{"paper_id":"584860a5-ec6b-470f-bea4-c69628a1f693","body_text":"Citation: Rahman, J. F. B., Banu, S., Sultana, T., & Pervin, S. (2026). Clinical Outcome of Hormonal Therapy in the \nManagement of Adenomyosis among Perimenopausal Women. Sch Int J Obstet Gynec, 9(9), 263-268. \nhttps://doi.org/10.36348/sijog.2026.v09i09.008  \n \n         263 \n \n \n \nScholars International Journal of Obstetrics and Gynecology \nAbbreviated Key Title: Sch Int J Obstet Gynec \nISSN 2616-8235 (Print) |ISSN 2617-3492 (Online) \nScholars Middle East Publishers, Dubai, United Arab Emirates \nJournal homepage: https://saudijournals.com  \n \n Original Research Article \n \nClinical Outcome of Hormonal Therapy in the Management of \nAdenomyosis among Perimenopausal Women \nDr. Jahane Ferdous Binte Rahman1*, Dr. Shabnam Banu2, Dr. Tahera Sultana3, Dr. Shelina Pervin4 \n \n1Assistant Professor, Department of Obstetrics and Gynaecology, Mugda Medical College and Hospital, Dhaka, Bangladesh \n2Assistant Professor, Department of Obstetrics and Gynaecology, Shaheed Suhrawardi Medical College \n3Assistant Professor, Department of Obstetrics and Gynaecology, Dhaka Medical College, Dhaka, Bangladesh \n4Junior Consultant, Department of Obstetrics and Gynaecology, Mugda Medical College and Hospital, Dhaka, Bangladesh  \n \nDOI: https://doi.org/10.36348/sijog.2026.v09i09.008     | Received: 27.07.2026 | Accepted: 19.09.2026 | Published: 23.09.2026 \n \n*Corresponding author: Dr. Jahane Ferdous Binte Rahman \nAssistant Professor, Department of Obstetrics and Gynaecology, Mugda Medical College and Hospital, Dhaka, Bangladesh \n \nAbstract  \n \nBackground: Adenomyosis is an estrogen -dependent uterine disorder commonly associated with heavy menstrual \nbleeding, dysmenorrhea, uterine enlargement and anemia. In perimenopausal women, hormonal treatment is often preferred \nto preserve the uterus and avoid surgery.  However, real-world evidence on treatment outcomes in this age group remains \nlimited, particularly in Bangladeshi clinical settings. This study evaluated clinical outcomes, satisfaction and tolerability  \nof hormonal therapy.  Methods: This retrospective observational study was conducted at the Department of Obstetrics and \nGynaecology, Mugda Medical College & Hospital, from June 2023 to July 2024. A total of 150 women aged 40 –52 years \nwith ultrasonography -confirmed adenomyosis received LNG -IUS, dienogest, or  GnRH agonists and had a six -month \nfollow-up. Clinical, hematological, satisfaction and adverse -effect data were extracted from records. McNemar’s test was \nused for paired outcomes, with p<0.05 considered significant. Results: At six months, menorrhagia decreased from 92.0% \nto 4.0%, severe pelvic pain/dysmenorrhea from 78.7% to 12.0%, uteromegaly from 49.3% to 14.7% and anaemia from \n69.3% to 17.3% (all p<0.001). Amenorrhea was achieved by 58.7% of participants, while 86.7% were satisfied or highly \nsatisfied with treatment. Irregular spotting/breakthrough bleeding was the most frequent adverse effect (29.3%), followed \nby weight gain (17.3%). Overall, adverse effects were manageable. Conclusion: Hormonal therapy was associated with \nsix-month improvement in bleeding, pain, uterine enlargement and anemia, with high treatment satisfaction and tolerable \nadverse effects. These findings support hormonal therapy as a uterus -conserving option for symptomatic adenomyosis in \nperimenopausal women.  \nKeywords: Adenomyosis, Perimenopausal women, Hormonal therapy, Levonorgestrel -releasing intrauterine system, \nDienogest. \nCopyright © 2026 The Author(s): This is an open -access article distributed under the terms of the Creative Commons Attribution 4.0 International \nLicense (CC BY-NC 4.0) which permits unrestricted use, distribution, and reproduction in any medium for non -commercial use provided the original \nauthor and source are credited. \n \nINTRODUCTION \nAdenomyosis is a benign gynecological \ncondition characterized by the ectopic presence of \nendometrial glands and stroma within the myometrium, \nresulting in reactive myometrial hypertrophy and an \nenlarged, tender uterus. Its reported prevalence varies \nwidely across populations, ranging from as low as 1% in \nthe general population to over 40% among women \npresenting with gynecological symptoms, largely due to \ndifferences in diagnostic criteria and imaging modalities \nused across studies [1]. The condition is most frequently \ndiagnosed in women in their fourth and fifth decades of \nlife, making the perimenopausal period a particularly \nrelevant window for clinical management, since \nsymptom severity often peaks in the years preceding \nmenopause. \n \nSeveral factors have been consistently \nassociated with a higher risk of developing adenomyosis, \nincluding advancing age, multiparity, prior uterine \nsurgery and elevated body mass index [2,3]. \nMechanistically, adenomyosis is now understood to arise \nfrom dis ruption of the endometrial -myometrial \njunctional zone, followed by a self -sustaining cycle of \nlocal hyperestrogenism, progesterone resistance and \nchronic tissue injury and repair that drives lesion growth \n\n\n \n \nRahman, J. F. B. et al; Sch Int J Obstet Gynec, Sep. 2026; 9(9): 263-268 \n© 2026 | Published by Scholars Middle East Publishers, Dubai, United Arab Emirates                                                                                       264 \n  \n \nand symptom generation [4]. This hormonal \ndysregulation, together with the resulting menstrual \ndysfunction, provides the biological rationale for \nhormonal suppression as a cornerstone of medical \nmanagement, particularly in women who wish to avoid \nor defer hysterectomy [5]. \n \nDiagnostically, transvaginal ultrasonography \nhas become the first -line imaging modality for \nadenomyosis, offering diagnostic accuracy comparable \nto magnetic resonance imaging in most clinical settings \nwhile remaining more accessible and cost -effective \n[6,7]. This has facilitated earlier recognition of the \ndisease and broader use of conservative, uterus -sparing \nhormonal treatments before patients are referred for \ndefinitive surgical management. \n \nAmong the available hormonal options, the \nLNG-IUS, oral dienogest and GnRH agonists are the \nmost widely used agents, each acting through different \nmechanisms to suppress endometrial proliferation and \nreduce menstrual blood loss and pain [8,9]. Comparative \nand cohort studies have shown that LNG-IUS effectively \nreduces uterine volume and bleeding over time, while \ndienogest is particularly effective in relieving \ndysmenorrhea and subdermal progestin implants have \nalso demonstrated symptomatic benefit in selecte d \npatients [10,11]. However, most of the existing evidence \nis derived from reproductive -age cohorts and \ncomparative outcome data specific to perimenopausal \nwomen, who often carry a heavier symptom burden and \ngreater risk of anemia, remain comparatively scarce [12]. \n \nThe clinical consequences of untreated or \ninadequately managed adenomyosis extend beyond \nmenstrual symptoms; heavy menstrual bleeding is \nstrongly associated with iron -deficiency anemia and a \nmeasurable decline in quality of life and adenomyosis \nhas additio nally been linked to adverse impacts on \nfertility and reproductive outcomes even in later \nreproductive life [12,13]. Given the substantial \nsymptomatic and hematological burden this disease \nimposes on perimenopausal women and the paucity of \ncontext-specific outcome data from Bangladeshi clinical \nsettings, there remains a clear need to systematically \ndocument real -world treatment responses in this \npopulation. \n \nTherefore, this study was undertaken to \nevaluate the clinical outcomes, patient satisfaction and \ntolerability of hormonal therapy, comprising LNG -IUS, \ndienogest and GnRH agonists, in the management of \nadenomyosis among perimenopausal women, with the \naim of  generating locally relevant evidence to guide \nclinical decision-making in similar resource settings. \n \nMATERIALS AND METHODS \nThis retrospective observational study was \nconducted in the Department of Obstetrics and \nGynaecology, Mugda Medical College & Hospital, \nDhaka, Bangladesh, over a period of one year, from June \n2023 to July 2024. The study population comprised \nperimenopausal women diagnosed with adenomyosis on \ntransvaginal ultrasonography who received hormonal \ntherapy during the study period. A total of 150 women \nwho fulfilled the eligibility criteria were enrolled \nthrough review of hospital records and outpatient follow-\nup registers. \n \nEligibility Criteria \nInclusion criteria:  \n• Perimenopausal women aged 40–52 years. \n• sonographically confirmed diagnosis of \nadenomyosis. \n• presence of at least one major symptom \n(menorrhagia, dysmenorrhea, or uteromegaly).  \n• women who received LNG -IUS, dienogest, or \nGnRH agonist therapy with a documented six -\nmonth follow-up. \n• Availability of complete baseline and follow -up \nclinical records. \n \nExclusion criteria:  \n• Women with coexisting uterine malignancy or \nsuspected endometrial hyperplasia with atypia. \n• Concurrent large uterine fibroids or ovarian \npathology confounding symptom assessment. \n• Prior hysterectomy or uterine -sparing surgery for \nadenomyosis. \n• Contraindications to hormonal therapy. \n \nData Collection and Study Variables \nData were extracted retrospectively from \nhospital case records, outpatient charts, ultrasonographic \nreports and laboratory records using a structured, \npretested data collection sheet. Baseline \nsociodemographic and clinical characteristics, type of \nhormonal therapy and treatment outcomes were \nrecorded. The principal clinical outcomes assessed at \nbaseline and six months were menorrhagia, severe pelvic \npain or dysmenorrhea and uteromegaly. Hematological \noutcome was assessed according to the presence of \nanemia, defined as a hemoglobin level below 11.0 g/dL. \nTreatment satisfaction and menstrual status at six months \nwere also recorded. Menstrual outcomes were \ncategorized as amenorrhea, hypomenorrhea, \nregular/normal menstruation, or persistent menorrhagia. \nTreatment-related adverse effects reported during \nfollow-up were documented, including irregular spotting \nor breakthrough bleeding, weight gain, hot flashes or \nmood changes, breast tenderness and acne or oily skin. \nParticipants could report more than one adverse e ffect; \ntherefore, adverse-effect percentages were not mutually \nexclusive. \n \nTreatment Groups:  \nParticipants received one of three hormonal \ntreatment modalities according to the treatment \ndocumented in their clinical records: LNG -IUS, \n\n \n \nRahman, J. F. B. et al; Sch Int J Obstet Gynec, Sep. 2026; 9(9): 263-268 \n© 2026 | Published by Scholars Middle East Publishers, Dubai, United Arab Emirates                                                                                       265 \n  \n \ndienogest at a dose of 2 mg/day, or GnRH agonist \ntherapy. Treatment allocation was not standardized by \nthe study protocol because of the retrospective \nobservational design. \n \nOutcome Assessment:  \nClinical and hematological outcomes were \ncompared between baseline and