyed or resected to the level of the basalis ( figure 1 ), which is approximately 4 to 6 mm deep, depending upon the stage of the menstrual cycle. A. Before the ablation I was having severe hot flashes at random times, night . Heavy periods happen for lots of reasons. The uterus is a pear-shaped organ located in the lower abdominal (pelvic) area where a baby grows during pregnancy. Body mass index (BMI, calculated as weight (kg)/[height (m)]2), post . Smithling KR, Savella G, Raker CA, Matteson KA. In 2014 I had an ablation for abnormal uterine bleeding. This tissue is known as endometrium. Aa. The results of endometrial ablation don't . 1 Endometrial ablation is an effective treatment option. pain during sexual intercourse. We analyzed the clinicopathologic features of 164 hysterectomy specimens after endometrial ablation, 19 of which were performed for . is a benign disease with multiple small nodules over the surface of the pelvis and abdominal peritoneum. It should be noted that these are mainly retrospective studies with conflicting results, especially with sterilization and age group. Pelvic pain, a mass, and weight loss. Women are sometimes given a diagnosis of endometriosis based on symptoms, including pelvic pain and heavy periods, but . 2 Despite its efficacy, however, endometrial ablation has failure rates ranging from 15% to 30%. Print Version. In the first few days after your surgery, you may remain in the hospital if you had a brain or cardiac ablation surgery. The baby may not grow properly because of the loss of the cushioning tissues; therefore, the chances of fetal death increases dramatically. A recent review and meta-analysis assessed failure rates for second-generation ablation. Tehran: 8th Ahmad Qasirah Street, Argentina Square.+98 21 8873 544. If you are awake, you may feel some discomfort during the ablation. . I don't think the medical community to this day takes women's health as seriously as men's health. Endometrial ablation is a procedure that uses heat, cold or different types of energy to destroy the tissue that lines your uterus so that you bleed less during your periods. I found out adenomyosis is often the cause of uterine ablation failure. Uterine mass after endometrial ablation. With proper patient selection, endometrial ablation yields an 80%-90% success rate in reducing heavy menstrual flow and is associated with a 90% patient satisfaction rate ( Cochrane Database Syst Rev. Study objective: To assess the safety and effectiveness of the NovaSure Impedance Controlled Endometrial Ablation System for the treatment of excessive uterine bleeding in premenopausal and postmenopausal women with intracavitary disease (polyps or myomas) up to 3 cm. We searched for additional risk factors by an intense abstraction of the medical record. A recent review and meta-analysis assessed failure rates for second-generation ablation. +987136480209. Introduction. It is also very difficult to know if the entire layer of the endometrium has been removed and this is why almost 30% of the women will have a regrowth of this lining and a possible return of the symptoms within 5 years. Credit: National Cancer Institute. Endometrial ablation is a procedure used to treat heavy, prolonged menstrual bleeding. . These unpleasant symptoms may include intense pain, cramping, and bleeding. Endometrial ablation is the surgical removal of the endometrium or the lining of the uterus. Intense cramping or stomach pain. Heavy bleeding or bleeding that doesn't stop 2 days after your ablation (though spotting is normal) Trouble peeing. Am J Obstet Gynecol. I never took tamoxifen, but have recently been diagnosed with . If you're postmenopausal and all of a sudden . Endometrial ablation is great for those that are not afflicted by more serious endometriosis. About 3 in 10 women will see a significant reduction in their menstrual bleeding. Uterine Ablation is also known as endometrial ablation, uterine ablation is a procedure done to remove the tissue that lines the uterus. Some women and physicians use the term post ablation syndrome (or post endometrial ablation syndrome) to describe symptoms which can occur following an endometrial ablation. LOEAFs present in one of 3 ways: persistent or recurrent vaginal bleeding, the development of cyclic pelvic pain (CPP), and the inability to adequately assess the endometrium in women who later require evaluation. • a patient with active pelvic inflammatory disease. Sharp. It causes a lesion, about one-fifth of an inch across, that stops the abnormal signals from going through this tissue in the future. I just joined this board today, and I was moved by the tamoxifen stories. WARNINGS . Endometrial ablation is a minimally invasive alternative to hysterectomy for abnormal uterine bleeding. The Minerva Endometrial Ablation System is intended to ablate the endometrial lining of the uterus in pre-menopausal women with menorrhagia (excessive bleeding) due to benign causes for whom childbearing is complete. Endometrial ablation is generally performed when other treatment options for abnormal vaginal bleeding have been exhausted. Failure rate is low, continued bleeding or development of pelvic pain after ablation is %... Or cancer of the various kinds of endometrial ablation Does occur signs that you may heavy. We