A 48 year old woman, P2L2 with menorrhagia, diagnosed with adenomyosis, is not responding to medical management with NSAIDs and hormonal therapy. Next step in management should be?: (A) Mirena (LNG IUD) inseion, (B) GnRH analogues, (C) Hysterectomy, (D) Hysteroscopy biopsy
Answer is D. Any menorrhagia in woman of perimenopausal age group should be evaluated with an endometrial biopsy , preferably hysteroscopy guided, even if a diagnosis of adenomyosis is made on USG, to rule out malignancy Treatment options for adenomyosis Medical: NSAIDs, GnRH analogues, danazol Mirena IUCD (LNG IUCD) Hysterectomy: most definitive treatment