six months after \ninitiation of hormonal therapy. The primary assessment \nfocused on changes in the prevalence of menorrhagia, \nsevere pelvic pain/dysmenorrhea, uteromegaly and \nanemia. Secondary outcomes included menstrual status, \ntreatment satisfaction and reported adverse effects at six \nmonths. \nStatistical Analysis:  \nStatistical analysis was performed using IBM \nSPSS Statistics version 25.0. Continuous variables were \nsummarized using mean and standard deviation, while \ncategorical variables were presented as frequencies and \npercentages. Changes in paired categorical outc omes \nbetween baseline and six-month follow-up were assessed \nusing McNemar’s test. A two-sided p-value of <0.05 was \nconsidered statistically significant. \n \nRESULTS \n \nTable 1: Baseline Socio-Demographic and Clinical Characteristics of the Study Population (N = 150)  \nVariable Frequency (n) Percentage (%) \nAge group (years) 40–44 42 28.0 \n45–49 88 58.7 \n50–52 20 13.3 \nMean age ± SD (range) 46.8 ± 3.2 (40–52) \nBMI (kg/m²) Normal (<25.0) 54 36.0 \nOverweight (25.0–29.9) 72 48.0 \nObese (≥30.0) 24 16.0 \nParity Primipara (1 child) 22 14.7 \nMultipara (≥2 children) 128 85.3 \nType of hormonal therapy LNG-IUS 72 48.0 \nDienogest (2 mg/day) 58 38.7 \nGnRH agonists 20 13.3 \nLNG-IUS = levonorgestrel-releasing intrauterine system; GnRH = gonadotropin-releasing hormone. \n \nTable 1 shows the baseline sociodemographic \nand clinical characteristics of the study population. The \nmean age of participants was 46.8 ± 3.2 years, with the \nmajority (58.7%) aged between 45 and 49 years. Nearly \nhalf of the women were overweight (48.0%) an d most \nwere multiparous (85.3%). The LNG -IUS was the most \ncommonly prescribed hormonal therapy (48.0%), \nfollowed by dienogest (38.7%) and GnRH agonists \n(13.3%). \n \nTable 2: Comparison of Clinical Parameters Before and 6 Months After Hormonal Therapy (N = 150)  \nClinical parameter Pre-treatment, \nn (%) \nPost-treatment at 6 \nmonths, n (%) \np-value \nMenorrhagia (heavy menstrual bleeding) Present 138 (92.0) 6 (4.0) <0.001 \nAbsent 12 (8.0) 144 (96.0) \nSevere pelvic pain/dysmenorrhea Present 118 (78.7) 18 (12.0) <0.001 \nAbsent 32 (21.3) 132 (88.0) \nUteromegaly (>12 weeks) Present 74 (49.3) 22 (14.7) <0.001 \nAbsent 76 (50.7) 128 (85.3) \nAnemia (hemoglobin <11.0 g/dL) Present 104 (69.3) 26 (17.3) <0.001 \nAbsent 46 (30.7) 124 (82.7) \n \nTable 2 presents the comparison of major \nclinical parameters before and six months after initiation \nof hormonal therapy. Significant reductions were \nobserved across all assessed parameters: menorrhagia \ndeclined from 92.0% to 4.0%, severe pelvic pain or \ndysmenorrhea from 78.7% to 12.0%, uteromegaly from \n49.3% to 14.7% and anemia from 69.3% to 17.3% \n(p<0.001 for all comparisons). Among women with \nbaseline uteromegaly, more than two -thirds showed \nresolution at follow-up. \n \n \n \n \n \n\n \n \nRahman, J. F. B. et al; Sch Int J Obstet Gynec, Sep. 2026; 9(9): 263-268 \n© 2026 | Published by Scholars Middle East Publishers, Dubai, United Arab Emirates                                                                                       266 \n  \n \nTable 3: Patient Treatment Satisfaction and Menstrual Status at 6-Month Follow-Up (N = 150) \nVariable Frequency (n) Percentage (%) \nOverall treatment satisfaction Highly satisfied 84 56.0 \nSatisfied 46 30.7 \nNeutral/uncertain 12 8.0 \nDissatisfied 8 5.3 \nMenstrual status at 6 months Achieved amenorrhea 88 58.7 \nHypomenorrhea (scanty bleeding) 41 27.3 \nRegular/normal menstruation 15 10.0 \nPersistent menorrhagia 6 4.0 \n \nTable 3 describes patient treatment satisfaction \nand menstrual status at the six -month follow -up. The \nmajority of women (86.7%) reported being highly \nsatisfied or satisfied with treatment, while a small \nproportion (5.3%) expressed dissatisfaction. Regarding \nmenstrual outcome, 58.7% of women achieved \namenorrhea, 27.3% experienced hypomenorrhea and \nonly 4.0% had persistent menorrhagia. \n \nTable 4: Adverse Effects Reported During Hormonal Therapy (N = 150) \nAdverse effect Frequency (n) Percentage (%) \nIrregular spotting/breakthrough bleeding 44 29.3 \nWeight gain (>2 kg) 26 17.3 \nHot flashes/mood changes 22 14.7 \nBreast tenderness 18 12.0 \nAcne/oily skin 12 8.0 \nNo significant side effects recorded 58 38.7 \n \nParticipants could report more than one adverse \neffect; therefore, percentages for individual adverse \neffects were not mutually exclusive and did not sum to \n100%. \n \nTable 4 outlines the adverse effects reported \nduring hormonal therapy. Overall, 61.3% of women \nexperienced at least one adverse effect, most commonly \nirregular spotting or breakthrough bleeding (29.3%), \nfollowed by weight gain (17.3%), hot flashes or mood \nchanges (14.7%), breast tenderness (12.0%) and acne or \noily skin (8.0%); 38.7% of women reported no \nsignificant adverse effects. \n \nDISCUSSION \nThe present study evaluated clinical outcomes \nof hormonal therapy among 150 perimenopausal women \nwith adenomyosis and found substantial improvement in \nmenorrhagia, pelvic pain, uterine size and anemia over \nsix months, alongside high satisfaction and manage able \nadverse effects. These findings are broadly consistent \nwith the growing body of literature confirming that \nprogestin- and GnRH -based hormonal regimens are \neffective, uterus-conserving alternatives to hysterectomy \nin symptomatic adenomyosis. \n \nIn the present study, LNG -IUS was the most \nfrequently used therapy (48.0%), consistent with its \nestablished role as first -line medical management for \nadenomyosis-related bleeding. Choudhury et al.,  \ncompared LNG -IUS with dienogest in a randomized \nclinical trial and found that both agents significantly \nreduced pain scores from baseline, with a greater \nproportion of women in the LNG -IUS arm achieving \nlighter menstrual bleeding compared with the dienogest \ngroup [10]. This pattern parallels our finding that LNG -\nIUS users, who formed the largest treatment subgroup, \ncontributed substantially to the overall reduction in \nmenorrhagia from 92.0% to 4.0% observed in our cohort. \nSimilarly, Yang et al.,  reported that dienogest more \neffectively controlled menstrual volume after six and \ntwelve months of treatment compared with LNG -IUS, \nwhile both groups showed significant improvement in \nendometrial thickness and bleeding parameters, findings \nthat mirror the  improvement in uteromegaly and \nmenorrhagia observed across both therapy groups in our \nstudy [14]. Ota et al.,  in a controlled trial comparing \nLNG-IUS and dienogest over an extended follow -up \nperiod, similarly demonstrated significant reductions in \nvisual analog pain scores and bleeding duration with \nboth agents, reinforcing the comparable efficacy of these \ntwo pr ogestin-based approaches irrespective of \nlocalization of adenomyotic lesions [15]. \n \nThe marked reduction in pelvic pain observed \nin our cohort, from 78.7% at baseline to 12.0% at six \nmonths, is consistent with Pragash and Khakhar, who \nreported a reduction in dysmenorrhea visual analog scale \nscores from 5.54 to 1.37 and blood loss from 66. 