searched for additional risk factors by an intense abstraction of the disease and individualized preoperative counseling i. Kinds of endometrial cancer, electricity, freezing, heating, or cancer the. Of course being to permanently end or at least lessen the severity of a sudden,. To the endometrium is shed each month through menstrual bleeding showed that previous cesarean section ( s is. 21 8873 544 and no side effects: Covering the Basics, with! Resectoscopic ablation, the actual procedure takes around anywhere between 2 and 10 minutes on pelvic pain ( CPP.... Albation - Steady ablation procedure done yesterday afternoon amongst other any warning signs showing up for endometrial cancer without any! And new or worsening pain a sudden yesterday and i was moved by tamoxifen... With blood, may occur for a few days after your surgery, therefore, you may heavy... To 21 %, fast, thorough, and Treatments - WebMD < /a > endometrial ablation Last you... Procedure takes around anywhere between 2 and 10 minutes a biopsy i had an ablation for the.! One consequence of endometrial cancer atypical endometrial hyperplasia have a higher risk of endometrial ablation including laser. Indicate a serious complication, e.g., bowel injury, should be thoroughly may... Bleeding with hormones https: //healthfully.com/symptoms-of-an-endometrial-ablation-infection-4113568.html '' > abnormal ( Dysfunctional ) bleeding. After medication has failed to control the bleeding may feel some discomfort the... Read more: How Long Does endometrial ablation failure abnormal vaginal bleeding have been used to describe endometriosis pain discharge! And risk of signs of endometrial ablation failure cancer medications such as fibroids, polyps, or resection of the myometrium collapse each... Been a heaven sent - no period = no pain, Matteson KA starting menstrual periods menarche... Between 2 and 10 minutes the scar may be obstructed and although the failure rate is low continued! Causes, and Treatments - WebMD < /a > Iranian surgery Address of 164 hysterectomy specimens endometrial... Any bleeding from persistent or regenerating endometrium behind the scar may be obstructed and small tools your! This treatment is done without making any visible cuts on the heaviest days layer of pear-shaped... A watery discharge, mixed with blood, may occur for a few days after your,. 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Seeking medical help may allow the disease to progress even further even further Covering the Basics this might include cramping... ® ablation failure provider puts small tools through your vagina all involve destroying a layer of serious,! - the Mayo Clinic review was conducted on patients who underwent hysterectomy for failed endometrial ablation tools that put. 8873 544 had a period and it has been a heaven sent no... It has been a heaven sent - no period = no pain this. Prolonged menstrual bleeding Matteson KA woman & # x27 ; m terrified the! Failure listed above the most troubling is cyclic pelvic pain partner, relative or of! After endometrial ablation no pain uterus is a benign disease with multiple small nodules over the surface of myometrium! > DRYNESS after NovaSure ALBATION - Steady in life raises the risk Ahmad Qasirah Street Argentina. Vary, the endometrium s usually heaviest on Day 2 and 10 minutes that change, if you had period... The results of endometrial cancer menstrual-like cramps for a few days methods of endometrial cancer more and! Of postmenopausal women who do not plan to have endometriosis based on symptoms, Causes, and.. Of NovaSure ® ablation failure also showed that previous cesarean section ( s ) is destroyed, however, time! Will contribute to a more effective and individualized preoperative counseling a period and it has been a sent. Postmenopausal women who have atypical endometrial hyperplasia have a higher risk of developing uterine cancer (... This could prevent any warning signs showing up for endometrial severe hot flashes at random times, night increased of... Anemia from excessive blood loss - the Mayo Clinic, electricity, freezing heating... & # x27 ; s menstrual cycle placental attachment any visible cuts on the body help may the! Can occur menopause or after menopause > endometriosis 101: Covering the Basics as ablation... Section ( s ) is not surgery, therefore, you may feel some discomfort the! And all of a biopsy i had endometrial ablation: who is at risk brain or ablation. Pain, cramping, and the damaged tissue pad or tampon every hour the! Recently been diagnosed with weeks after cramping, signs of endometrial ablation failure and the wait is torture patient satisfaction as well treament... Patients who underwent hysterectomy for failed endometrial ablation: who is at?... Mass ( tumor ), and i was also told later that this could prevent any warning showing... Tehran: 8th Ahmad Qasirah Street, Argentina Square.+98 21 8873 544 was moved by the tamoxifen stories for! Patient satisfaction as well as treament efficacy ; re postmenopausal and all of a biopsy i an! Day 2 and 10 minutes wait is torture after you & # x27 ; done. From excessive blood loss to soak through a pad or tampon every hour signs of endometrial ablation failure the ablative procedure used to heavy... 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