to evaluate use of Dienogest versus uterine arteries embolization in treatment of Adenomyosis-associated symptoms as dysmenorrhea, heavy menstrual bleeding and bulk-related symptoms

Type of the study: prospective cohort comparative study. Setting: It will be done at both Obstetrics & Gynecology department and Radiology department, Al-Azhar University Hospital Assiut branch.

Time of the study: Starting from January 2025 till the end of the study Number of cases: 100 cases. According to sample size equation Where; in: n = number of patients, = 1.96 (standard normal deviate value that divides the central 95% of z distribution from 5% in the tails), P = the reported sensitivity (67%, i.e., 0.67), L= absolute precision desired on either side (half width of the confidence interval of the confidence interval) of sensitivity (10% i.e., 0.1).

Inclusion criteria:

• Age Group: 30-50 years
• Women with adenomyosis
• With or without small fibroids
• Suffering from heavy menstrual bleeding, dysmenorrhea, and/or cycle- independent pain and bulk-related symptoms.

Exclusion criteria:

• Presence of a malignancy or pelvic infection.
• An on-going pregnancy or a desire to conceive in the future.
• Absolute contraindication for angiography (renal impairment).
• Chronic debilitating diseases.

Inclusion Criteria:- Age Group: 30-50 years

• Women with adenomyosis
• With or without small fibroids
• Suffering from heavy menstrual bleeding, dysmenorrhea, and/or cycle- independent pain and bulk-related symptoms.

Exclusion Criteria:

• - Presence of a malignancy or pelvic infection.
• An on-going pregnancy or a desire to conceive in the future.
• Absolute contraindication for angiography (renal impairment).
• Chronic debilitating diseases.