<prompt> A 48 year old woman, P2L2 with menorrhagia, diagnosed with adenomyosis, is not responding to medical management with NSAIDs and hormonal therapy. Next step in management should be?Mirena LNG IUD inseionGnRH analoguesHysterectomyHysteroscopy biopsy  <response>: Any menorrhagia in woman of perimenopausal age group should be evaluated with an endometrial biopsy , preferably hysteroscopy guided, even if a diagnosis of adenomyosis is made on USG, to rule out malignancy Treatment options for adenomyosis Medical: NSAIDs, GnRH analogues, danazol Mirena IUCD LNG IUCD Hysterectomy: most definitive treatment 