73 mL \nto 4.86 mL six months after LNG-IUS insertion, with all \noutcome measures reaching statistical significance [16]. \nWei et al.,  similarly compared etonogestrel implants \nwith LNG-IUS and found significant symptomatic relief \nwith both modalities, supporti ng the broader principle \nthat continuous progestin exposure, regardless of \ndelivery route, effectively suppresses adenomyosis -\nrelated bleeding and pain [17]. \n \n\n \n \nRahman, J. F. B. et al; Sch Int J Obstet Gynec, Sep. 2026; 9(9): 263-268 \n© 2026 | Published by Scholars Middle East Publishers, Dubai, United Arab Emirates                                                                                       267 \n  \n \nA particularly relevant comparison arises from \nChen et al., who specifically examined perimenopausal \nwomen aged 40 years and above receiving dienogest for \nsymptomatic adenomyosis and reported that nearly half \nof the treated patients achieved excellent long -term pain \nand bleeding control, while older age and larger uterine \nvolume were associated with poorer treatment response \n[18]. In our study, 58.7% of women achieved \namenorrhea and 86.7% reported treatment satisfaction, \nfigures that are consistent with and  somewhat more \nfavorable than, those reported by Chen et al., possibly \nreflecting differences in follow -up duration and the \ncomposite use of three hormonal modalities rather than \ndienogest alone. \n \nThe improvement in anemia prevalence \nobserved in our study, from 69.3% to 17.3%, aligns with \nthe well -established relationship between heavy \nmenstrual bleeding and iron -deficiency anemia \ndescribed by Kocaoz et al., who found that prolonged \nmenstrual durati on was significantly associated with \ndeclining ferritin levels and impaired quality of life in \nwomen of reproductive age [13]. The correction of \nanemia alongside cessation or reduction of bleeding in \nour cohort therefore represents a clinically meaningful \nsecondary benefit of hormonal therapy beyond symptom \ncontrol alone. \n \nRegarding tolerability, irregular spotting was \nthe most common adverse effect in our cohort (29.3%), \na pattern consistent with findings from comparative trials \nof LNG -IUS and dienogest, which similarly report \nirregular bleeding as the predominant early sid e effect, \ngenerally self -limiting with continued use [10,14]. The \noverall low rate of serious adverse effects and high \ntreatment continuation implied by our satisfaction data \nsupport the favorable safety profile of hormonal therapy \ndescribed in the wider literature on medical management \nof adenomyosis, including comprehensive reviews \nhighlighting progestins and GnRH agonists as effective \noptions with manageable side -effect profiles for women \nwishing to avoid surgical intervention [8,19]. \nCollectively, these findings reinforce hormonal therapy \nas an effective, well -tolerated and clinically meaningful \nstrategy for managing adenomyosis in perimenopausal \nwomen. \n \nLimitations of the study \nThis retrospective single -center study lacked a \ncontrol group, long -term follow -up beyond six months \nand standardized comparison across hormonal \nsubgroups, which may limit generalizability. Recall and \ndocumentation bias cannot be excluded. Multicentric, \nprospective studies with extended follow -up and head -\nto-head comparison of hormonal agents are \nrecommended to strengthen the evidence base for \nindividualized treatment selection in perimenopausal \nadenomyosis. \n \n \nCONCLUSION \nHormonal therapy, including LNG -IUS, \ndienogest and GnRH agonists, effectively reduced \nmenorrhagia, pelvic pain, uterine size and anemia among \nperimenopausal women with adenomyosis, with high \npatient satisfaction and acceptable tolerability. These \nfindings support hormonal therapy as a safe, effective, \nuterus-conserving first -line management option for \nsymptomatic adenomyosis in this age group. \n \nConflict of Interest: None. \n \nREFERENCES \n1. Upson K, Missmer SA. Epidemiology of \nadenomyosis. Semin Reprod Med. 2020;38(2-3):89-\n107. \n2. Beniuk VO, Kurochka VV, Susak KI. Risk factors \nfor adenomyosis in women of reproductive age. Ukr \nJ Health Woman. 