Adenomyosis is a common disease in women aged 40-50 years. It associates with dysmenorrhea and menorrhagia. Hysterectomy was considered the main treatment that could definitively cure this disease. Other treatment options are increasingly offered, including hormonal suppression with gonadotropin-releasing hormone agonists or danazol and endometrial ablation. However, deep adenomyosis responds weakly to the above treatment options, which are commonly not considered for long-term management because of the associated side effects.

Dienogest is a progestin medication which is used in birth control pills and in the treatment of endometriosis and adenomyosis. Low-dose combined oral contraceptive (COC) pills have been widely used as the primary treatment for menorrhagia. COCs can also be used to induce endometrial atrophy and to decrease endometrial prostaglandin production, which can consequently improve menorrhagia and dysmenorrhea that are associated with adenomyosis

Inclusion Criteria:

• Women aged 20-40 years
• Women with ultrasonographic evidence of adenomyosis
• Woman complains of vaginal bleeding or pelvic pain related to adenomyosis

Exclusion Criteria:

• Women with a history of malignancy or histological evidence of endometrial hyperplasia
• any adnexal abnormality on ultrasound
• undiagnosed vaginal
• contraindication to receive Vissane or gynera .