Comparative Analysis of Surgical vs. Medical Management of Adenomyosis

Background: Adenomyosis is a chronic gynecological condition involving ectopic endometrial tissue within the myometrium, leading to pelvic pain, heavy menstrual bleeding and reduced fertility. Although both medical therapy and total abdominal hyterectomy are commonly used, evidence comparing their short-term effectiveness in South Asian settings remains limited. This study compared the short-term outcomes of surgical and medical management of adenomyosis in a tertiary hospital in Bangladesh. Methods: A comparative analytical study was conducted in the Department of Obstetrics &Gynaecology, Bangladesh Medical University, from June 2024 to July 2025. Seventy-five women with sonographically diagnosed adenomyosis underwent either total abdominal hysterectomy (n=38) or medical therapy (n=37) are included in this study. Baseline characteristics, dysmenorrhea (VAS), menorrhagia status and uterine volume were evaluated at enrolment, 3 months and 6 months. Medical treatment included oral progestin therapy (dienogest) and GnRH agonists.Data were analyzed using SPSS 25.0. Results: Baseline variables were comparable between the groups. At 6 months, significant dysmenorrhea improvement (VAS 20% reduction in uterine volume was observed in 86.8% of the surgical group versus 40.5% of the medical group. Hormone-related adverse effects were more common among medically treated participants. Conclusion: In this short-term comparison,surgery produced greater symptom relief and structural improvement than medical therapy alone. Both approaches remain clinically relevant, yet surgery appears more effective for women presenting with substantial symptom burden. DOI: https://doi.org/10.52783/jchr.v15.i6.11200