الفهرس 
Introduction
Overview of adenomyosisOnly 14 pages are availabe for public view
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Abstract
Adenomyosis is diagnosed when endometrial glands and stroma present in the myometrium. Women in the middle-aged and multiparous women are in a higher risk to develop adenomyosis. The common symptom associated with adenomyosis is menorrhagia and dysmenorrhea. The diagnosis of adenomyosis can be done by TVS and MRI. Combined oral contraceptive pills (COCs) cause decidualisation and atrophy of the endometrium, so it used for management of adenomyosis with good results. Dienogest is a synthetic oral progestin which can induce a strong local hypergestagenic state that causes atrophy of adenomyotic lesions. Decreased in the uterine volume and blood flow inside the uterus may be a strong theory that clarifies the effect of the treatment on adenomyosis. Therefore, we compared the effectiveness and safety of dienogest with COCs on patients with symptomatic adenomyosis, focusing on treatment effect on uterine volume and uterine artery blood flow.Patient and methods The current study is a clinically registered open labeled, parallel, randomized clinical trial conducting from 1st of March 2019 to 1st of August 2020atAssiut Woman’s Health Hospital. The study included symptomatic women with adenomyosis. Eligible women were randomized using a computer generated table of random numbers with allocation concealment. group I received dienogest 2.5 mg, while group II received COCs starting between the second and fifth day of the menstrual cycle for 6 months. The level of adenomyosis-associated pain from before to 6 months after treatment was our primary outcome. While the changes in the number of bleeding days, number of bleeding free days and number of sanity pads, the uterine and ovarian volume (cm3), uterine artery Doppler indices, reported side effects of each treatment and patient’s satisfaction were our secondary outcomes. All women were instructed to come to follow up after 1, 3 and 6 months.