2024;3(172):12-16. \n3. Gymnastiar A, Kurniati YP. Case-control study: risk \nfactors for adenomyosis in women of reproductive \nage in relation to blood pressure and body mass \nindex. J Riset Kesehat. 2025;14(2). \ndoi:10.31983/jrk.v14i2.13995. \n4. Bulun SE, Yildiz S, Adli M, Yin P, Milad M, Kayisli \nU, et al.,Adenomyosis pathogenesis: insights from \nnext-generation sequencing. Hum Reprod  Update. \n2021;27(6):1086-97. \n5. Munro MG. Uterine polyps, adenomyosis, \nleiomyomas and endometrial receptivity. Fertil \nSteril. 2019;111(4):629-40. \n6. Andres MP, Borrelli GM, Ribeiro J, Baracat EC, \nAbrão MS, Kho RM. Transvaginal ultrasound for \nthe diagnosis of adenomyosis: systematic review \nand meta -analysis. J Minim Invasive Gynecol. \n2018;25(2):257-64. \n7. Chapron C, Vannuccini S, Santulli P, Abrão MS, \nCarmona F, Fraser IS, et al., Diagnosing \nadenomyosis: an integrated clinical and imaging \napproach. Hum Reprod Update. 2020;26(3):392 -\n411. \n8. Cope AG, Ainsworth AJ, Stewart EA. Current and \nfuture medical therapies for adenomyosis. Semin \nReprod Med. 2020;38(2-3):151-6. \n9. Etrusco A, Barra F, Chiantera V, Ferrero S, Bogliolo \nS, Evangelisti G, et al.,Current medical therapy for \nadenomyosis: from bench to bedside. Drugs. \n2023;83(17):1595-1611. \n10. Choudhury S, Jena SK, Mitra S, Padhy BM, \nMohakud S. Comparison of efficacy between \nlevonorgestrel intrauterine system and dienogest in \nadenomyosis: a randomized clinical trial. Ther Adv \nReprod Health. 2024;18:26334941241227401. \n11. Chene G, Baffet H, Cerruto E, et al., The role of \nprogestin subdermal implant in the management of \nadenomyosis: a systematic review. Eur J Contracept \nReprod Health Care. 2024;29(2):61-8. \n12. Vercellini P, Viganò P, Bandini V, Buggio L, \nBerlanda N, Somigliana E. Association of \n\n \n \nRahman, J. F. B. et al; Sch Int J Obstet Gynec, Sep. 2026; 9(9): 263-268 \n© 2026 | Published by Scholars Middle East Publishers, Dubai, United Arab Emirates                                                                                       268 \n  \n \nendometriosis and adenomyosis with pregnancy and \ninfertility. Fertil Steril. 2023;119(5):727-40. \n13. Kocaoz S, Cirpan R, Degirmencioglu AZ. The \nprevalence and impacts of heavy menstrual bleeding \non anemia, fatigue and quality of life in women of \nreproductive age. Pak J Med Sci. 2019;35(2):365 -\n70. \n14. Yang S, Liu Y, Wen J, Sun Y, Ren F. Clinical \nefficacy of dienogest versus levonorgestrel -\nreleasing intrauterine system for adenomyosis. Evid \nBased Complement Alternat Med. \n2022;2022:1995472. \n15. Ota I, Taniguchi F, Ota Y, Nagata H, Wada I, \nNakaso T, et al., A controlled clinical trial \ncomparing potent progestins, LNG -IUS and \ndienogest, for the treatment of women with \nadenomyosis. Reprod Med Biol. 2021;20(4):427 -\n34. \n16. Pragash V, Khakhar A. Efficacy and outcomes of \nthe hormone -releasing levonorgestrel -intrauterine \nsystem for adenomyosis treatment. Cureus. \n2025;17(11):e97669. \n17. Wei A, Tang X, Yang W, Zhou J, Zhu W, Pan S. \nEfficacy of etonogestrel subcutaneous implants \nversus the levonorgestrel -releasing intrauterine \nsystem in the conservative treatment of \nadenomyosis. Open Med (Wars). 2024; \n19:20240914. \n18. Chen CH, Lin YH, Lee CY, Shen H, Hsu YT, Wu \nPC. Long -term clinical outcomes of dienogest for \nperimenopausal women with symptomatic \nadenomyosis. Sci Rep. 2025;15(1):8174. \n19. Younes G, Tulandi T. Conservative surgery for \nadenomyosis and results: a systematic review. J \nMinim Invasive Gynecol. 2018;25(2):265-76.","source_license":"CC0","license_restricted":false}